Molar incisor hypomineralization (also known as MIH) is a developmental disorder of the teeth. However, when it comes to the cause, doctors are puzzled; no actual reasons have been found as to why molar incisor hypomineralization occurs.
What is molar incisor hypomineralization?
Molar incisor hypomineralization is a new phenomenon that can occur in the first permanent molars or incisors. In a few cases, the canines are also affected by molar incisor hypomineralization. See nonprofitdictionary for Keel Chest (abbreviated as KC).
The doctor finds yellowish-brownish defects or discolouration in the tooth enamel on the affected teeth; the teeth subsequently become temperature-sensitive, so that those affected report pain.
Children who suffer from molar incisor hypomineralization have less enamel than those children who have healthy teeth. It is not known why molar incisor hypomineralization occurs. Doctors suspect that sometimes several factors are decisive for the new phenomenon.
Possible causes and factors are, for example, infectious diseases such as inflammation of the middle ear, pneumonia, chickenpox or feverish infections, bisphenol A (so-called softener, which can also be found in pacifiers and drinking bottles), nutrient deficiencies ( e.g. calcium deficiency in children), dioxins in breast milk or hereditary factors.
Symptoms, Ailments & Signs
As part of the molar incisor hypomineralization, the doctor observes defects in the enamel that can occur in the molars, incisors or canines. The affected teeth discolour yellow-brownish or creamy-whitish. Due to the load on the teeth (e.g. when chewing), it is possible that parts of the tooth enamel can break off or flake off.
In many cases, the affected teeth are also very porous. Subsequently, those affected complain about an extreme temperature sensitivity of their teeth, so that the so-called hot-cold change can cause severe pain. Mechanical stimuli can also cause pain. Subsequently, those affected complain of pain when cleaning their teeth.
Diagnosis & course of disease
The doctor recognizes the molar incisor hypomineralization during the dental examination. The discoloration is a first clue; very soft or porous tooth enamel is another indication that molar incisor hypomineralization is present.
Molar incisor hypomineralization already occurs when the affected teeth are erupted. How quickly the defects progress or how intense the pain and symptoms are depends on the individual form of molar incisor hypomineralization.
If the molar incisor hypomineralization is not treated by a dentist, the damage to the enamel increases, resulting in tooth decay. This means that the tooth structure suffers further damage. A circumstance that is sometimes also promoted because those affected – because they have pain in the context of dental care – neglect their teeth cleaning and refuse to “brush their teeth”.
However, if molar incisor hypomineralization is discovered in the early stages, regular and very close checks can mean that new enamel defects can be identified and treated relatively quickly.
The molar incisor hypomineralization primarily causes problems in the patient’s teeth. This can lead to various defects or malformations in the oral cavity, so that those affected experience pain when taking food or liquids. Furthermore, the teeth are often yellow or brown in color, resulting in reduced aesthetics.
Those affected do not feel comfortable with this coloring and can suffer from inferiority complexes or reduced self-esteem. The teeth break off more often, so the patients suffer from a reduced quality of life. Cold or heat can also cause pain or other unpleasant feelings. Taking care of your teeth is often associated with pain.
As a rule, early treatment is necessary for molar incisor hypomineralization so that consequential damage does not occur in adulthood. Various interventions are necessary to care for the teeth and protect them from external influences. As a rule, no special complications arise. In many cases, the teeth have to be replaced with implants. The life expectancy of the affected person is not affected or reduced by the molar incisor hypomineralization.
When should you go to the doctor?
If irregularities in the growth of the teeth are noticed, a doctor should be consulted. Pain, discomfort or an increasing feeling of pressure indicate health problems of the person concerned, which should be examined and treated. If the existing symptoms gradually increase in intensity, there is a need for action. Children who are in the growth phase of their second teeth are primarily affected by molar incisor hypomineralization. Enamel changes, tooth discoloration, and tooth chipping are uncommon and should be seen by a doctor. If you experience pain while brushing your teeth, loss of appetite or weight loss, you need to see a doctor.
Complaints with a change of food in hot and cold temperature indicate discrepancies. They should be examined in a timely manner, before there is a further deterioration in health. If the child suffers from a headache, refuses to eat at all, or has trouble concentrating, consult a doctor. Learning problems, deficits in attention, behavioral problems and sleep disturbances are further signs of an existing discrepancy. A visit to the doctor is advisable as soon as the symptoms persist for several weeks. Withdrawal from participation in social life, profuse crying, mood swings, exhaustion and apathy should be discussed with a doctor.
Treatment & Therapy
In addition to treating the tooth damage that has occurred and the symptoms, there are other methods available to treat molar incisor hypomineralization. However, there is no uniform therapy or treatment recommendation, so that the doctor has to create individual treatment plans – depending on the severity of the molar incisor hypomineralization.
It is important that treatment is given early. This is the only way to protect the teeth from even worse damage. This means that regular check-ups are important. This is the only way that newly occurring damage is not only recognized quickly, but also treated immediately. One possibility is fluoridation.
The doctor can treat the hot-cold sensitivity of the teeth and make the affected teeth less sensitive to pain. Besides, the sufferer should use a toothpaste with high fluoride content and also use fluoridated mouthwashes.
A very mild form of molar incisor hypomineralization can be treated with fissure sealing. The doctor seals the resulting fissures; the depressions that have appeared in the chewing surfaces can be closed with a special material. This can prevent any caries bacteria from settling in.
The doctor can also treat any tooth defects with tooth fillings. It is important that consideration is given to those affected; such treatments can be painful, so the tooth fillings should only be placed under local anesthesia. It is important that the dentist prevents any painful treatments, otherwise the person concerned will develop “dental anxiety”. This could mean that he does not perceive further treatments and therapies, which leads to an enormous deterioration of the teeth.
Dental crowns are another treatment option for molar incisor hypomineralization. However, the method is only possible if the molars are affected. Many dentists see crowns as a relatively uncomplicated solution, since not only is the tooth structure protected, but any problems with sensitive teeth are also a thing of the past.
Furthermore, crowns are also durable and represent a long-term solution to the problem. The method cannot be used on incisors or canines. However, if the enamel keeps chipping off or the tooth is so sensitive that the affected person suffers constant pain, the only option in many cases is extraction of the tooth. The tooth will then be extracted.
Outlook & Forecast
The treatment of molar incisor hypomineralization is successful with various therapeutic measures. The prognosis is accordingly positive. If the dental disease is diagnosed early, the treatment can be effective and the disease can be completely eliminated. The prognosis is based on the condition of the teeth and the chosen treatment method.
It is crucial that the parents are fully informed. In addition, the dentist must be sufficiently informed about the little-researched disease. If caries and painful fractures can be avoided, the prognosis is positive. In addition, the condition should be diagnosed in the first four years of the child’s life. If this succeeds, the prospect of a full recovery is given. A prerequisite for a good prognosis, however, is that the child carefully cares for its teeth from now on and informs the parents about pain or other complaints.
The dentist makes the prognosis with regard to the condition of the teeth, the time of the diagnosis and the willingness of the parents to cooperate. Life expectancy is not limited by molar incisive hypomineralization. Well-being can be limited until the end of the treatment, since severe pain sometimes occurs and the external abnormalities trigger feelings of shame in the child.
Preventive measures are not known. This is because the cause of molar incisor hypomineralization is not yet known. It is advisable to pay attention to oral hygiene or, if the first symptoms appear that suggest molar incisor hypomineralization, to see a dentist immediately so that any negative progression of the disease can be prevented.
The specific follow-up measures for molar incisor hypomineralization usually depend on the success of the treatment. The affected patients always have to be treated intensively, as they are more susceptible to caries and other diseases of the teeth. It is important to regularly check the restorations with which the defective teeth are usually treated.
In young patients, only therapeutic interim restorations, which must be closely monitored, are often used. Sometimes it is necessary to replace these several times before a definitive solution is possible. The adhesion of all forms of restorations on hypomineralized enamel is usually much worse than on healthy enamel.
As a result, further complications often arise. In addition, those affected have an increased risk of further defects. In addition to close dental check-ups, intensive daily dental care is necessary. The patients must absolutely follow the instructions of the treating dentist.
Ideally, they should examine the results themselves on a regular basis. In addition, it is advisable to have dental oral hygiene performed every few months. Another aftercare measure is to stick to a tooth-friendly diet. This is particularly necessary in children with molar incisor hypomineralization.
You can do that yourself
Although there is no universal method or approach to treating molar incisor hypomineralization and the condition is not fully understood, some of the symptoms can be reduced through self-help.
However, the focus is on early diagnosis of the disease, as this can prevent further complications and damage to the teeth. The affected person should consult a doctor at the first sign of the disease. Furthermore, the person concerned should use a toothpaste that contains a lot of fluoride and is indicated for pain-sensitive teeth. Mouthwashes that have a high fluoride content can also be used here. This strengthens the teeth.
However, the means of self-help do not replace a visit to the dentist. If you experience pain or other unpleasant sensations in your teeth, you should always consult a doctor. If the patient suffers from a fear of the dentist, an appropriate specialist should be consulted. A visit to a psychologist or a detailed conversation with a person you trust can also have a positive effect on anxiety. In many cases, the symptoms can be permanently alleviated by using the crowns.