Molar incisor hypomineralization (also known as MIH) is a developmental disorder of the teeth. However, doctors – when it comes to the cause – are faced with a mystery; no actual reasons have yet been found as to why molar incisor hypomineralization occurs.
What is molar incisor hypomineralization?
Molar incisor hypomineralization is a recent phenomenon that can occur in the first permanent molars and incisors, respectively. In a few cases, the canines are also affected by molar-incisor hypomineralization. Doctors notice yellowish-brown defects or discoloration in the enamel of the affected teeth; the teeth subsequently become sensitive to temperature, so that those affected report pain.
Causes
Children who suffer from molar incisor hypomineralization have lower enamel than those children who have healthy teeth. It is not known for what reasons molar incisor hypomineralization occurs. Medical experts suspect that several factors are sometimes responsible for the new phenomenon. Possible causes and factors include infectious diseases such as middle ear infections, pneumonia, chicken pox or even febrile infections, bisphenol A (so-called plasticizer, which is also found in pacifiers and drinking bottles), nutrient deficiencies (such as calcium deficiency in children), dioxins in breast milk or even hereditary factors.
Symptoms, complaints, and signs
In the context of molar incisor hypomineralization, physicians observe defects in the enamel that can occur in the molars, incisors or even canines. The affected teeth discolor yellow-brownish or even creamy-white. Due to the strain on the teeth (e.g. when chewing), it is possible that parts of the enamel can also break off or flake off. In many cases, the affected teeth are also highly porous. As a further consequence, those affected complain of extreme temperature sensitivity of their teeth, so that the so-called hot-cold alternation can certainly cause severe pain. Mechanical stimuli can also cause pain. As a further consequence, those affected complain of pain during dental care.
Diagnosis and course of the disease
The medical professional recognizes molar incisor hypomineralization during the dental examination. Discoloration is the first indication; very soft or porous 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 molar incisor hypomineralization is not treated by a dentist, the enamel damage increases, so that caries subsequently develops. This means that the tooth structure will suffer further damage. A circumstance that is sometimes also promoted by the fact that those affected – because they are in pain as part of their dental care – neglect their dental cleaning and refuse to “brush their teeth”. However, if molar incisor hypomineralization is detected at an early stage, regular and very close monitoring can result in new enamel defects being detected and treated relatively quickly.
Complications
Molar incisor hypomineralization primarily causes discomfort to the patient’s teeth. This can result in various defects or malformations in the oral cavity, causing affected individuals to experience pain when taking food or liquids. Furthermore, it is not uncommon for the teeth to be stained yellow or brown, resulting in reduced aesthetics. Sufferers do not feel comfortable with this coloration and may suffer from inferiority complexes or lowered self-esteem. Teeth chip more often, causing patients to suffer from a decreased quality of life. Likewise, cold or heat can also cause pain or other unpleasant feelings. It is also not uncommon for the care of the teeth to be associated with pain. As a rule, early treatment is necessary in the case of molar incisor hypomineralization to prevent consequential damage in adulthood.This requires various procedures that care for the teeth and protect them from external influences. As a rule, no particular complications occur. In many cases, the teeth have to be replaced by implants. The life expectancy of the affected person is not affected or reduced by 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 sensation of pressure indicate that the individual has health problems that should be investigated and treated. If the existing complaints gradually increase in intensity, there is a need for action. In molar incisor hypomineralization, children who are in the growth phase of the second teeth are primarily affected. Changes in the enamel, discoloration of the teeth and chipping of the tooth substance are unusual and should be presented to a doctor. If there is pain during dental care, a loss of appetite or weight loss, a doctor is needed. Complaints of alternating hot and cold temperature foods indicate inconsistencies. They should be investigated in a timely manner before further deterioration occurs. If the child suffers from headaches, completely refuses to eat, or if there is an impairment of concentration, a doctor should be consulted. Learning problems, deficits in attention, behavioral problems and sleep disturbances are further signs of a present discrepancy. A visit to the doctor is advisable as soon as the complaints persist for several weeks. Withdrawal from participation in social and community life, severe crying, mood swings, lassitude and apathy should be discussed with a physician.
Treatment and therapy
Besides the treatment of the occurred tooth damage as well as discomfort, furthermore other methods are available so that molar incisor hypomineralization can be treated. However, there is no uniform therapy or treatment recommendation, so that the medical professional must create individual – depending on the severity of molar incisor hypomineralization – treatment plans. It is important that treatment is carried out at an early stage. This is the only way to save the teeth from even worse damage. This means that regular check-up visits are important. This is the only way to ensure that any new damage that has occurred is not only quickly detected, but also promptly treated. One option is fluoridation. In this case, the doctor can treat the hot-cold sensitivity of the teeth and make the affected teeth less sensitive to pain. In addition, the affected person should use a toothpaste with a high fluoride content and also use mouth rinses containing fluoride. Fissure sealing can be used to treat a very mild form of molar incisor hypomineralization. The dentist seals the fissures that have formed; the depressions that have appeared in the occlusal surfaces can be sealed with a special material. This prevents any caries bacteria from settling in. The dentist can also treat any tooth defects by means of dental fillings. It is important to be considerate here; such treatments can be painful, so the dental fillings should only be placed under local anesthesia. It is important that the dentist prevents any painful treatments, otherwise the affected person will get a “dental fear”. This could result in him not noticing further treatments and therapies, which leads to an enormous deterioration of the teeth. Dental crowns are another treatment option for molar incisor hypomineralization. However, this method is only possible if the molars are affected. Many dentists see crowns as a relatively uncomplicated solution, as 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 provide a long-term solution to the problem. The method cannot be applied to incisors or canines. However, if the enamel keeps chipping or if the tooth is so sensitive that the patient suffers permanent pain, the only option in many cases is to extract the tooth. The tooth is subsequently extracted.
Outlook and prognosis
Treatment of molar incisor hypomineralization succeeds through various therapeutic measures. Accordingly, the prognosis is positive. Insofar as the dental condition is diagnosed early, the treatment can be effective and the condition can be completely resolved. The prognosis is based on the condition of the teeth and the selected therapy procedure. Comprehensive information of the parents is crucial. In addition, the dentist must be sufficiently informed about the little-researched disease. Insofar as caries and pain fractures can be avoided, the prognosis is positive. Moreover, the condition should be detected in the first four years of the child’s life. If this is successful, there is a prospect of complete recovery. However, a prerequisite for a good prognosis is also that the child takes careful care of the teeth from then on and informs the parents of any pain or other complaints. The prognosis is made by the dentist with regard to the condition of the teeth, the time of diagnosis and the parents’ willingness to cooperate. Life expectancy is not limited by molar incisive hypomineralization. Well-being may be limited until treatment is completed, as severe pain is sometimes experienced and the external abnormalities cause feelings of shame in the child.
Prevention
Preventive measures are not known. This is because so far the cause for which molar incisor hypomineralization occurs is not known. It is advisable to pay attention to oral hygiene, respectively, when the first symptoms appear that suggest molar incisor hypomineralization, to immediately consult a dentist, so that any negative disease progression can be prevented.
Follow-up
The specific follow-up measures for molar incisor hypomineralization usually depend on the success of treatment. Affected patients generally require intensive follow-up treatment, as they are more susceptible to caries and other dental diseases. It is important to regularly check the restorations with which the defective teeth are usually restored. In young patients, often only therapeutic interim restorations, which must be closely monitored, are used. Sometimes it is necessary to replace them several times before a definitive solution is possible. Adhesion for all forms of restorations on hypomineralized enamel is usually much poorer than on healthy enamel. Therefore, further complications often occur. In addition, those affected are at increased risk of further defects. In addition to close dental monitoring, intensive daily dental care is necessary. It is essential that patients follow the instructions of the dentist treating them. Ideally, they should examine the results regularly themselves. In addition, it is advisable to have dental oral hygiene performed every few months. Another follow-up measure is to adhere to a tooth-friendly diet. This is especially necessary in children with molar-incisor hypomineralization.
What you can do yourself
Although there is no universally accepted method or approach to treating molar incisor hypomineralization, and the condition has not been fully researched, some of the symptoms can be limited by self-help remedies. However, early diagnosis of the disease is paramount, as this can prevent further complications and damage to the teeth. The affected person should consult a doctor at the first signs of the disease. Furthermore, the affected person should use a toothpaste that contains a lot of fluoride and is indicated for pain-sensitive teeth. Likewise, mouthwashes that have a high fluoride content can also be used here. This will strengthen the teeth. However, self-help remedies do not replace a visit to the dentist. Therefore, in case of pain or other unpleasant sensations on the teeth, a doctor should always be consulted. If the patient suffers from a fear of the dentist, an appropriate specialist should be consulted. In this case, a visit to a psychologist or a detailed conversation with a trusted person can also have a positive effect on the fear. In many cases, the discomfort can be permanently alleviated by the use of crowns.