MIH Flashcards

1
Q

What type of children are more likely to be affected by MIH?

A

Those with poor health during the first 3 years of life

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2
Q

Rules for balancing/compensating 6s

A

Class I molars: compensate (balance if crowded) Class II molars: Min crowding: extract upper 6 if likely to overerupt; maintain until 7s erupt if not; no balancing Crowding: compensate if upper 6 likely to overerupt;remove before or after 7s erupted; no balancing Class III: orthodontic advice to be sought; avoid balancing and compensating

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3
Q

What causes hypoplasia

A

A disruption in the secretory phase. Occurs early in development forming gross enamel surface defects and small pits and grooves

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3
Q

What causes the increased sensitivity

A
  1. Greater innervation in the subodontoblastic/pulp horn regions
  2. Increased immune cell density
  3. Increased vascularity in sensitive teeth
  4. porous enamel – exposed dentine
  5. Activation of A delta fibres
  6. Underlying increase in c-fibre action
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4
Q

Aetiology of MIH

A
  1. Hypoxia of the mother/child
  2. Exposure to chemicals
  3. Peri-natal and neo-natal problems
  4. Common childhood illnesses and medically compromised children
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5
Q

What occurs in the secretory phase?

A

It defines the form of the tooth. There is the deposition of organic matrix plus small thin crystalites. There is incremental growth in thickness although it is not a continuous process

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5
Q

Advantages of using SSCs for MIH

A
  1. Single visit for placement
  2. relatively quick and simple procedure
  3. usually reduce sensitivity totally because the whole tooth is covered
  4. Inexpensive compared with cast restorations
  5. good retention rate
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5
Q

When do you not want to XLA the 6s?

A

when there is spaced dentition

with a severe class 2/3

in hypodontia

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6
Q

What does MIH stand for

A

Molar/ incisor hypomineralisation

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7
Q

General management of MIH

A
  1. Recognisation and review
  2. Desensitisation
  3. Temporisation
  4. Restore
  5. Extract
  6. Orthodontic integration
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8
Q

Restoring centrals with MIH

A
  1. Microabrasion
  2. Etch-bleach-seal
  3. Bleach
  4. Composite
  5. Bleach and composite
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9
Q

Prevalence of MIH

A

3.6 - 25%

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10
Q

What is MIH

A

Clinically hypomineralisation of systemic origin affecting one or more of the first permanent molars and any associated and affected incisors CHRONOLOGICAL DEFECT

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12
Q

Differential diagnosis of MIH

A
  1. Fluorosis
  2. Amelogenesis imperfecta
  3. Turner tooth
  4. Idiopathic hypomineralisation
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12
Q

How does CPP-ACP work

A

Casein phosphopeptide - amorphous calcium phosphate. Milk derived product that remineralises teeth. It provides bioavailable calcium, phosphate and fluoride ions to the tooth

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13
Q

Why does amalgam have limited use in MIH

A

It is non adhesive and therefore further post eruptive breakdown can jeprordise the filling

14
Q

Managing sensitivity associated with MIH

A
  1. Repeated application of 5% sodium fluoride varnish. DURAPHAT
  2. Sensitive toothpastes
  3. Daily use of 0.4% stannos fluoride gels
  4. GIC/ Comp restorations
  5. SSC
15
Q

How effective is LA when restoring a molar with MIH

A

Teeth are more difficult to anaesthatise, often staying sensitive when normal levels of anaesthesia is given - could lead to an increase in dental fear and anxiety

16
Q

When is the best time to extract the 6s

A

Bifurcation of the 7 to prevent tipping, to allow mesial drift and to prevent rotation of the 7

This is usually at the dental age of 9

17
Q

What are the two phases of Amelogenesis

A

Secretory phase and maturation phase

18
Q

How does MIH present

A
  1. Demarcated patches
  2. White-brown, cream
  3. Post eruptive breakdown
  4. Missing 6s
  5. Heavily restored, abnormal restorations
  6. calculus
19
Q

What causes hypomineralisation

A

Disruption in the maturation phase. Poor mineralisation of the matrix. Occurs later in development. There is the normal thickness of enamel but dubious quality

20
Q

When do central incisors start to form?

A

3-4 months in-utero

21
Q

Is it worse to extracts 6s too early or too late?

A

Too late. 5s are less likely to tip distally compared to 7s tipping mesially. It is difficult to close space involving a 7

23
Q

Prevention of sensitivity and caries in MIH

A

Fluoride, desensitising toothpaste, CPP-ACP, fissure sealants and oral hygiene

24
Q

What does the asymmetrical distribution of MIH suggest?

A

That ameloblasts are affected at a very specific stage in the development

26
Q

Alternative terms for MIH

A
  1. Cheese molars
  2. Hypomineralised 6s
  3. Idiopathic hypomineralisation
  4. Non-fluoride hypomineralisation
28
Q

Molar restoration

A

Compostie, SSC, Gold/CoCr onlays

29
Q

What occurs in the maturation phase?

A

It establishes the quality of the tooth. You get degradation of the organic matrix, coupled with mineralisation. Ameloblasts move calcium and phosphate and the process continues post eruption. Apoptosis of the ameloblasts.

30
Q

Challenges faced by MIH

A

Patient and restorative factors.

31
Q

What happens if you XLA the 6s too late or too early

A

too early - 5 tips too late - 7 tips

32
Q

When do first permanent molars start to form and when do they calcify?

A

For after 4 months in-utero and calcify at birth

33
Q

Microscopically what do you see in MIH

A
  1. Altered calcium/phosphate ratio
  2. Less distinct enamel rods
  3. Bacterial penetration of enamel
  4. Lower hardness of enamel