Association between systemic exposure to antibiotics in early childhood and molar-incisor hypomineralization (MIH): A systematic review and meta-analysis

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OBJECTIVE: Molar Incisor Hypomineralization (MIH) is a developmental enamel defect affecting one in six children worldwide. Although antibiotics have been suggested to influence dental development, their association with MIH remains unclear. This systematic review and meta-analysis evaluated the association between early childhood antibiotic exposure and the risk of developing MIH. DATA SOURCES: MEDLINE (via PubMed), Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to December 17, 2024. STUDY SELECTION: Observational studies (cross-sectional, case-control) including children aged 6-14 years diagnosed with MIH using validated criteria were eligible. Exposure was defined as antibiotic use before age 4. Studies involving special populations or other enamel defects were excluded. Risk of bias was assessed using the QUIPS tool. A random-effects model calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: From 3308 records, 41 studies met the criteria and 31 were included in the meta-analysis, with 22,141 participants aged 6-14. Antibiotic use before age 4 was significantly associated with MIH (OR:1.50, 95% CI 1.13 - 1.99, p = 0.0070). Amoxicillin (OR: 1.87; 95% CI: 0.83-4.21, p = 0.104) and penicillin (OR: 2.15; 95% CI: 0.73-6.34, p = 0.130) resulted in higher odds for the development of MIH. CONCLUSION: Early antibiotic use before age 4 is associated with higher odds of developing MIH. However, given the low certainty of evidence, this finding should be interpreted with caution, as it remains unclear whether the link is direct or indirect, highlighting the need for further research to guide prevention strategies. CLINICAL RELEVANCE: MIH poses diagnostic and treatment challenges. Contributing factors must be identified judiciously. Prudent antibiotic use should be integrated into clinical practice to reduce potential risk and promote better long-term oral health in children.

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