Molar Incisor Hypomineralisation (mih) wordt omschreven als een hypomineralisatie (van systemische oorsprong) van een tot vier blijvende eerste molaren, vaak in combinatie met aangedane incisieven. mih-molaren zijn fragieler en cariesgevoeliger dan gewone molaren. Een kenmerk van mih-molaren is een extreme overgevoeligheid voor koude, warmte en/of lucht. De behandeling van deze molaren kan de behandelaar soms voor klinische problemen stellen. Het aantal gevallen van mih verschilt per land en per geboortejaar en varieren tussen de 3,6% en 25%. De oorzaak van mih is nog niet duidelijk. Wel duidelijk is dat het moet ontstaan in de periode van maturatie van het glazuur, dus tijdens de eerste levensjaren van het kind. Zolang de oorzaken van mih nog niet bekend zijn, is het verstandig om kinderen die in hun eerste levensjaren vaak ziek zijn geweest, kinderen met hypomineralisatie van de 2e melkmolaren en kinderen die op de blijvende incisieven duidelijk begrensde opaciteiten vertonen, tijdens de eerste wisselfase regelmatig te controleren om op tijd eventuele mih te signaleren.

Molar-incisor hypomineralisation.

Summary. Objectives. To assess the demand for restorative treatment, dental anxiety and dental behaviour management problems among children with severe hypomineralization of their first molars (MIH).

Design. Case control study.

Sample and methods. Data were compiled from the dental records of 32 9-year-old children with severe enamel hypomineralization of their first molars and from 41 controls of the same age group concerning dental health, a number of restorative treatments, use of local anaesthesia and clinical behaviour management problems (BMP). A questionnaire containing specific questions on children’s experiences of dental care and the Children’s Fear Survey Schedule – Dental Subscale (CFSS-DS), was answered by the parents.

Results. The children in the study group had undergone dental treatment of their first molars nearly 10 times as often as the children in the control group. Repeated treatments of these teeth at brief intervals were common. The dental treatment was often undertaken without the use of local anaesthesia, and BMP, and dental fear and anxiety (DFA) were more common than in the controls.

Conclusions. Children with severe enamel hypomineralization of their first molars had had to undergo a considerable amount of dental treatment. It is reasonable to assume that experiences of pain and discomfort on repeated occasions were related to the occurrence of BMP in patients with MIH. An early treatment planning and prognostication based on increased knowledge of hypomineralized first molars is desirable. Local anaesthesia and other pain-reducing techniques, e.g. sedation, should be used when treating these teeth. Extraction should be considered in cases of extensive disintegration of the crown, in cases of frequently repeated treatments or when pulpal symptoms are hard to cure.

Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars.

OBJECTIVES: The aim of this study was to investigate the morphological appearance of severe hypomineralized enamel of permanent first molars by means of polarized light microscopy, and to estimate the possible time, severity and longevity of the insult. Furthermore, the aim was to survey some commonly implicated aetiological factors in order to gain knowledge about possible pathogenesis of the enamel disturbances which could be compared with future epidemiological studies. SAMPLE AND METHODS: Seventy-three teeth, which had been extracted due to severe hypomineralizations of the enamel, were collected and serially cut longitudinally in a bucco-lingual direction. The sections were examined in polarized light, dry and embedded in water. The children were also examined with respect to the demarcated opacities of other permanent teeth than those that were extracted. The parents were asked about their health during the mother's pregnancy, the time of gestation, birth weight and any complications. They were also asked about the child's health during the first 2 years of its life, the length of time of breast-feeding and also about fluoride supplements. RESULTS: The hypomineralized areas extended cervically from the cusps, comprising about half of the buccal and lingual sides. The cervical borders to normal enamel were well defined and mainly followed the lines of Hunter-Schreger. The hypomineralized zones were covered by thin well-mineralized enamel. The majority of the children had demarcated opacities of all their first molars and also of some permanent incisors. No obvious correlation to the anamnestic data could be found. CONCLUSIONS: The hypomineralized enamel in the investigated teeth demonstrated areas of porosity of varying degrees. The yellow/brown defects were more porous than the white-cream and extended through the whole enamel layer, while the white-cream opacities were situated in the inner parts of the enamel. There had probably been an interacting disturbance of short duration of systemic origin of the activity of the ameloblast during the first 2 years of the child's life, resulting in chronological dispersed hypomineralized demarcated opacities in the developing teeth.

Enamel hypomineralization of permanent first molars: a morphological study and survey of possible aetiological factors

Review Molar Incisor Hypomineralisation (MIH) is defined as a hypomineralisation of systemic origin of one to four permanent first molars frequently associated with affected incisors. MIH molars are fragile and caries can develop very easily in those molars. Although MIH molars are well known by paediatric dentists and their occurrence is related in severe cases to major clinical problems, only limited data are available of the size of the problem. The prevalence of MIH ranges in the literature from about 3.6 to 25% and seems to differ in certain regions and birth cohorts. Unfortunately more complete comparable valid data are lacking at the moment. It seems that several etiological factors can cause the enamel defects and that their occurrence is child related. Conclusion For children with repeated illnesses in the first years after birth and children with opacities on erupted molars or incisors it seems useful to increase the frequency of dental check-ups during the period of erupting first permanent molars.

http://admin.ejpd.eu/download/2003-03-02.pdf

Molar incisor hypomineralisation (MIH).

AIM: This was to review and assess the studies on aetiology of Molar-Incisor Hypomineralisation (MIH) or, as a proxy, of demarcated opacities in permanent first molars and to consider the potential factors involved with findings obtained in animal experiments. METHODS: A systematic search by Medline® online database was performed. Abstracts behind appropriate titles were studied and finally the full articles were evaluated for their strength of evidence in the aetiology of MIH. RESULTS: From a total of 1,142 articles 28 were identified and selected for review. The selected papers covered medical problems in prenatal, perinatal and postnatal period, medication of the child during the first years of life, and exposure to fluoride or environmental toxicants (dioxins and PCBs) in the early childhood. Based on the assessment of the articles it was still not possible to specifically name those factors causing MIH although correlations between several potential factors and MIH were presented. Among the factors suggested and found to cause enamel defects in animal experiments were: high fever, hypoxia, hypocalcaemia, exposure to antibiotics (amoxicillin, a macrolide), and dioxins. CONCLUSION: Despite increased knowledge on the aetiology of MIH insufficient evidence to verify the causative factors exists. Further studies, especially prospective ones, are needed to improve the level and strength of evidence of the role of the present putative factors and to reveal new factors that may be involved. Any combined effect of several factors should be taken into account. Experimental dose/response studies and research on the molecular mechanisms causing the abnormal function of the ameloblasts are also necessary to deepen our knowledge of MIH.

Aetiology of Molar-Incisor Hypomineralisation: A systematic review.

The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral health and compare the results to those of four cross-sectional studies carried ...

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 40 years (1973-2013). II. Review of clinical and radiographic findings.

In the late seventies an increasing number of children showing extensive and severe idiopathic hypomineralization of the enamel of incisors and permanent first molars was reported within the Public Dental Services in Sweden. An epidemiologic study was initiated to analyze the prevalence, extension and severity in Swedish children born in 1970 and in the years before and after. 2252 children born in 1966–74 were examined according to well defined criteria on enamel hypomineralization. It was found that 15.4% of the children born in 1970 showed such changes. The corresponding figures for children born in 1966, 1969, 1971, 1972 and 1974 were 6.3, 7.3, 7.1, 5.2 and 4.4, respectively.

Epidemiologic study of idiopathic enamel hypomineralization in permanent teeth of Swedish children

Papillon-Lefevre syndrome is an autosomal recessive disorder characterized by palmoplantar hyperkeratosis and early development of aggressive periodontal infection. The aims of this study were to rank the severity of dermatologic and oral affections using a semiquantitative scoring system, and to evaluate whether the severity of the dermatologic changes were correlated to age, degree of periodontal infection, or both. The study included 47 patients with Papillon-Lefevre syndrome. With no exception both skin and oral changes developed early in life. The dermatologic involvement showed no correlation with age, whereas the periodontal infection was significantly worse in young children with deciduous teeth. A strong correlation was found between the condition of feet and hands, although the scores for the feet were significantly higher. No significant correlation could be demonstrated between the level of periodontal infection and severity of skin affections, supporting the concept that these 2 major components of Papillon-Lefevre syndrome are unrelated to each other. (J Am Acad Dermatol 2003;48:345-51.)

Dermatologic and oral findings in a cohort of 47 patients with Papillon-Lefèvre syndrome.

During the 1970s dentists reported an increasing prevalence of a "new" type of enamel disturbance. The disturbance was very specific, with areas of demarcated hypomineralised enamel, and was mostly ...

Aetiology of severe demarcated enamel opacities--an evaluation based on prospective medical and social data from 17,000 children.

Periodontal health in relation to systemic retinoid medication was evaluated retrospectively in patients with Papillon-Lefevre Syndrome (PLS). The material consisted of 18 children/young adults ranging from 8 to 28 years of age, all with a confirmed diagnosis of PLS. 9 participants, comprising a medication group, had been on long-term (range 1.5-9 years) retinoid medication for their cutaneous lesions. The remaining 9 served as controls. Regardless of whether or not retinoid medication was received, every patient experienced an early and devastating periodontitis, with atypical edematous and erythematous gingiva, suppuration from deep gingival pockets and premature loss of teeth. No correlation could be found between the severity of skin involvement and the severity of periodontal involvement. An improvement with age could be seen for the cutaneous lesions but not for the periodontal condition. Systemic medication with retinoids had a favorable therapeutic effect on cutaneous lesions, and no severe complication/side effect could be seen after several years of continuous use. However, from the results of this study it can be concluded that, at least in a situation with poor compliance of daily oral home-care, no positive effect on the periodontal health in patients with PLS could be seen by the retinoid medication.

Christer Ullbro

Papers

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 40 years (1973-2013). II. Review of clinical and radiographic findings.

Epidemiologic study of idiopathic enamel hypomineralization in permanent teeth of Swedish children

Dermatologic and oral findings in a cohort of 47 patients with Papillon-Lefèvre syndrome.

Aetiology of severe demarcated enamel opacities--an evaluation based on prospective medical and social data from 17,000 children.

Systemic retinoid medication and periodontal health in patients with Papillon‐Lefèvre syndrome