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MIH Flashcards

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1
Q

What does MIH stand for in dental terminology?

A

Molar Incisor Hypomineralization

MIH is defined as hypomineralization of systemic origins presenting as demarcated qualitative defects of enamel.

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2
Q

Define hypomineralised enamel.

A

Disturbance of enamel formation resulting in reduced mineral content

Hypomineralised enamel has normal thickness but reduced mineral content, making it soft and porous.

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3
Q

What is the difference between hypomineralised and hypoplastic enamel?

A
  • Hypomineralised: Reduced mineral content with normal thickness
  • Hypoplastic: Reduced bulk or thickness of enamel, enamel never forms

Hypoplastic enamel is quantitatively defective due to incomplete enamel formation.

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4
Q

What are the clinical presentations of MIH?

A

Demarcated defects in first permanent molars, may or may not include incisors

MIH refers to qualitative defects in enamel.

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5
Q

List some reasons why it is important to recognize MIH.

A
  • Aesthetic concerns
  • Dental anxiety
  • Post eruptive breakdown
  • Hypersensitivity
  • Difficult anaesthesia
  • Increased caries risk
  • Compromised bonding for restoration
  • Early diagnosis for preventive strategies

Recognizing MIH can help in managing its complications effectively.

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6
Q

What are some aetiological factors associated with MIH?

A
  • Perinatal: Neonatal diseases, respiratory issues, low birth weight
  • Postnatal: Early childhood illness
  • Genetic: AMELX gene
  • Environmental: BPA, dioxins, pollutants

The aetiology of MIH is multifactorial, involving systemic and genetic factors.

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7
Q

True or false: Hypomineralised enamel is characterized by reduced thickness.

A

FALSE

Hypomineralised enamel has normal thickness but reduced mineral content.

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8
Q

What is a common characteristic of soft enamel?

A

It crumbles away

Soft enamel is a result of hypomineralization.

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9
Q

Fill in the blank: MIH is frequently associated with affected _______.

A

incisors

MIH may present with defects in both molars and incisors.

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10
Q
A
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11
Q

What is the first phase of enamel formation?

A

Initiation and matrix formation

Enamel is produced by ameloblasts from the inner enamel epithelium.

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12
Q

What do ameloblasts secrete during enamel formation?

A
  • Amelogenin
  • Enamelin

These secretions form the enamel matrix.

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13
Q

What occurs during the mineralization phase of enamel formation?

A

Calcium and phosphate crystals form hydroxyapatite

The matrix starts mineralizing but is not fully matured.

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14
Q

What is the maturation phase in enamel formation characterized by?

A

Ameloblasts remove proteins and water

This allows for full mineralization of enamel, which is 96% mineral.

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15
Q

What is the result of hypomineralization during enamel formation?

A
  • Hypoplastic enamel
  • Disruption in matrix formation

Ameloblasts fail to produce enough enamel matrix, leading to pits, grooves, and missing areas.

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16
Q

What happens during the disruption of the mineralization phase?

A

Enamel does not get enough minerals

This results in white, yellow, or brown spots and makes enamel prone to breakdown.

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17
Q

What is the impact of disruption during the maturation phase?

A

Some proteins remain, preventing full maturation

Enamel appears normal but is softer, less resilient, and prone to rapid wear and sensitivity.

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18
Q

What is the mineral density of enamel histology?

A

Lower mineral density

This is characterized by a reduced Ca: P ratio.

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19
Q

What is the Ca: P ratio in enamel histology?

A

Reduced Ca: P ratio

This contributes to lower mineral density.

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20
Q

What is the micorhardness of enamel histology?

A

Lower micorhardness

This indicates a decrease in the hardness of the enamel.

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21
Q

What is the fracture toughness of enamel histology?

A

Reduced fracture toughness

This affects the enamel’s ability to resist crack propagation.

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22
Q

What is retained within enamel that affects its histology?

A

Retained organic matrix

Increased levels of retained amelogenin and organic matrix proteins are observed.

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23
Q

What is the structure of enamel histology characterized by?

A

Disorganized structure and increased porosity

This leads to surface roughness and subsurface porosities.

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24
Q

What is the surface roughness in enamel histology?

A

Surface roughness and subsurface porosities

These features contribute to the overall texture of the enamel.

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25
What is the **fluoride uptake** in enamel histology?
Reduced fluoride uptake ## Footnote This can affect the enamel's resistance to decay.
26
What is the **DEJ** in dentine histology characterized by?
Irregular DEJ ## Footnote This results in reduced adhesion between enamel and dentine.
27
What is the structure of dentine histology characterized by?
Disorganized structure ## Footnote This includes increased tubular density and widening of tubules.
28
What is the **surface roughness** in dentine histology?
Surface roughness and subsurface porosities ## Footnote These features are similar to those observed in enamel.
29
What is the **fluoride uptake** in dentine histology?
Reduced fluoride uptake ## Footnote This can similarly affect the dentine's resistance to decay.
30
What is the **mineral density** of dentine histology?
Lower mineral density ## Footnote This is also characterized by a reduced Ca: P ratio.
31
What is the **Ca: P ratio** in dentine histology?
Reduced Ca: P ratio ## Footnote This indicates a decrease in mineral content.
32
What is the **micorhardness** of dentine histology?
Lower micorhardness ## Footnote This indicates a decrease in the hardness of the dentine.
33
34
What is the **severity level** for mild enamel opacities?
* Demarcated enamel opacities without enamel breakdown * Induced sensitivity to external stimuli (e.g., air/water) but not brushing * Mild aesthetic concerns on discoloration of the incisors ## Footnote Mild severity indicates minimal impact on function and aesthetics.
35
What are the characteristics of **severe enamel opacities**?
* Demarcated enamel opacities with breakdown and caries * Spontaneous and persistent hypersensitivity affecting function (e.g., brushing, mastication) * Strong aesthetic concerns that may have socio-psychological impact ## Footnote Severe severity indicates significant impact on both function and aesthetics.
36
What is **Molar Incisor Hypomineralisation (MIH)**?
Hypomineralisation of systemic origins of one or more first permanent molars and associated incisors ## Footnote MIH presents as demarcated defects in first permanent molars, which may or may not be associated with defects in incisor teeth.
37
What are the **stages of enamel formation**?
* Ameloblast retreat from ADJ * Secretion of matrix proteins for initial mineralization * Translation phase for full mineralization ## Footnote Initial mineralization reaches about 20%, while maturation stage allows full mineralization to 99%.
38
What are the types of **enamel defects** classification?
* Systemic * Environmental * Genetic * Local ## Footnote Examples include MIH, fluorosis, and amelogenesis imperfecta.
39
What are the **characteristics of demarcated enamel defects**?
* Distinct, clear boundary * Yellow, white, or brown color ## Footnote These defects are often indicative of hypomineralisation.
40
What are the **timing of damage** stages in enamel formation?
* Hypoplastic * Hypomineralization ## Footnote Damage can occur during the laying down of the enamel matrix or during calcification and maturation stages.
41
What are the **aesthetic concerns** associated with MIH?
* Dental anxiety * Post eruptive breakdown * Hypersensitivity * Compromised bonding for restoration ## Footnote These concerns highlight the importance of early diagnosis and preventive strategies.
42
What are the **affected teeth** in MIH?
* First permanent molars * Incisors * Sometimes canines ## Footnote These teeth are most commonly impacted by hypomineralisation.
43
What factors should be considered in **treatment planning** for MIH?
* Patient's age * Medical history * Ability to cooperate * Access to dental care * Number of teeth affected ## Footnote These factors influence the approach to treatment and management.
44
What are the **restorative options** for treating MIH?
* Fissure sealants * Composite * Stainless steel crowns (SSC) * Onlays ## Footnote The choice of restoration depends on the severity and extent of the defects.
45
What is the role of **Tooth Mousse** in MIH treatment?
* Enhances remineralization * Reduces sensitivity * Prevents early caries management ## Footnote Contains casein phosphopeptides and amorphous calcium phosphate.
46
What are the **indications for using GIC Fuji Triage**?
* Temporary protection for affected molars * Preventative for high-risk teeth * Sealant for partially erupted molars ## Footnote GIC is moisture tolerant and ideal for high-risk patients.
47
What are the **characteristics of composite restorations**?
* Aesthetic tooth-colored * Risk of marginal leakage * Good wear resistance ## Footnote Best for mild to moderate MIH lesions with sufficient unaffected enamel.
48
What is the **treatment of choice** for extensive defects in MIH?
Stainless steel crowns (SSC) ## Footnote SSCs provide effective protection and prevent further deterioration.
49
What are the **non-invasive treatments** for MIH?
* Topical fluoride * Resin infiltration * Vital bleaching ## Footnote These treatments aim to enhance remineralization and improve aesthetics.
50
What are the **psychosocial impacts** of MIH?
* Visible aesthetic defects affecting self-esteem * Parental concern and treatment expectation ## Footnote These impacts can lead to increased dental anxiety in affected individuals.
51
True or false: **Mesial movement of 7s** is encouraged if 6s are extracted due to poor prognosis.
TRUE ## Footnote This strategy aims to replace the 6s with 7s, which are less likely to be affected by MIH.
52
What is a **composite onlay**?
A type of dental restoration used for aesthetic purposes ## Footnote It is designed to improve adaptation and durability.
53
What are the two types of **appliance** in relation to composite onlays?
* Direct - immediate placement * Indirect - improved adaptation and durability ## Footnote Direct onlays are placed immediately, while indirect ones are crafted outside the mouth for better fit.
54
When is a composite onlay indicated?
* Moderate MIG cases * Surface intact enamel and tooth structure * Full coverage restoration not required ## Footnote These criteria help determine the suitability of a composite onlay.
55
What is the long-term aesthetic alternative to **stainless steel crowns (SSC)** in older patients?
Composite onlay ## Footnote It provides a more aesthetic solution for dental restorations.
56
What should be included in the **informed consent** process?
* Discuss all possible options * Opinions and values of the child, parents, and guardian * Capacity of the child to accept treatment/intervention ## Footnote The plan may change significantly if a general anaesthetic is required.
57
True or false: Parents may prefer to lose a tooth rather than keep it.
TRUE ## Footnote This highlights the importance of discussing options and preferences during treatment planning.
58
What is the **impact of MIH** on oral health and patient experience?
* Increased caries risk * Sensitivity * Restorative and orthodontic challenges * Psychosocial effects ## Footnote MIH leads to porous and weak enamel, increasing susceptibility to caries and causing discomfort that affects eating and oral hygiene.
59
How does **hypomineralised enamel** affect caries risk?
Increased susceptibility to caries ## Footnote Hypomineralised enamel is porous and weak, leading to post-eruptive breakdown that exposes dentine and accelerates decay.
60
What are the **sensitivities** associated with MIH?
* Severe discomfort * Difficulties with eating and drinking * Challenges in maintaining oral hygiene ## Footnote Sensitivity can complicate dental treatment, making it difficult to anaesthetise affected molars.
61
What are the **restorative and orthodontic challenges** posed by MIH?
* Increased treatment need * High failure rate of restorative procedures * Possible need for preformed metal crowns or extraction * Orthodontic implications if first permanent molar extraction is required ## Footnote Reduced enamel quality leads to complications in achieving successful restorations.
62
How can **psychosocial effects** of MIH impact a patient?
* Affects self-esteem * Negative dental experiences due to sensitivity * Multiple treatments required ## Footnote Discolored incisors can lead to a decrease in self-esteem and negative perceptions of dental care.
63
What is **molar incisor hypomineralisation (MIH)**?
Hypomineralisation of systemic origin affecting one or more first permanent molars, often with associated incisors, presenting as demarcated opacities. ## Footnote MIH is characterized by enamel defects that can lead to various dental issues.
64
Which teeth are affected in **MIH**?
* First permanent molars * Permanent incisors ## Footnote These teeth are commonly affected due to their developmental timing.
65
During which stage does **MIH** occur?
Maturation stage of enamel formation. ## Footnote This stage is critical for the quality of enamel.
66
What is the difference between **hypoplasia** and **hypomineralisation**?
* Hypoplasia: reduced enamel thickness (secretory stage defect) * Hypomineralisation: normal thickness but poor quality enamel (maturation stage defect) ## Footnote Understanding these differences is essential for diagnosis.
67
What is the role of **ameloblasts**?
* Secrete enamel matrix * Initiate mineralisation * Remove organic material during maturation ## Footnote Ameloblasts are crucial for proper enamel formation.
68
What percentage is enamel initially **mineralised**?
~20%. ## Footnote This low percentage increases significantly during the maturation stage.
69
What happens during the **maturation stage**?
Removal of proteins and water, allowing mineral content to increase to ~96–99%. ## Footnote This stage is vital for achieving strong enamel.
70
What is the difference between **demarcated** and **diffuse defects**?
* Demarcated: well-defined borders * Diffuse: poorly defined, patchy ## Footnote This distinction helps in identifying the type of enamel defect.
71
How do **hypoplastic defects** present?
* Pits * Grooves * Reduced enamel thickness ## Footnote These features are indicative of enamel development issues.
72
Give one **systemic** and one **local cause** of enamel defects.
* Systemic: fluorosis * Local: trauma ## Footnote Both causes can lead to significant enamel defects.
73
What is the **critical period** for MIH development?
Birth to ~2–3 years. ## Footnote This period is crucial for the development of permanent molars.
74
Give two **risk factors** for MIH.
* Prenatal: maternal illness * Postnatal: early childhood illness ## Footnote These factors can increase the likelihood of MIH.
75
Why are **second permanent molars** usually unaffected?
They develop later (3–4 years), outside the critical period. ## Footnote This timing protects them from the same risks affecting first molars.
76
What **colours** are seen in MIH?
* White * Yellow * Brown opacities ## Footnote The colour indicates the severity of hypomineralisation.
77
What does a **brown lesion** indicate?
More severe hypomineralisation with weaker enamel. ## Footnote This can lead to increased dental issues.
78
What is **post-eruptive breakdown (PEB)**?
Breakdown of enamel after eruption due to functional forces. ## Footnote PEB can complicate the management of MIH.
79
Why is **caries risk** increased in MIH?
Porous enamel and increased plaque retention. ## Footnote These factors make teeth more susceptible to decay.
80
Why is **anaesthesia** difficult in MIH teeth?
Chronic pulpal inflammation reduces effectiveness. ## Footnote This can complicate dental procedures.
81
Name two **patient** and two **tooth factors**.
* Patient: age, cooperation * Tooth: severity, number of surfaces affected ## Footnote These factors influence treatment planning.
82
Why is **early diagnosis** important?
Allows preventive management and reduces complications. ## Footnote Early intervention can significantly improve outcomes.
83
What is the treatment for **severely affected molars**?
* Stainless steel crowns * Extraction ## Footnote These options help manage severe cases effectively.
84
When should **FPMs** be extracted?
Poor prognosis, extensive breakdown, symptoms. ## Footnote Extraction may be necessary for non-viable teeth.
85
What is the ideal **extraction timing** for lower FPMs?
8–9 years. ## Footnote Timing is crucial for optimal outcomes.
86
Why is **mesial drift** important?
Allows second permanent molars to move into the space. ## Footnote This natural movement can aid in dental alignment.
87
Should opposing **FPMs** be routinely extracted?
No, only if there is a clear occlusal indication. ## Footnote Unnecessary extractions can lead to complications.
88
What does **Tooth Mousse** do?
Promotes remineralisation and reduces sensitivity. ## Footnote It is beneficial for managing enamel defects.
89
What is a **contraindication** for Tooth Mousse?
Milk protein allergy. ## Footnote Patients with this allergy should avoid the product.
90
Why is **GIC** useful?
Fluoride release and moisture tolerance. ## Footnote These properties make it effective in dental treatments.
91
When are **fissure sealants** used?
Intact enamel, no sensitivity, no caries. ## Footnote Sealants help prevent decay in at-risk teeth.
92
When is **composite** used?
Mild–moderate defects with good enamel margins. ## Footnote Composite restorations are versatile for various defects.
93
Why is **bonding** difficult in MIH?
Porous, protein-rich enamel. ## Footnote This can complicate restorative procedures.
94
Give one **advantage** and one **disadvantage** of SSCs.
* Advantage: protects tooth * Disadvantage: poor aesthetics ## Footnote These factors must be considered in treatment planning.
95
What are the main concerns in **incisors**?
* Aesthetics * Sensitivity ## Footnote These concerns are critical for patient satisfaction.
96
Name two **non-invasive treatments**.
* Fluoride * CPP-ACP (Tooth Mousse) ## Footnote These treatments can help manage early enamel defects.
97
Why is **microabrasion** limited?
It only removes superficial defects. ## Footnote Deeper defects may require more invasive treatments.
98
Why is **vital bleaching** not commonly used <18 in the UK?
Not licensed for under 18s. ## Footnote This regulation is in place for patient safety.
99
Why are **radiographs** not reliable for MIH?
They do not show enamel quality well. ## Footnote This limitation affects diagnosis and treatment planning.
100
What radiographic sign helps with **extraction timing**?
Bifurcation mineralisation of second permanent molars. ## Footnote This sign indicates the readiness for extraction.
101
What **occlusal factor** is important before extraction?
Presence and position of second and third molars. ## Footnote These factors can influence the extraction process.
102
Which teeth are primarily affected in Molar Incisor Hypomineralisation (MIH)? (select one answer) Primary molars and incisors First permanent molars and incisors Second permanent molars and incisors Primary canines and second molars
First permanent molars and incisors
103
What are the clinical features of MIH? (Select one answer) Enamel is normal thickness but discolored Enamel is poorly mineralised with opacities Enamel is thin but hard Enamel is grey and translucent
Enamel is poorly mineralised with opacities
104
Which of the following is the most common clinical problem associated with molar incisor hypomineralisation (MIH)? (Select one answer) Hypersensitivity to thermal stimuli Increased risk of periodontal disease Associated with systemic enamel hypoplasia Delayed eruption of first permanent molars
Hypersensitivity to thermal stimuli
105
Which of the following is considered an aetiological factor associated with molar incisor hypomineralisation (MIH)? (Select one answer) High sugar intake during the first year of life Localised trauma to primary teeth Excessive fluoride intake Early childhood illness
Early childhood illness
106
A 10 year old child attends with hypomineralised first permanent molars. Which of the following radiographic findings on their OPG may affect your decision whether to restore or extract their hypomineralised first permanent molars (FPMs)? (select one answer) The degree of pulp chamber calcification in the first permanent molars The degree of resorption of the primary canines The presence of upper anterior spacing Presence of developing third molars
Presence of developing third molars
107
A 9 year old child presents with well-demarcated white opacities on the maxillary permanent central incisors (see image below). The teeth are asymptomatic and intact, but the appearance is a cosmetic concern to the child and parent. Which of the following is the most appropriate first-line management option? (Select one answer) Silver diamine fluoride (SDF) Microabrasion Resin infiltration Full coverage composite veneers
Resin infiltration
108
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