This can be especially challenging in paediatric dentistry thus more specialised methods may be needed to increase the efficiency of anaesthetising teeth.Opacities due to MIH can be quite visible especially on anterior teeth which could present as a problem aesthetically. Patients frequently claim aesthetic discomfort when anterior teeth are involved. The discoloured appearance of the anterior teeth could also have negative effects on a child’s psychological development and self-esteem. Tooth breakdown and restoration problems
MIH-affected teeth are more prone to breakdown as they are hypomineralised which weakens the enamel structure. Restorations placed on MIH-affected teeth were found to be more prone to failure due to both loss of tooth structure and material loss. The enamel can also fracture more easily due to chewing forces. Causes
The exact cause of MIH is unknown but thought to be multifactorial.Pre-natally: risks, such as infection, maternal psychological stress and frequent exposure to ultrasonic scans were all correlated with increased risks of MIH. During the perinatal stage, Pitiphat found that cesarean section and complications during vaginal delivery could contribute to an increased chance of MIH. Children born preterm and those with poor general health or systemic conditions in their first 3 years of development also run a higher risk of developing MIH. It has also been proposed that developmental dental defects were associated with long-term breastfeeding due to exposure to dioxin. More recent evidence has suggested a relationship between respiratory diseases and oxygen shortage of the ameloblasts and MIH.
It will be useful for the children who are suspected to suffer from MIH to visit their dentist more frequently during the eruption of their first permanent molars to prevent any further complications affecting their oral health. Signs and symptoms
The distribution of disease in those affected with MIH can vary greatly. It can be common for the enamel of one molar to be affected while the enamel of the contralateral molar is clinically unaffected, or with minor defects only. Lesions
The lesions that appear in teeth affected with MIH can present as opacities that vary from white to yellow-brown. They are usually asymmetrical in appearance, with a sharp demarcation that distinguishes between normal and affected enamel. The lesions usually do not involve the cervical third of affected teeth. Post-eruptive breakdown
Post-eruptive breakdown (PEB) is a clinical feature, often observed in the majority of severely affected cases. The rate of PEB may be increased by the loading of masticatory forces on enamel weakened by MIH. The lesions resulting from PEB are irregularly shaped, with rough margins from the shearing of the enamel. PEB is more likely to occur in MIH affected teeth with yellow or brown opacities rather than those with white opacities, as darker lesions reflect a greater deficit in mineral content. Atypical caries
Teeth affected with MIH are at an increased risk of acquiring dental caries. This is because the properties of the enamel are altered by increased porosity and decreased hardness.