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Paediatrics > MIH > Flashcards

MIH Flashcards

1
Q

What is MIH?

A

hypomineralisation of systemic origin or one or more of the four permanent first molars as well as associated and affected incisors

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2
Q

What is the prevelance of MIH?

A

3.6-25% Weerhijme 2001§

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3
Q

How does MIH present?

A 
affects one more more FPM and incisors
demarcated patches
white brown and cream
post eruptive breakdown
missing 6's
heavily restored abnormal restorations 
calculus
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4
Q

WHat are the alternative terms to MIH?

A

cheese molars
hypomineralised 6’s
idiopathic hypomineralisation
non fluoride hypomineralisation

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5
Q

Differential diagnosis?

A

fluorosis
AI
Turner tooth
Idiopathic hypomineralisation

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6
Q

When does tooth formation begin?

A

6 weeks IU

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7
Q

What is the structure of enamel?

A

Unique
Organised tightly packed crystals
Highly mineralised 95% HAP

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8
Q

What are the phases of enamel production?

A

Sectretion

maturation

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9
Q

what is the first phase of amelogenesis?

A

Odontoblasts secrete collagen type 1
Then amelobalats differntiate in the internal enamel epithelium and they secrete enamel proteins which change shape and leads to mineralisation

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10
Q

What is the purpose of the secretoy phase?

A

defines the tooth form
deposition of organic matrix and amll thin crytsallites
there is an incremental growth in thickeness

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11
Q

t/f the secretory phase is a contrinuous process

A

F

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12
Q

What does a faiulre in the secreotry phase leasd to?

A

hypoplasia

this leads to small pits and grooves and gross enamel surface defects

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13
Q

What happens during the maturation phase of amelogenesis?

A

this is wehrre the quality of the tooth is established and the organic matrix is degraded and becomes minerlaised

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14
Q

What do ameloblasts do to calcium and phospate ions during maturation?

A

they move them

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15
Q

t/f the matrutration process is a contunous orocess post eription?

A

t

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16
Q

what happens to the ameloblasts following maturation?

A

apoptosis

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17
Q

What does failure in the maturation process lead to?

A

hypomineralisation

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18
Q

what is hypomineralisation?

A

this is when there is poor mineralisation of the enamel matrix and occurs later in development

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19
Q

What kind of enamel defect does hypomineralisation lead to?

A

this leads to white and brown opacities

20
Q

t/f hypomineralised enamel is normal thickness?

A

T

but enamel is poor quality

21
Q

What does hypomineralised enamel appear like down a microscope?

A

altered Ca/P balance withless distinct enamel rods and there is bacterial penetration into the enamel rods and it has a lower hardness than normal enamel

22
Q

How does MIH occur?

A 
not sure
many factors 
timing of the insult
pyrexia
hypocalcaemia
hypoxia of child or mother?

Lygidakis 2008

23
Q

according to Crombie et al 2009 what is the aetology of MIH?

A

systematic review
exposiure to chemical: breasfeeding and fluride
peri natal and neonatal problems: malnutrituion, maternal health, birth problems
common child hood illness and mdeically compormised children: respiratory problms, otitis media, coeliac, renal, CF

24
Q

T/F breastfeeding is protective against MIH?

A

T crombie et al 2009

25
Q

What is the effect of early cessation of breast feeding and malnutrition on MIH?

A

this can lead to MIH

crombie 2009

26
Q

WHat is the effect of fluoride on MIH?

A

there is weak evidence and leads to more diffude defects

Crombie 2009

27
Q

What does it mean if there are visible defects in E’s? ref

A

Crombie et al 2009

co existing factoirs

28
Q

How strong is the evidence for childhood illnesses and MIH link

A

Poor link
poor parental recall
confounding factors

29
Q

What are the patient related challenging factors?

A

appearance:children and parents concenred about appearance, transition to secondary school
sensitivity: greater innneravtion of te subodontoblastic pulp horn regions, increased immune cell density, increased vascularuty in sensitive teeth, porous enamel causes dentine to become exposed, activation of A delta fibres. and increase C fibre action
Behaviour management: young pateints, repeated restrations, LA, fears

30
Q

What are the restorative callanges?

A

incisors: site, colour, bonding, immature dentine, crumbly
molars: size, bonding, caries develpment, poor progmosis, immature dentine, difficult to anesthetise, crumbly, over eruption of molars

31
Q

WHat are the solutions for the molars?

A 
Phase 1: surveillance, recognise and review
Phase 2: desens
phase 3: temporarise, 
phase 4: restore, extract, orthodontic
phase 5: maintenance
32
Q

What does surveillance entail?

A 
knowledge of prevalnce of the diease
hypomin and plasia of primary teeth
past medial history
family histry
review as teeth erupt
33
Q

WHat does recognition and review entail?

A

consider differntial diagnosis
review according to caries risk status and abscence of problems
implement prevetativ regimen

34
Q

WHat preventative techniques are there?

A 
fluroide
desensitising toothpaste
CPP-ACP
fissure sleants
OH
35
Q

How do you temporaise MIH teeth?

A

GIC, SSC

36
Q

when would you restore or extract MIH teeth?

A

repemds on the extent of damage and consider the structure of the female and age of child, presence of adjacent teeth and consider oclusal and orthodontic factors

37
Q

What can you rstore molars with?

A

composite
SSC
GOld or Cobalt Chrome onlays

38
Q

WHat are the advanatges of using SSC?

A

good longevity
easy to fit
occlusion dimesnion settles

39
Q

What are the advantages and dis of using fabricated onlays?

A

well tolerated
good longevity
permanents

BUT: time and lab bill

40
Q

WHen would you xla MIH teeth?

A

poor prognosis
age dependant eg dependant on formatio of 7
are 7’s and 8’s present?
MUST CONSULT ORTHO

41
Q

WHat are the options for incisors?

A 
microabrasion
etch bleach seal
bleach
composite
bleach and comp
42
Q

HOw does microabrasion work?

A

imprives surface discolouration which is limited to the outer surface only
100nm enamel is removed and can only be used for mild lesions
brown stains more easily removed than white

43
Q

WHat do you use in microabrasion?

A

pumice and HCL

44
Q

WHat do you use in etch bealch and seal?

A

60s etch and use 5% NAOCl bleach for 5-10mins and then re etch the tooth and apply clear fissure sleant

45
Q

What type of bleaching agents should you use?

A

localised yellow brown patches: sodoum hypochlorite

darker lesions: peroxide

46
Q

WHen are cast restoratons and comoposte done in MIH?

A

permanent teeth

cast used for seevre cases

Paediatrics (31 decks)

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