What is MIH?
MIH is a tooth condition that affects the enamel (hard outer layer) of the tooth. It usually presents as white opaque, yellow or even brown lesions and commonly affect the adult incisors (front teeth) and molars (back teeth). In severe cases the teeth can break down and cavities can form. Teeth affected by MIH tend to be sensitive and it is often difficult to get anaesthesia with a local anaesthetic for dental treatment.
MIH is not usually noticed until the adult incisors or molars come into the mouth around age 6-7 years. However it can sometimes affect the back baby molar teeth and in these cases can be seen in the mouth from 2-3 years of age upwards.
What causes MIH?
It is thought to be caused by a disturbance in tooth development around the time of birth or in the first few years of life. The cells that secrete the enamel (the ameloblasts) are very sensitive to:
Changes in temperature (e.g. fever)
Changes in pH (due to diet, illness or medication)
Pollution, etc.
The cause of it is not fully understood although severe childhood illnesses, high fevers, or a traumatic birth period have all been suggested as possible causes.
What are the signs and symptoms of MIH?
You or your child may have noticed that their front and/or back teeth may be discoloured and appear cream, yellow or brown. Also, their teeth may be painful or sensitive, and even crumbly.
See photographs below showing the signs of MIH.
Are any tests needed to confirm the diagnosis?
See your dentist for a full examination. He/she may take X-rays if necessary. Your dentist might also ask about your child’s medical and family history to attempt to highlight possible causes and rule out any other causes of enamel problems.
What happens if I do not get treatment?
If your child’s teeth are sensitive and broken down it is likely that treatment would be of benefit. Without treatment this breakdown can continue to get worse, which could lead to more pain, sensitivity and possible nerve involvement. This could ultimately lead to abscess formation and subsequent removal of the tooth.
What treatments are available for my child?
There are different types of treatment for different types of teeth. Your dentist will discuss these options in more detail and help you and your child decide the best option.
Mild forms of MIH can usually be treated with fluoride toothpastes or mouth rinses or with topical application of fluoride by your dentist.
In more severe cases where sensitivity, discolouration or breakdown is a problem the following treatments may be suggested by your dentist depending on the extend of the problem.
Front teeth
The front teeth are treated to improve sensitivity and poor appearance, and to improve surface roughness or breakdown. There are different treatment options depending on the type and extent of the defect. These treatments include:
fluoride varnish to decrease sensitivity.
micro abrasion to remove the outer layer of tooth enamel to improve the appearance and smoothness of the tooth.
resin infiltration: This method uses resin filling material without using the dental drill to fill the defects and improve the appearance of the teeth
tooth whitening to blend the discolouration to the colour of the unaffected teeth. (This can cause temporary sensitivity. Tooth whitening is not used in under 18 year olds.)
white resin filling: a thin layer of white filling is added over the front of the tooth (usually with little or no drilling) but will make the tooth thicker. This will fill any areas of breakdown as well as masking the discolouration. This filling will need maintaining over time by your dentist.
Back teeth
Like front teeth, back teeth can be sensitive. We also have to consider how decayed or broken down the teeth are and whether they are likely to last in the long term. The treatments of MIH on back teeth are:
Fissure sealant: covers and protects the natural grooves in a mildly affected tooth.
Glass ionomer filling: a filling is placed with little or no drilling, which will reduce sensitivity and protect the tooth. This filling will need future maintenance by your dentist.
White resin filling: a white filling is placed after local anaesthesia and drilling away of the affected area of the tooth.
Stainless steel crown: a silver-coloured metal tooth-shaped cap which is recommended for a more decayed or broken down tooth.
Tooth removal: if the tooth is of poor quality it may need to be taken out. Done at the right time, this can allow other adult teeth to move into the gaps.
Affected teeth may receive some of the treatments above, in order to provide relief from sensitivity and further breakdown, and allow for growth and development of the remaining adult teeth, before they need to be removed.
Kindly contact TinySmile Dentistry in the east of Pretoria on: 063 639 7839 or info@tinysmile.co.za for an evaluation if you suspect that your child may be suffering from MIH so that Dr Helét can provide the right treatment option for you.
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