Assessing Child and Family 2

Question 1

What is Molar Incisor Hypomineralisation (MIH)?

Answer 1

• Hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors.
• Second primary molars can be similarly affected

Question 2

What are some negatives of MIH?

Answer 2

• Prone to breakdown
• Poor quality of enamel means sensitive to temp and sometimes brushing
• Increased caries susceptibility
• Abnormal etching and bonding pattern that compromises restorative outcomes

Question 3

How does MIH present?

Answer 3

• Different for individuals
• Can be small, demarcated discoloured areas (white opacities)
• Can be large, yellow to dark brown, areas that fracture and expose underlying dentine

Question 4

How do restorations present on MIH if lesion no longer visible?

Answer 4

• Atypical in shape

Question 5

What factors do you need to consider when determining whether teeth affected by hypomineralisation are of poor prognosis?

Answer 5

• Enamel colour in order severity and increasing likelihood of breakdown (white/cream then yellow then brown)
• Location of defects in order of severity (smooth surface then occlusal surface/incisal edge then cuspal involvement
• Sensitivity form brushing or temp
• Atypically shaped restorations
• Any patient reported symptoms

Question 6

What factors must you include when deciding most appropriate management option for each carious lesion?

Answer 6

• Extent of lesion
• Site of lesion
• Activity of lesion
• Time to exfoliation
• Number of other lesions present in dentition
• Childs medical status
• Anticipated cooperation of child, now and in future
• Anticipated cooperation of parent/carer with preventative intentions and to attend repeat management appointments
• Range of clinical procedures the clinician has skill to provide

Question 7

Are pulp polyps likely to cause infection before exfoliation?

Answer 7

• No they are unlikely to cause infection before exfoliation
• Indicates at least one root is vital while other may be necrotic
• If signs or symptoms of infection then extraction or pulp therapy required

Question 8

What to do for each diagnosed carious lesion in primary tooth?

Answer 8

• Assess risk of pain or infection developing prior to exfoliation of tooth
• Decide on management option

Question 9

How to assess toothbrushing and plaque levels?

Answer 9

• Record plaque levels
• Assess whether gingiva appear healthy or whether inflammation indicative of poor plaque removal
• Record presence of plaque on surface of open carious lesions at recall visits for lesions where prevention-alone management strategy has been selected previously

Question 10

What are the plaque level scores?

Answer 10

10/10 = Perfectly clean tooth
8/10 = Plaque line around cervical margin
6/10 = Cervical third of crown covered
4/10 = Middle third covered

• Worst score at each sextant recorded