Molar Incisor Hypomineralization

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Enamel hypoplasia on the upper central incisors

The Molar-incisors-hypomineralisation (MIH, English Molar incisor hypomineralization ) mentioned, locally as "chalk teeth", is a special form of melt formation disorder, namely a systemically related hypomineralisation the first molars (teeth 16, 26, 36, 46 ) and / or the upper permanent incisors ( incisors ). It is a variant of the structural disorders of the hard tooth substance ( tooth enamel ).

Endogenous structural disorder

Molar incisive hypomineralization is one of the endogenous structural disorders that occur as a result of a temporary deficiency state or a direct impairment of function or damage to the normally applied tooth-forming cells. The disorders can occur pre-, peri- and postnatally . Therefore, both dentitions (both milk teeth and permanent teeth) can be affected; the permanent teeth are affected much more frequently, especially teeth or groups of teeth that mineralize at the same time . The structural damage is limited to a certain development phase of the teeth .

etiology

The influence on mineralization that leads to MIH occurs mainly in the first year of life. The cause of MIH is largely unclear. The majority of previous studies on this subject have a low level of evidence. There is evidence that the uptake of dioxins or polychlorinated biphenyls (PCBs) in breast milk is involved in the etiology of MIH. Diet, birth incidents and numerous acute or chronic childhood diseases or their treatment could play a role, with amoxicillin or erythromycin administration in the first year of life significantly increasing the risk of developing MIH. A greater prevalence in northern European countries compared to southern countries also suggests an influence of the vitamin D balance.

A study of the prevalence and distribution of MIH in Germany found that the average number of permanent teeth affected by MIH was 2.8 ± 1.7. Most teeth showed circumscribed opacities, but a good half of the children suffered from the severe form with loss of substance, atypical restorations or pain. A clear connection to changes in second deciduous molars could be established and in the severe form the number of affected teeth increased on average. A comparison with the regional antibiotic consumption in young children could not establish a connection to differences in the MIH rate.

There is a connection between amelotin (AMTN) and tooth enamel defects and their development. In the absence of AMTN, weak spots appear on the tooth edges that are more easily broken or splintered. In this case, the mineralization of the tooth enamel takes place more slowly. In the ripening stage, the crystallites' volume growth is restricted, which in turn leads to hypomineralization.

Clinical picture

The mineralization disorder of the affected teeth is very variable. It ranges from white-yellowish or yellow-brown, delimited opacities to severe hypomineralization with missing enamel and dentin areas of varying dimensions. Hypomineralized teeth are often hypersensitive, especially to cold stimuli, which in everyday life lead to a natural, protective posture that is often not perceived by parents. The children suffer considerably as a result.

Severity degrees of hypoplasia

Severity of the hypoplasia according to Wetzel and Reckel
Degree description
Grade I. Individual cream-colored to brown areas on the chewing surfaces / cusp tips or on the vestibular surfaces of the incisors.
Grade II Mainly yellow-brown enamel, hypomineralized areas beyond the occlusal surface or on the entire vestibular surface
of incisors. Increased risk of enamel fractures and increased sensitivity of the affected teeth
Grade III Large yellowish-brown areas in the entire tooth area. If necessary, enamel losses often before the teeth have fully erupted.
High sensitivity of the teeth.
Classification of MIH according to Alaluusua et al.
class description
Class I. mild defects - color changes
Class II moderate / moderate defects - isolated melt losses
Class III severe defects - loss of enamel with affected dentin parts

Differential diagnosis

When it comes to structural disorders of the hard tooth substance, a distinction is made between exogenous, endogenous and genetic structural disorders. Various theories, such as antibiotic use during pregnancy, bisphenol A exposure, dioxins and furans from the environment, an existing vitamin D deficiency and infections with chickenpox have been discussed as the cause of children's teeth - predominantly the six-year-old molars or the incisors - do not develop normally.

Exogenous structural disorders

Exogenous structural disorders are caused by exogenous, i.e. external ( inflammatory , traumatic or radiation- physical ) noxae on individual tooth germs . The structural disorders occur solitary, asymmetrically and predominantly unilaterally on individual teeth or groups of teeth.

Genetically determined structural disorders

Genetic structural disorders are hereditary. One recognizes a generalized occurrence in the first and second dentition. The family history can provide information if there is comparable damage to the teeth that are affected in the same way. This includes the amelogenesis imperfecta.

Regional odontodysplasia

The regional odontodysplasia (tooth deformity) is a non-genetic structure disorders. The causes are unknown. A disorder of the development of the mesenchymal and ectodermal structures of the teeth, a disorder in the cells of the neural crest , an infection or a lack of vascular supply are suspected , the latter hypothesis being the most common. A radiation therapy can lead to odontodysplasia. Teeth affected by this abnormality may persist (not erupt). The teeth are smaller, show increased pits and furrows and often have a brown to yellowish discoloration. Radiographically, a large pulp lumen with a thin hard substance coat can be seen , root growth is delayed, enamel and dentine can hardly be distinguished from one another, and the radio opacity (radiopacity) is reduced. These teeth often appear transparent to X-rays and washed out, giving them the name Ghost teeth ( Engl. : Has introduced ghost teeth).

Dental fluorosis

While fluoride in a dose of around 1 mg / day is considered to be an effective means of preventing tooth decay (fluoridation), in higher doses it causes dental fluorosis, in which white to brown discolouration in the form of spots or streaks on the surface of the tooth enamel.

Tetracycline teeth

(Since the tetracyclines in pregnant women placental barrier freely pass) and nursing mothers are tetracyclines contraindicated, since it with calcium incorporated into irreversible complex formation in the child's tooth enamel (and bones). This leads to an increased susceptibility to fractures and brown discoloration of the teeth. Tetracyclines can only be used in children from the age of 10 to 12 years. It is not certain whether tetracyclines can also cause enamel hypoplasia. A tetracycline therapy should therefore u. a. are not used in the therapy of acne in children and adolescents.

therapy

Local anesthetics often only have a limited effect on these teeth, which means that treatment is usually only possible under analgesic sedation or under general anesthesia . Composites , prefabricated metal crowns, glass ionomer cement (only as a temporary filling) are suitable as filling or replacement materials for MIH teeth . The use of amalgam is not recommended because of the high cold / heat conductivity of these temperature-sensitive teeth and because the growing organism should not be exposed to any additional heavy metal loads. Fissure sealing may be sufficient for only minor defects (grade I). Hypersensitivity after filling therapy can be avoided through correct use of the adhesive system and the resulting complete sealing of the dentinal tubules . Close follow-up appointments at intervals of three to four months, including professional teeth cleaning and regular local fluoridation (for caries prophylaxis) are recommended.

Extractions of the hypomineralized 6-year-old molars are useful if rapidly progressive flaking of the tooth structure is to be diagnosed, if there is a lack of space that entails orthodontic treatment anyway, or if oral hygiene is severely restricted due to the pronounced temperature sensitivity.

The definitive restoration of the defects takes place in early adulthood using dental crowns .

In addition to conventional oral and dental care, products with calcium phosphates (e.g. amorphous calcium phosphate / ACP, tricalcium phosphate, hydroxyapatite) can be used to achieve possible subsequent ripening of the hypomineralizations.

Term history

The concept of molar-incisor-hypomineralisation is since the Congress of the European Academy of Pediatric Dentistry (EAPD, the European Academy of Pediatric Dentistry used) in the 2,001th Previously, these structural disorders were referred to as non-endemic enamel spots , idiopathic enamel hypomineralization of the first molars , cheese molars or non-fluoride-related hypomineralization of the first molars , or also as molar incisive hypoplasia .

literature

Web links

Individual evidence

  1. ^ F. Crombie, D. Manton, N. Kilpatrick: Aetiology of molar-incisor hypomineralization: a critical review. In: International journal of pediatric dentistry / the British Pedodontic Society [and] the International Association of Dentistry for Children. Volume 19, Number 2, March 2009, pp. 73-83, doi: 10.1111 / j.1365-263X.2008.00966.x , PMID 19250392 . (Review).
  2. ↑ S. Laisi, H. Kiviranta et al. a .: Molar-incisor-hypomineralization and dioxins: new findings. In: European archives of pediatric dentistry: official journal of the European Academy of Pediatric Dentistry. Volume 9, Number 4, December 2008, pp. 224-227, PMID 19054476 .
  3. ↑ AB: MIH: causes of mineralization disorder in children unknown. In: dentalmagazin.de. June 8, 2015, accessed March 7, 2019 .
  4. ↑ MA Petrou, Prevalence of Molar-Incisor-Hypomineralization (MIH) among German school children at four cities in Germany: an epidemiological study (PDF) Dissertation, University of Greifswald (2013)
  5. ^ Y. Nakayama, J. Holcroft, B. Ganss: Enamel Hypomineralization and Structural Defects in Amelotin-Deficient Mice. In: Journal of dental research. Volume 94, number 5, 2015, pp. 697-705, doi: 10.1177 / 0022034514566214 , PMID 25715379 .
  6. ↑ M. Schüler, R. Heinrich-Weltzien, Diagnosis and Therapy of Structural Disorders of the Hard Dental Substance in Children and Adolescents ( Memento of the original from December 3, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , ZMK, Spitta Verlag (2010) @1@ 2Template: Webachiv / IABot / www.zmk-aktuell.de
  7. ↑ Take WE Wetzel, U. Reckel, missing Structured molars to - a survey. Dentist Mitt 1991; 81: 650-652
  8. ↑ S. Alaluusua, PL Lukinmaa u. a .: Polychlorinated dibenzo-p-dioxins and dibenzofurans via mother's milk may cause developmental defects in the child's teeth. In: Environmental Toxicology and Pharmacology . Vol. 1, Number 3, May 1996, pp. 193-197, PMID 21781681 .
  9. ^ BW Neville et al .: Oral & Maxillofacial Pathology. 2nd Edition. (2002) p. 99
  10. ↑ MA Kahn: Basic Oral and Maxillofacial Pathology (2001) p. 88
  11. ↑ SQ Cohlan: Tetracycline staining of teeth. In: Teratology . Vol. 15, number 1, February 1977, pp. 127-129, doi: 10.1002 / tera.1420150117 , PMID 841479 .
  12. ^ LG Antonini, HU Luder: Discoloration of teeth from tetracyclines – even today? In: Swiss monthly journal for dentistry = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia / SSO. Vol. 121, number 5, 2011, pp. 414-431, PMID 21656385 .
  13. ↑ SA Fayle: Molar incisor hypo mineralization: restorative management. In: European journal of pediatric dentistry: official journal of European Academy of Pediatric Dentistry. Vol. 4, Number 3, September 2003, pp. 121-126, PMID 14529331 (Review).
  14. ↑ C. Baroni, S. Marchionni: MIH Supplementation Strategies . In: Journal of Dental Research . tape 90 , no. 3 , 2011, p. 371-376 , doi : 10.1177 / 0022034510388036 .
  15. ^ F. Meyer, J. Enax: Early Childhood Caries: Epidemiology, Aetiology, and Prevention . In: International Journal of Dentistry . tape 2018 , 2018, doi : 10.1155 / 2018/1415873 .
  16. ↑ Frederic Meyer, Bennett T. Amaechi, Helge-Otto Fabritius, Joachim Enax: Overview of Calcium Phosphates used in Biomimetic Oral Care . In: The Open Dentistry Journal . tape 12 , May 31, 2018, ISSN  1874-2106 , p. 406-423 , doi : 10.2174 / 1874210601812010406 , PMID 29988215 , PMC 5997847 (free full text).
  17. ^ European Academy of Pediatric Dentistry
  18. ↑ D. JACKSON: A clinical study of non-endemic mottling of enamel. In: Archives of oral biology. Vol. 5, December 1961, pp. 212-223, PMID 13957195 .
  19. ↑ G. Koch, AL Hallonsten u. a .: Epidemiologic study of idiopathic enamel hypomineralization in permanent teeth of Swedish children. In: Community dentistry and oral epidemiology. Volume 15, Number 5, October 1987, pp. 279-285, PMID 3477361
  20. ↑ WE van Amerongen, CM Kreulen: Cheese molars: a pilot study of the etiology of hypocalcifications in first permanent molars. In: ASDC journal of dentistry for children. Vol. 62, Number 4, 1995, pp. 266-269, PMID 7593885
  21. ↑ EC Lo, CG Zheng, NM King: Relationship between the presence of demarcated opacities and hypoplasia in permanent teeth and caries in their primary predecessors. In: Caries Research . Volume 37, Number 6, 2003, pp. 456-461, doi: 10.1159 / 000073400 , PMID 14571126