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This document discusses molar incisor hypomineralization (MIH), which causes qualitative defects in the enamel of first permanent molars and sometimes incisors. MIH is acquired during development for unknown reasons and seems to be multifactorial, associated with illnesses or environmental exposures during late pregnancy and early childhood. It affects the prevalence varies internationally but averages around 15% of children. Management involves remineralization techniques, resin infiltration, fluorides, restorations, and extractions in severe cases.

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Nour Sandoqa
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110 views15 pages

Mih PDF

This document discusses molar incisor hypomineralization (MIH), which causes qualitative defects in the enamel of first permanent molars and sometimes incisors. MIH is acquired during development for unknown reasons and seems to be multifactorial, associated with illnesses or environmental exposures during late pregnancy and early childhood. It affects the prevalence varies internationally but averages around 15% of children. Management involves remineralization techniques, resin infiltration, fluorides, restorations, and extractions in severe cases.

Uploaded by

Nour Sandoqa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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MIH

Hisham Y. El Batawi

molar incisor hypomineralization


Causes of Anomalies
MIH is acquired during
development for unknown
1. Acq uire d reason 

2. De ve lo p m e nta l
3. Id io p a thic
mostly occurs in permanent teeth but if the second primary molar
had MIH the permanent teeth will have a severe form of MIH

Molar Incisor Hypomineralisation not hypoplasia

● ‘Hyp o m ine ra lisa tio n o f syste m ic o rig in, p re se nting a s


d e m a rca te d , q ua lita tive d e fe cts o f e na m e l o f o ne to fo ur
first p e rm a ne nt m o la rs (FPMs) fre q ue ntly a sso cia te d with
a ffe cte d inciso rs.’ patchy white appearance on the
incisors and the molars
all other teeth are intact tho
Causes of MIH
In general, the condition seems to be multifactorial and
syste m ic fa cto rs such a s a cute o r chro nic illne sse s o r e xp o sure
to e nviro nm e nta l p o lluta nts d uring the la st g e sta tio na l
trim e ste r a nd first thre e ye a rs o f life ha ve b e e n sug g e ste d .

Calcification of first permanent


molars starts at birth while that of
upper central incisors starts at 3-4
during birth only incisors
months of life. and molars are being
calcified
so most likely there was
an insult during birth
jaundice or AB taken
How big is the problem?
• Very challenging
regarding both esthetics
and pain management.

• Prevalence varies from


country to country
ranging from 2.8% to
40% with average of 15%
of all children.
in the UAE its around 30-32%
Classification of Molar Incisor Hypomineralisation
only patch discolor but no surface huge cavity, soft floor,
loss of integrity of enamel slight loss of the surface super imposed dental caries

Mild Moderate Severe


Opacities without Opacities with
Opacities with enamel
breakdown nor hypersensitivity and
breakdown but with pulpitis with
pain or sensitivity
normal sensitivity secondary caries
Differential diagnosis
● Fluorosis. - history of fluoride exposure
- occurs in all teeth

Am e lo g e ne sis im p e rfe cta .


- occurs in all teeth
● - similar in appearance
to the fluorosis

● Tra um a tic hyp o m ine ra lisa tio n


(Turne r Hyp o p la sia ). occurs only on one tooth
sometimes one
Clinical Problems related to MIH side might be
mild the other
side is severe
● Post-e rup tive e na m e l b re a kd o wn le a d ing to d e ntine e xp o sure a nd this
m a ke s the to o th a t risk o f p ulp invo lve m e nt
● To o th se nsitivity, which m ig ht le a d to p o o r o ra l hyg ie ne a nd the re fo re ,
ca rie s susce p tib ility incre a se s child cant eat or brush
● Lo ca l a na e sthe sia p ro b le m s which a re p o ssib ly re la te d to chro nic p ulp
infla m m a tion
● Be ha vio ura l m a na g e m e nt p ro b le m s d ue to d e nta l fe a r a nd a nxie ty which
is re la te d to the p a in e xp e rie nce d b y the p a tie nts d uring m ultip le tre a tm e nt
a p p o intm e nts
● Ae sthe tic p ro b le m s in a nte rio r te e th
● To o th lo ss
● Ne g a tive im p a ct o n the child ’s scho o l p e rfo rm a nce d ue to the a b se nce
fro m scho o l patient need GA or nitrous
● Fina ncia l co nce rns fo r fa m ilie s. oxide because the pain
threshold is low
Management

● In an effort to
re m ine ra lise MIH
te e th, the lo ng -te rm
use o f p ro d ucts
co nta ining ca se in
p ho sp ho p e p e tid e CPP-ACP is an
agent that changes
a m o rp ho us ca lcium the dynamic of the
p ho sp ha te (CPP- tooth toward
ACP) is a d vise d . calcification enamel
will acquire calcium
hydroxyapatite

works in
mild-moderate cases
only
The Black stone of Mecca
polymer mostly
The original stone is now the stone is barely seen

formed of 13 broken pieces


now suspended in resin
Management

2. Resin infiltration.
Etching , rinsing the n
a p p ly se a la nt to
co ve r a ll a ffe cte d
e na m e l surfa ce s.
● 3. Fluoride
a p p lica tio n o n
inta ct e na m e l
surfa ce s
Management
last solution is a SSC without
constricted neck
4. Composite when the child's become an adult
we place zirconia
re sto ra tio ns o r
ve ne e rs (m o d e ra te
ca se s).

5. Full m e ta l co ve ra g e
fo r se ve re ca se s.

6. Extra ctio n fo r
d a m a g e d te e th
b e yo nd re p a ir. (Whe n
ca n I d e cid e tha t?)
management?
1- CPP-ACP
Management 2- resin infiltration
3- composite
4- fluoride
5- SS crown
In severe hyper 6- extract

sensitivity we might
or a combination of 2 or more

need to go for
conscious sedation or
even general
anesthesia
the doctor revised exam questions

Enjoy your day


Every morning this nice guy visits my
terrace for breakfast  In return he
poses for some photo shooting.

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