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BDS2 - paediatrics > MIH > Flashcards

MIH Flashcards

1
Q

what does MIH stand for

A

molar incisor hypomineralisation

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2
Q

define MIH

A

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

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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

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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

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5
Q

why are the marks caused by MIH distinctive

A

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

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6
Q

what is the prevalence if MIH

A

10-20%

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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

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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

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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

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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

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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

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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
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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

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14
Q

what kind of condition is MIH

A

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

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15
Q

what are the 3 clinical periods of enquiry

A
  • Prenatal
  • Natal
  • Postnatal
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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

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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

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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

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

25
what other issues can arise with rubella
• Encephalitis, arthritis, purpura ○ Swelling in the brain and joints ○ Other rashes
26
what are the signs / symptoms of chicken pox
• Low grade fever • Rash • Crops of spots progressing from macule-papule-vesicle Can burst / rupture
27
what is the duration of ilness for chicken pox
6-10 days
28
what other issues can arise with chicken pox
• Secondary infection of lesion ○ Bacterial infection • Encephalitis • Pneumonia
29
why would mild presentations of MIH be excluded from studies
in case diagnosis was incorret
30
what aetiology proved to be a cause in one large study of MIH in sweden
• 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
what effect does MIH have on children's dental experience
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
what is the histology of MIH teeth
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
what are the key findings with regards to neural density
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
what are the key findings with regards to immune cell accumulation
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
what are the key findings with regards to vascularity
There was a significant increase in vascularity in sensitive MIH samples When something is inflamed then blood flow is higher
36
what are the theories of pain mechanisms
• 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
what are the clinical problems of MIH
``` • 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
what affect can MIH have on children's psychological health
§ Can cause children to worry about their teeth | Kids wont smile / cover their mouth when they laugh
39
what are the treatment options for MIH
• 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
what indication do you look for in an x ray before removing a patients lower 6s
Want to see calcification of the bifurcation of the lower 7s
41
before extracting first permanent molars because of MIH what do you need to consider
• 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
how can you treat affected incisors
• 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
what do you want the patient to have before microabrasion and bleaching treatment
Want the patient to have full permanent dentition before considering carrying out the above treatment on patients - around 11-13 years old
44
what advice should be given with regards to full porcelain veneers
○ 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)

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