PAEDS MIH

Question 1

What are the stages of enamel formation?

Answer 1

1. Matrix formation
2. Initiation mineralisation
3. Maturation

Question 2

What happens during enamel matrix formation?

Answer 2

Enamel matrix is formed by ameloblasts

Question 3

What happens during enamel initial mineralisation?

Answer 3

Large amounts of ca2+ are deposited and mineralised during initial mineralisation. Stage 2 cannot occur without the formation of matrix

Question 4

What happens during enamel maturation?

Answer 4

10% of ca2+ is deposited and water and protein content are removed leading to maturation of enamel.

Question 5

What is DDE

Answer 5

Developmental defects of enamel

Question 6

Types of DDE

Answer 6

1. Hypoplasia - quantitative defect
2. Hypomineralistion - qualitative defect

Question 7

What stage of enamel development is affected when hypoplasia occurs?

Answer 7

Stage 1 - matrix formation

Question 8

What stage of enamel formation is affected in hypomineralisation?

Answer 8

Stage 2 or 3 - calcification

Question 9

DDE Aetiology

Answer 9

SYSTEMIC:
Ph change
Temperature change
Nutritional deficiencies
Calcium deficiency
Pollutants
Genetics
Childhood diseases - especially those that cause fevers
Respiratory disease
Brain hypoxia
Antibiotics - amoxicillin

LOCAL:
Trauma
Abscess formation over deciduous tooth

Question 10

Define MIH

Answer 10

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

Question 11

Diagnostic criteria for MIH

Answer 11

Demarcated opacity
Post eruptive enamel breakdown
Atypical restorations

Question 12

What is the prevalence of DDE

Answer 12

20% is otherwise healthy children, 80% in children with genetic or medical conditions

Question 13

Prevalence of MIH

Answer 13

Prevalence is varied, 20% generally.

Question 14

Signs of hypomineralised teeth and tooth structure changes?

Answer 14

Increased porosity
Decreased hardness
Decreased mineral content
Defective microstructure
Increased carbonate content
Poor bonding properties
Associated pupal changes

Extremely sensitivity
Ineffective LA
Increased caries risk
Wear, erosion
PEB
Poor restorative results

Question 15

Defective molar teeth are more susceptible to…

Answer 15

PEB from occlusal forces and caries

Question 16

Why wont restorations succeed in MIH

Answer 16

Prismatic morphology in porous enamel is altered, so there is poor bonding

Question 17

If enamel is more carbonated, waht does that mean?

Answer 17

Enamel is more soluble

Question 18

What are the treatment options for MIH

Answer 18

Microabrasion
CR Veneers/Crowns
Resin infiltration
Porcelain veneers
Etch bleach seal technique
External bleaching

Question 19

Explain microbabrasion

Answer 19

Using 18 or 37% phosphoric acid on enamel and followed by CPP-ACP for remineralisation. Treats whitish, creamy, shallow opacities, not usually effective for MIH, as defects usually extend thru full enamel thickness.

Question 20

Explain resin infiltration

Answer 20

Resin infiltration is done with 15-20% HCl acid etchant, ethanol and triethylene glycol dimethacrylate monomer, to improve the translucency of enamel.

Question 21

Explain etch seal technique

Answer 21

To remove yellow brown stains, tooth is bleached with 5% NaOCl for up to 20mins and then 37% phosphoric acid is applied for clear resin sealant. Effectiveness = ?