MOLAR INCISOR HYPOMINERALIZATION IN MONOZYGOTIC TWINS : A CASE REPORT
Figure 11 . Postop upper occlusal , MB .
Figure 12 . Postop upper occlusal , SB .
This follows the recommendations made by Weerheijm in 2003 , 14 that the diagnosis of MIH is confirmed by clinical examination on clean and wet teeth ideally after the age of 8 years when all permanent incisors and first molars will mostly be erupted and that at least one FPM has to be affected . 8 , 14 Weerheijm et al . 15 also proposed that the clinical appearance of the 4 FPMs and 8 incisors should be recorded for the following features which will aid in the correct diagnosis of the condition : presence or absence of demarcated opacities ; post eruptive enamel breakdown ; atypical restorations ; extraction of a FPM ; failure of eruption of a FPM or an incisor . Teeth affected by MIH , with or without enamel loss , are often associated with hypersensitivity to air and cold stimuli . This could be explained by the findings of Rodd et al . 16 that there is increased neural innervation in the pulp horn and subodontoblastic areas of the hypomineralized teeth . An increase in immune cells and vascularity , resembling an inflammatory response , was noted in hypomineralized teeth with enamel loss . The post eruptive enamel breakdown often leads to dentinal exposure to external oral stimuli , which may further contribute to hypersensitivity . 16 As a result , sometimes the affected teeth might not be adequately anesthetized due to peripheral sensitization , despite effective local anesthesia techniques . This may lead to poor patient cooperation and difficulty in treating these teeth . In addition , the sensitivity may lead to the avoidance of brushing in the area , which can hasten the post eruptive enamel breakdown . 3 , 8 The management of MIH is thus very challenging and depends on various factors such as the extent and severity of the lesion , presence of
Figure 13 . Postop lower occlusal , MB .
Figure 14 . Postop lower occlusal , SB .
sensitivity , post eruptive enamel breakdown , the patient ’ s age and cooperation level and the child and parental expectations . Clinical approaches may vary accordingly , from simple preventive measures such as resin or glass ionomer sealants to more invasive approaches such as extraction in association with orthodontic management . A multidisciplinary approach is therefore mandatory . 3 , 8 , 13 In a study conducted by Jalevik et al . 17 on Swedish children , it was found that by the age of 9 , children with MIH-affected FPMs had undergone dental treatment nearly ten times more frequently than the controls undergone by healthy children , who were the controls , and the affected teeth had each been treated twice , on an average . This underscores the importance of maintaining good oral hygiene and other preventive measures which may help in the prevention of dental caries and post eruptive breakdown . Brushing with a fluoridated toothpaste ( 1000-1500ppm F ) twice a day and good dietary habits must be reinforced . Remineralizing agents such as fluoride varnish ( Duraphat , 22600ppm ) and Casein Phosphopepetide Amorphous Calcium Phosphate ( CPP-ACP ) have been shown to reduce the sensitivity of the enamel . 11 Preventive measures such as fissure sealants are recommended on FPMs with mild MIH with no evident enamel breakdown or sensitivity . These teeth do however require regular follow up to monitor the retention of the sealants . 3 A study by Lygidakis 10 has shown that application of a 5 th generation bonding agent prior to sealant placement improves its retention . Glass ionomer sealants are recommended for partially erupted molars or when adequate
Case Reports
Stomatology Edu Journal
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