MIH BDS2 Flashcards
Molar Incisor Hypomineralisation (MIH)
Hypomineralisation of systemic 1-4 first permanent molars, frequently associated with affected incisors
Appearance
cheesy molars, enamel not form properly, overlying issue with caries, post eruptive breakdown
Anterior teeth
marks on upper and lower central and laterals
Prevalence of MIH
10 - 20%
Hypomineralisation
- disturbance of enamel formation resulting in reduced mineral content
- weaker bonding to COMP as less mineralised enamel
Hypoplastic
- reduced bulk/ thickness of enamel; not the right shape
1. true: enamel never form
2. acquired: post- eruptive loss of enamel bulk; hypomineralised bits fall off
Is there an underlying pulpal inflammation in MIH teeth?
- pulpal innervation; increase in neural density (green)
- immune cells; increase in immune cell accumulation (red)
- vascularity; increase if sensitive MIH tooth (blue)
Theories of why MIH sensitive?
- Dentine hypersensitivity; porous enamel/ exposed dentine facilitates fluid flow within dentine tubules - activate AD nerve fibres
- Peripheral sensitisation; underlying pulpal inflammation; sensitisation of c fibres
- Central sensitisation; nociceptive input
What causes MIH?
- unclear diagnostic criteria
- most parents cant remember details from 8-10 yrs
- variations in quality and completeness of case records
- study populations small
What’s the critical period for formation of MIH?
- first year of life
- enamel crown of FPM is complete by one year
- developmental problem / environment, not genetic
Questions to parents regarding time frame?
- Pre- natal
- Natal
- Post- natal, up to age of 2
Aetiology of Prenatal ?
- no causative causes
- usually ask mothers about their general health in 3rd trimester of pregnancy
- may have pre-eclampsia/ gestational diabetes
Aetiology of perinatal?
- birth trauma/ anoxia (baby stuck and lack of oxygen)
- hypocalcaemia
- preterm birth
Aetiology of post- natal?
- prolonged breast feeding
- dioxins in breast milk
- fever and medication (NOT USUALLY BECAUSE OF AB, BUT THE WAY CHILD TAKING IT)
- socioeconomic status
Viral infection - Measles
- incubation period: 10-14 days
- fever
- rash
- Koplik’s spots - white spots
- Conjunctivitis
- Coryza- funny nose
- cough
duration of illness 7-10 days - secondary infection, eg: otitis media, bronchopneumonia
- corneal ulcer, stomatitis, gastroenteritis, appendicitis
Symptoms of Rubella?
- mild fever
- maculopapular rash
- generalised lymphadenopathy, eg: suboccipital nodes; DO E/O exam
- malaise
- URTI: upper respiratory tract infections
- 8-10 days
- encephalitis, arthritis, purpura
Symptoms of Chicken Pox (Varicella)
- low grade fever
- rash
- crops of spots progressing from macule- papule - vesicle rupture
- 6-10 days of illness
Secondary infection of lesions
- encephalitis
- pneumonia
What does yellow/ brown staining mean?
- more porous
- affecting whole enamel layer
What does white/ cream mean?
- affecting inner parts of enamel affected
- important to know for tx wise whether to go for microabrasion/ ICON
Clinical Problems of MIH
- loss of tooth substance
- breakdown of enamel
- toothwear
- secondary caries - sensitivity; posterior > anterior
- appearance
What are the tx options for Molars?
- COMP/GIC restorations
- SSC
- adhesively retained copings
- extraction (8.5- 9.5 yrs old)
Molar with Post- eruptive breakdown
with GI
Extraction of HFPM
Consider
- age
- skeletal pattern
- future orthodontic needs
- quality of teeth, eg: caries
What is the right time of removal of lower FPM?
- calcification of bifurcation of 7’s on radiograph
- we know if we remove, then the space will close with the 7’s
