Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS2 - paediatrics > MIH > Flashcards

MIH Flashcards

1
Q

what does MIH stand for

A

molar incisor hypomineralisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define MIH

A

Hypomineralisation of systemic origin of 1-4 permanent molars, frequently associated with affected incisors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

does it have to be both incisors and molars for it to be MIH

A

Doesn’t have to be both incisors and molars for it to be MIH

Just have to have this on one of the first permanent molars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

is it MIH if other teeth are affected by hypomineralisation

A

If hypomineralisation is affecting other teeth that are not first permanent molars or incisors then it is another condition and not MIH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

why are the marks caused by MIH distinctive

A

demarcated patches
white (chaliksih) or yellow or brown colour
not symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the prevalence if MIH

A

10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is hypomineralisation

A

• Disturbance of enamel formation resulting in a reduced mineral content
• Happens at later stage of amelogenesis
○ Secretory stage creates the jelly template as normal
○ Then the mineralisation phase happens but something goes wrong and it does not properly change the jelly template into hard enamel

• Tooth erupts the right shape but has defects
○ Part of enamel not as strong as they should be

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what effect does hypomineralisation have on bonding materials to enamel

A

• Bonding materials are designed to work on normal enamel

○ Therefore these materials may not work as they should on hypomineralised enamel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is hypoplastic

A

• Reduced bulk or thickness of enamel
○ Something goes wrong during the secretory stage so the jelly template is not like it should be so the erupted tooth will not be the right shape
○ Mineralisation stage happens as it should so the quality of the enamel is normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how does bonding materials work on hypoplastic teeth

A

Bonding materials will work as normal on these teeth as the mineralisation stage has happened as it should

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the types of hypoplastic teeth

A

○ True
§ Enamel never formed

○ Acquired
§ Post-eruptive loss of enamel bulk
§ Sometimes in hypomineralised teeth the enamel can be so soft that bits just fall off them so they can appear as though they are the wrong shape post eruption □ But in this case the teeth did erupt the normal shape but then the shape altered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

why is it so difficult to determine the aetiology of MIH

A

• Unclear diagnostic criteria in classification

• Most parents cannot remember details from 8-10 years previous
○ Children present with this when they are around 8-10 years old
○ Need to ask parents questions about things when the tooth was forming and from the pregnancy of the child

  • Variations in quality and completeness of case records
  • Study populations small
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the critical period for the formation of MIH

A

• First year of life is generally agreed
○ Agreed that there is some kind of disturbance during the first year of life of the child

• Enamel matrix of crown of FPM’s is complete by one year
○ Add on another year to catch the incisors crown as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what kind of condition is MIH

A

○ It is a developmental condition
§ Not inherited / genetic
§ Something happens to the child during development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the 3 clinical periods of enquiry

A
  • Prenatal
  • Natal
  • Postnatal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what factors are looking at prenatally

A

• No definitive causative factors identified
• Usually ask mothers about their general health during the 3rd trimester of pregnancy
○ Eg pre-eclampsia, gestational diabetes

§ Teeth are not formed before the 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what factors are you looking at perinatally

A

• Birth trauma / anoxia
○ Not enough oxygen at the time of birth
○ Was there anything in particular that made the birth traumatic
§ Emergency C section?
§ Suctioned cupped birth?
§ Forceps delivery?
§ Did they spend any time in a special baby unit?
§ Did the baby spend any time in an incubator?
§ Was baby handed to mum no problem?
○ Any issues with the baby?
§ Could the baby breathe properly when they came out?
§ Did the baby have any respiratory defect?

• Hypocalcaemia
○ Not enough calcium

• Preterm birth
○ Preterm births show a high incidence of MIH along with lots of other issues as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what factors are you looking at post natally?

A

• Prolonged breast feeding
○ Beyond 6 months of age
○ Studies are inconclusive

• Dioxins in breast milk
○ No firm evidence

• Fever and medication
○ Problems in breathing / respiratory issues
○ Common childhood illnesses
§ Chicken pox
§ Mumps
§ Measles
□ Last 2 should be less common due to the MMR vaccine against this diseases

  • Socioeconomic status
  • Rural Vs Urban
19
Q

what is the incubation period for measles

A

10-14 days

20
Q

what are the signs / symptoms of measles

A 
○ Fever
○ Rash 
○ Koplik's spots = White spots inside the mouth
○ Conjunctivitis 
○ Coryza = Runny nose
Cough
21
Q

what is the duration of illness with measles

A

7-10 days

22
Q

what other issues can arise with measles

A

• Secondary infections, otitis media, bronchopneumonia
○ Middle ear infections
○ Chest issues
• Corneal ulcers, stomatitis, gastroenteritis, appendicitis

23
Q

what are the signs / symptoms of rubella

A 
• Mild fever 
• Maculopapular rash
Generalised lymphadenopathy especially suboccipital nodes
○ Swollen glands
• Malaise = Tiredness
Upper respiratory tract infections
24
Q

what is the duration of illness with rubella

A

8-10days

25
Q

what other issues can arise with rubella

A

• Encephalitis, arthritis, purpura
○ Swelling in the brain and joints
○ Other rashes

26
Q

what are the signs / symptoms of chicken pox

A

• Low grade fever
• Rash
• Crops of spots progressing from macule-papule-vesicle
Can burst / rupture

27
Q

what is the duration of ilness for chicken pox

A

6-10 days

28
Q

what other issues can arise with chicken pox

A

• Secondary infection of lesion
○ Bacterial infection
• Encephalitis
• Pneumonia

29
Q

why would mild presentations of MIH be excluded from studies

A

in case diagnosis was incorret

30
Q

what aetiology proved to be a cause in one large study of MIH in sweden

A

• The following showed increased odds of SDO
○ Breast feeding longer than 6 months
○ Late into gruel (children weaned onto solid food late) over 6 months
○ Late into infant formula after 6 months

Disturbances in nutrition in first 6 months might have an effect

31
Q

what effect does MIH have on children’s dental experience

A

Children with MIH need more treatment
Fear and anxiety is more common among these child as they have had more intervention at a younger age
Behaviour management problems are more common as the children try to resist more treatment

32
Q

what is the histology of MIH teeth

A

Yellow / brown more porous - whole enamel layer
White / cream - inner parts of enamel affected
Chronologically dispersed hypomineralised opacities
Higher carbon content, lower Ca,PO4

33
Q

what are the key findings with regards to neural density

A

Significant increases in neural density in the pulp horn and subodontoblastic regions of MIH samples
• Lots more innervation in MIH
○ Children complain about sensitivity
These children can sometimes be difficult to anaesthetise as there is more neural activity in these teeth

34
Q

what are the key findings with regards to immune cell accumulation

A

Significant increases in immune cell accumulation in MIH samples, especially with post-eruptive enamel loss
• Normal teeth can see barely any
Lots in MIH samples showing more immune cell activity

35
Q

what are the key findings with regards to vascularity

A

There was a significant increase in vascularity in sensitive MIH samples
When something is inflamed then blood flow is higher

36
Q

what are the theories of pain mechanisms

A

• Dentine hypersensitivity
○ Porous enamel or exposed dentine facilitates fluid flow within dentine tubules to activate A-delta nerve fibres (hydrodynamic theory)
○ Rubbish enamel trying to protect the tooth won’t protect the tooth as well

• Peripheral sensitisation
○ Underlying pulpal inflammation leads to sensitisation of C-fibres
○ Lot more neural C fibres there

• Central sensitisation
○ From continued nociceptive input?
○ Pain process from the brain due to continued assault on teeth
Nerves on brain firing off

37
Q

what are the clinical problems of MIH

A 
• Loss of tooth substance
○ Breakdown of enamel
	§ Enamel is not as hard as it should be
○ Tooth wear
○ Secondary caries

• Sensitivity
○ Can cause OH problems of the child doesn’t want to brush teeth because it hurts too much

Appearance

38
Q

what affect can MIH have on children’s psychological health

A

§ Can cause children to worry about their teeth

Kids wont smile / cover their mouth when they laugh

39
Q

what are the treatment options for MIH

A

• Composite / GIC restorations
○ Composite restorations - remember the bonding might not work to the enamel of hypomineralised teeth as the enamel is different
○ If just trying to maintain the tooth until it can be removed GIC is a good option = Releases fluoride which helps with sensitivity and can make tooth tougher

• Stainless steel crowns
○ If the tooth is very sensitive or badly broken then this is the go to option
○ Hard to do - need to cut and shape the crown

• Adhesively retained copings
○ Keep the teeth
○ Gold works best - patients don’t like how this appears

• Extraction (8.5-9.5 years)
○ More to do with the child’s dental age instead of their actual age

40
Q

what indication do you look for in an x ray before removing a patients lower 6s

A

Want to see calcification of the bifurcation of the lower 7s

41
Q

before extracting first permanent molars because of MIH what do you need to consider

A

• Age
○ Patient usually between 8.5 and 9.5 but more important to think of the dental age of the patient (x-rays)

  • Skeletal pattern
  • Future orthodontic needs

Quality of teeth eg caries

42
Q

how can you treat affected incisors

A

• Acid pumice microabrasion
○ Can get rid of the yellow / brown marks and patients can be happy enough with this

• External bleaching
○ White chalky marks won’t go away with bleaching but can make the rest of the teeth more white so there is less of a contrast

• Localised composite placement
○ Composite camouflage - good for younger children
○ Composite over the patch - rarely disappears but can make it look much less obvious

• Full composite veneers
○ Direct composite to cover marks

• Full porcelain veneers

43
Q

what do you want the patient to have before microabrasion and bleaching treatment

A

Want the patient to have full permanent dentition before considering carrying out the above treatment on patients - around 11-13 years old

44
Q

what advice should be given with regards to full porcelain veneers

A

○ Don’t use porcelain until the patient is in their 20s
○ Some say can use at the age of 16 bit there is a big change in the gum level between 16 year olds and 20 year olds
Can result in exposed margins and can look rubbish

BDS2 - paediatrics (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions