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Martina Hodgson ChD MJDF PGDip
Prof. Bekes, how do you define molar incisor hypomineralisation (MIH)?
We all know that this is a growing subject in paediatric dentistry. It is defined as a hypomineralisation of systemic origin, which affects one to four permanent first molars and is frequently associated with affected incisors. The term was founded in 2001. Global knowledge of the condition has increased over the years, which is reflected in a rising number of studies focused on this dental anomaly. Around the world, MIH prevalence is about 13%.
Clinically, affected teeth show a hypomineralisation that can be seen as an alteration in the translucency of the enamel. It can vary in colour shade from white to yellow or brown. Affected molars can represent a spectrum of severity and extension of the defect, from hardly visible opacities to severe destruction of the enamel, as the porous enamel can easily chip off, especially under the influence of masticatory forces. Furthermore, affected teeth might show hypersensitivity.
What causes MIH?
The causes have not been clarified yet: the aetiology is still unknown. Several hypotheses have been proposed, including childhood illness, use of amoxicillin, or exposure to environmental toxins (BPAs). MIH seems to be a phenomenon of our time. However, there is still conjecture on what the causative factors are. The problem is that we cannot diagnose MIH before eruption.
How do you effectively treat MIH?
As we cannot currently prevent MIH from happening, we focus on a good treatment concept. The available treatment modalities for teeth with MIH are extensive, ranging from prevention and restoration to extraction. The suitability of these, however, differs depending on a number of factors. Commonly identified factors are severity of the condition (for example, extent of the defective enamel and quality of both the defective enamel and the unaffected parts of the tooth), presence of symptoms (with or without association of hypersensitivity), the patient’s dental age, and the child/parent’s social background and expectations.
It is very important to start approaching affected children with appropriate preventive advice. The preventive approach includes thorough oral hygiene with fluoride toothpaste as well as the application of other topical fluoride varnishes. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) oral care products are similarly recommended for remineralisation and desensitisation. Severe cases of MIH with cavitated structural defects can be restored directly using glass ionomer cements (temporarily) and resin composite (definitively) or indirectly (using ceramic, composite or metal restorations).
What are some of the challenges you face in treating children with MIH?
Patients affected by MIH present several clinical problems, including rapid wear, enamel loss, increased susceptibility to caries, loss of fillings, and most of all, severe hypersensitivity that often results in severe discomfort. Children often report that toothbrushing, air flow, and hot, cold, or sweet drinks and foods cause sensitivity. During the dental examination, behaviour management problems and even dental fear are common.
This treatment plan should incorporate a short-, as well as long-term approach, keeping in mind the coping skills of the child and avoiding repeated treatment as much as possible.