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Enamel Defects Among Orphanage Children: A Multi-Country Case-Control Study
Heba Jafar Sabbagh1, Mohammed Jamal Barry2, Ola B Al-Batayneh3
1Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
International Dental Journal
|November 28, 2025
Summary
Children in orphanages have a higher risk of enamel defects and molar incisor hypomineralisation (MIH) due to early-life stress. Early screening and preventive programs are crucial for these vulnerable populations.
Area of Science:
- Pediatric Dentistry
- Developmental Biology
- Public Health
Background:
- Enamel defects, including molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM), increase dental treatment complexity.
- Early-life stress is a suspected risk factor for enamel defects, but its impact is challenging to quantify due to reliance on subjective recall.
- Orphaned children, often experiencing chronic stress and lacking parental care, represent a vulnerable group for studying the effects of early-life stress on development.
Purpose of the Study:
- To compare the prevalence of enamel defects and MIH/HSPM in children residing in orphanages versus those living with parents.
- To investigate the potential association between institutional living, early-life stress, and the occurrence of enamel developmental defects.
- To assess the impact of living conditions on the prevalence of specific dental enamel conditions across multiple countries.
Main Methods:
- A matched case-control study involving 1,838 children aged 7-10 years across 6 countries.
- Dental examinations conducted using WHO and EAPD diagnostic criteria for enamel defects, MIH, and HSPM.
- Caregiver interviews to collect demographic data and medical history, assessing potential confounding factors.
Main Results:
- Orphaned children exhibited a significantly higher prevalence of enamel defects (39.9%) and MIH in first permanent molars (29.1%) compared to controls (29.8% and 22.3%, respectively; P < .001).
- Prevalence of HSPM was also elevated in orphaned children (15.4%) compared to controls (7.9%).
- No significant difference in MIH affecting incisors was observed; however, a chronological pattern indicated that earlier-developing teeth were more severely affected.
Conclusions:
- Living in an orphanage is significantly associated with an increased risk of enamel defects and MIH, particularly in teeth that develop earlier.
- These findings suggest a potential role for early-life stress experienced in institutional settings on enamel formation and development.
- The study recommends implementing preventive programs and early dental screening for children in at-risk populations, such as orphanages.
