MIH

Question 2

What is molar incisor hypomineralisation?

Answer 2

Hypo-mineralisation of systemic origin of 1-4 permanent molars frequently associated with affected incisors

Question 3

How would you describe teeth affected by MIH?

Answer 3

• Hypomineralised
• Hypoplastic

Question 4

Define hypomineralised?

Answer 4

Disturbance of enamel formation resulting in a reduced mineral content

Question 5

Define hypoplastic?

Answer 5

reduced bulk or thickness of enamel

Question 6

What is increased in the pulp horn in hypominarlised enamel?

Answer 6

• Significant increases in neural density in the pulp horn and subodontoblastic region - more sensitive to neural stimuli
• Increases in immune cell accumulation - more inflammation
• Significant increase in vascularity - more blood supply meaning more responsive to pain

Question 7

3 ways of pain mechanisms related to MIH?

Answer 7

• Dentine hypersensitivity
• Peripheral sensitisation
• Central sensitisation

Question 8

Explain Dentine hypersensitivity in MIH?

Answer 8

Porous enamel or exposed dentine facilitates fluid flow within dentine tubules to activate A delta fibres (hydrodynamic theory)

Question 9

Explain peripheral sensitisation in MIH?

Answer 9

underlying pulpal inflammation leads to sensitisations of C-fibres

Question 10

Explain central sensitisation in MIH?

Answer 10

from continued nociceptive input

Question 11

How would you describe MIH lesions?

Answer 11

Demarcated

Question 12

4 reasons why it is difficult to determine the aetiology of MIH?

Answer 12

• most parents cannot remember what happened before 10 years
• Unclear diagnostic criteria
• Study populations are small

Question 13

What is the agreed critical period that may affect the aetiology of MIH and why?

Answer 13

• First year of life
• Enamel matrix of crown of FPM is complete by one year

Question 14

What 3 periods you need to enquire about for MIH?

Answer 14

• Pre-natal
• Natal
• Post-natal

Question 15

What would you ask mother about prenatal period?

Answer 15

• General health in 3rd trimester for example Pre-eclampsia or gestational diabetes

Question 16

What 3 things would you ask mother about in perinatal period?

Answer 16

• Birth trauma or anoxia
• Hypocalcaemia
• Pre term birth

Question 17

What 5 things you would ask mother about in postnatal period?

Answer 17

• Prolonged breast feeding - Dioxins in breast milk
• Fever and medications (childhood infections)
• Socioeconomic status

Question 18

3 childhood infections that may contribute to MIH?

Answer 18

• Measles
• Rubella
• Chicken pox

Question 19

What is the incubation period of measles

Answer 19

10-14 days
Duration of illness 7-10 days

Question 20

4 symptoms of measles?

Answer 20

• Fever
• Rash
• Koplik’s spots
• Cough

Question 21

How may the secondary infection of measles present? (4)

Answer 21

• Otitis media
• Bronchopeumonia
• Stomatitis
• Corneal ulcers

Question 22

Duration of rubella?

Answer 22

8-10 days

Question 23

4 Signs/Symptoms of rubella?

Answer 23

• Mild fever
• Rash
• Malaise
• Arthritis

Question 24

Duration of illness in chicken pox?

Answer 24

6-10 days

Question 25

3 signs and symptoms of chicken pox?

Answer 25

* Low grade fever * Rash * Crops of spots progressing from macule-papule then vesicle

Question 26

According to fagrell et al. What three things increased the odds of SDO (severe demarcated opacities) in MIH?

Answer 26

* Breast feeding more than 6 months * Gruel late into of more than 6 months * Late introduction of infant formula of more than 6 months

Question 27

According to Balmar al , what was the aetiology of MIH?

Answer 27

* Prevalence of 15.9% * Associated with first 4 deprivation quintiles * no difference between fluoridated and non fluoridated areas

Question 28

3 clinical problems associated with MIH?

Answer 28

* Loss of tooth substance - breakdown of enamel, toothwear, secondary caries * Sensitivity * Appearance

Question 29

4 treatment options for MIH?

Answer 29

* Composite and GIC restorations * Stainless steel crowns * Adhesively retained copings * XLA between 8.5 and 9.5 yrs