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BDS2 Paediatric dentistry > Molar Incisor Hypomineralisation > Flashcards

Molar Incisor Hypomineralisation Flashcards

1
Q

What % of child referrals are due to MIH?

A

25%

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2
Q

what teeth does MIH affect

A

1st permanent molars

permanent incisors

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3
Q

What does MIH look like

A
  • distinctive from everything else
  • very well demarked
  • white, yellow, brown parts
  • not symmetrical
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4
Q

What does “hypomineralised” mean

A

disturbance of enamel formation (secretory phase) resulting in a reduced mineral content

(shape is fine)

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5
Q

What does “hypoplastic” mean

A

reduced bulk or thickness of enamel

True= enamel never formed
Acquired = post-eruptive loss of enamel bulk

(shape is not fine)

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6
Q

why is it so difficult to determine aetiology

A
  • unclear diagnostic criteria in classification
  • most parents can’t remember details from 8-10 years before
  • variations in quality and completeness of case records
  • study populations small
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7
Q

when is the critical period for formation of MIH

A

first year of life

as enamel matrix of crown of first permanent molars is complete by 1 year

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8
Q

what time period do you ask about to diagnose MIH?

A

Ask about the 3 different time periods:

  • pre-natal
  • natal
  • post-natal
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9
Q

What prenatal questions do you ask mothers

A
  • about their general health in 3rd trimester of pregnancy e.g. pre-eclampsia, gestational diabetes
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10
Q

What natal questions do you ask mothers

A

(time around birth)

  • are they full term or premature?
  • any emergency procedures?
  • forceps?
  • baby not getting enough oxygen etc?
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11
Q

What postnatal questions do you ask mothers?

A
  • could they breathe properly when they came out?
  • did they spend any time in a special baby unit?
  • have they had chickenpox?
  • any breathing problems?
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12
Q

How can you spot measles in children

A
  • fever
  • rash
  • Koplik’s spots (white spots in mouth)
  • conjunctivitis
  • cough
  • coryza (runny nose)
  • duration of illness =7-10days
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13
Q

How can you spot rubella in children

A
  • mild fever
  • maculopapular rash
  • generalised lymphadenopathy
  • malaise
  • URTI
  • duration of illness = 8-10days
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14
Q

How can you spot chicken pox in children

A
  • low grade fever
  • rash
  • lots of spots
  • duration of illness = 6-10 days
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15
Q

What did Fagrell et al find out about the possible aetiological factors of severe demarcated opacity (SDO)

A

Disturbances in nutrition in first 6 months might have an effect

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16
Q

What did Balmer et al find out about the relationship of MIH to socioeconomic status

A

association with first 4 deprivation quintiles

17
Q

what is the histology like with MIH

A
  • whole enamel layer yellow/brown (more porous)
  • inner parts of enamel white/ cream
  • chronologically dispersed hypomineralised demarcated opacities, higher carbon content, lower Ca,PO4
18
Q

Is there underlying pulpal inflammation in MIH teeth

A
  • more nerve innervation (senstivity, difficult to anaesthitise)
  • lots more immune cell activity
  • significant increase in vascularity (more inflamed)
19
Q

What are the consequences for pain for MIH

A
  • dentine hypersensitivity
  • peripheral senstitisation
  • central senstitisation
20
Q

what is dentine hypersensitivity

A

porous enamel or exposed dentine facilitates fluid flow within dentine tubules to activate Adelta nerve fibres (hydrodynamic theory)

21
Q

what is peripheral sensitisation

A

underlying pulpal inflammation leads to sensitisation of C-fibres

22
Q

what is central sensitisation

A

from continued nociceptive input?

23
Q

clinical problems for MIH

A
  • loss of tooth substance (breakdown of enamel, tooth wear, secondary caries)
  • sensitivity (don’t like brushing)
  • appearance (won’t smile)
  • very poorly caries resistant
24
Q

treatment options for MIH

A
  • composite/GIC restorations
  • stainless steel crowns
  • adhesively retained copings
  • extraction (8.5-9.5yrs old)
25
Q

If you’re just trying to maintain the tooth until it’s time to extract what could you use

A

GIC

  • releases F
  • deals with sensitivity
  • makes tougher til time to remove
26
Q

If it’s extremely sensitive what could you use

A

stainless steel crown

27
Q

When do you decide to remove the tooth

A
  • radiographic calcification/bifurcation of the lower 7

- good to see developing 3rd molars too

28
Q

what happens if you take out the tooth too early

A

they will also lose perfectly good premolars to try and make space

29
Q

roughly what age would you look at taking out the tooth

A

8.5-9.5 years (but look at dental age)

30
Q

what do you consider when considering extracting HFPM’s

A
  • age
  • skeletal pattern
  • future orthodontic needs
  • quality of teeth e.g. caries
31
Q

how do you treat affected incisors

A
  • acid pumice microabrasion (gets rid of yellow, brown bits)
  • external bleaching (13yrs before you do this, makes normal tooth colour whiter as can’t get rid of white bits)
  • localised composite placement
  • full composite veneers
  • full porcelain veneers (not advised until after 20 as gum level changes a lot)

BDS2 Paediatric dentistry (5 decks)

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