An in vivo investigation of salivary properties, enamel hypomineralisation, and carious lesion severity in a group of Iraqi schoolchildren

Int J Paediatr Dent. 2013 Jan;23(1):2-12. doi: 10.1111/j.1365-263X.2011.01215.x. Epub 2012 Jan 18.


Background: Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post-eruptively particularly in the presence of an unfavourable oral environment.

Aims: To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect's clinical presentation.

Design: Recruitment consisted of 445 seven- to nine-year-old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects (N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub-sample, equally divided as MH-affected and non-affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined.

Results: Molar hypomineralisation-affected children have significantly higher mean caries scores compared to the non-affected group. Dentinal carious lesions were ten times more frequent in teeth with post-eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB.

Conclusion: Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment.

Publication types

  • Comparative Study

MeSH terms

  • Buffers
  • Case-Control Studies
  • Child
  • Cross-Sectional Studies
  • DMF Index
  • Dental Caries / classification*
  • Dental Caries / diagnosis
  • Dental Enamel / pathology*
  • Humans
  • Hydrogen-Ion Concentration
  • Iraq
  • Molar / pathology
  • Population Surveillance
  • Saliva / physiology*
  • Secretory Rate / physiology
  • Tooth Demineralization / complications*
  • Tooth, Deciduous / pathology
  • Viscosity


  • Buffers