MIH

Question 1

What is the prevalence of Molar-Incisor Enamel Hypomineralization?

Answer 1

2.8-40% of children
(1 in 6 Worldwide)

Question 2

What is the most common enamel defect?

Answer 2

Molar-Incisor Enamel Hypomineralization

Question 3

What are potential causes of MIH?

Answer 3

Pre-natal - UTI

Peri-natal - Premature birth, Hypoxia, C-section

Post-natal- early Amoxicillin, childhood illness (Chicken Pox)

Question 4

T/F- MIH commonly affects all surfaces of affected teeth

Answer 4

False - tends to affect OB surfaces, not M/D

Question 5

MIH Diagnostic Criteria?

Answer 5

1+ permanent molars affected
Demarcated Opacities
Tooth Sensitivity
Enamel pits

Question 6

MIH Treatment Options?

Answer 6

Minor sensitivity → Toothpaste, Fluoride Varnish, CPP-ACP Calcium phosphate
Moderate sensitivity → Restorative

Question 7

How can anterior teeth with MIH be treated?

Answer 7

Etch, bleach (10-38% carbamide peroxide

Question 8

What are some MIH mimics?

Answer 8

Fluorosis
Amelogenesis imperfecta
Traumatic Hypomineralization

Question 9

What is the main problem with hypomineralized enamel?

Answer 9

Poor pulpal insulator leading to sensitivity

Question 10

In MIH and Medical history, what is important to ask?

Answer 10

Early childhood illness, antibiotic use in first 12-24months of life

Question 11

Patients who had early childhood illness such as ear infections are more likely to have MIH by how much?

Answer 11

2x as likely to have MIH

Question 12

From a developmental standpoint, which stage of development does MIH affect?

Answer 12

The Apposition phase (Maybe ameloblasts never developed)

Question 13

What are treatment strategies for MIH?

Answer 13

Prevention (early mixed)

Adhesive & Sealants (late mixed)

Restoration or crown (permanent)

Question 14

By age 9, patients with MIH are _____ more likely to need treatment for their molars

Answer 14

10x more likely

Question 15

Why are MIH teeth more sensitive?

Answer 15

1) Increased nerve density
2) Increased vascularity

Question 16

Treatment options for difficulty with Anesthesia

Answer 16

Articaine infiltration as adjunct to nerve block

In office sedation, or GA

Question 17

What are the goals with early occlusal coverage for MIH patients?

Answer 17

Protect from future tooth loss
Protect against caries
Alleviate sensitivity

Question 18

Preventative Strategies for MIH?

Answer 18

Immature teeth → MI Paste (unless milk allergy)/ Calcium Phosphate

Sensitive teeth → Fluoride Varnish

Question 19

How can you improve bond strength in MIH patients?

Answer 19

5.25% NaOCL before bonding (remove surface proteins of poorly matured enamel)

Question 20

Should you use amalgams in MIH patients?

Answer 20

No - not adhesive & poor insulator (metal) & doesn’t protect against PEB

Question 21

What is the Palmetto Technique?

Answer 21

Keep marginal integrity: Molar Band + RMGI + composite

Question 22

Options for Treatment of MIH anterior teeth:

Answer 22

1) Etch, Bleach, Re-etch & Seal (5% NaOCL)

2) Carbamide Peroxide Bleaching

3) Microbrasion 18% HCL + 37%HP3O4 + abrasive paste

Question 23

When is extraction viable for MIH?

Answer 23

When all else fails, in between 9-11 years of age.

Question 24

What is SMART Technique?

Answer 24

Silver Modified Atraumatic Restorative Technique
SDF + 2) GIC on top in single visit

Question 25

What is the advantage of GC Equia Forte?

Answer 25

*polyacid modified resin composites (PMRC)* Stronger than traditional GI, has F- release

Question 26

Key findings for MIH(4):

Answer 26

Well-demarcated radiopacity Cream, yellow, or brown 1+ molar affected Post-eruptive breakdown

Question 27

What is D3?

Answer 27

3 Developmental Dental Defects: - Fluorosis - Enamel Hypoplasia (low quantity) - Amelogenesis Imperfecta

Question 28

Is there a known cause of MIH?

Answer 28

NO. Suspect Systemic Illness or treatment during infancy.

Question 29

What are the 3 big problems with MIH?

Answer 29

1) Increased Sensitivity 2) Increased Caries Risk 3) Poor anterior Aesthetics

Question 30

Clinical problems with MIH

Answer 30

1) Sensitive Teeth 2) Pain & Behaviour management 3) Restorative challenge

Question 31

What is the best long term restorative option for MIH molars?

Answer 31

SSC or Resin Composite (if limited involvement)

Question 32

Messer's MIH severity index is based on?

Answer 32

1) Extent of Hypomineralization 2) Sensitivity 3) Number of restorations per FPM

Question 33

Messer's MIH severity index is proposed to range from

Answer 33

1.25 - 7.00 (OG) or 1.25-10.00 (include PEB & Atypical restos)