*Sylwia Kuderewska1, Monika Stawiecka1, Renata Milewska2, Anna Kuźmiuk2, Ewa Chorzewska2
Molar-incisor hypomineralisation (MIH) – aetiology, clinical picture, treatment
Hipomineralizacja trzonowcowo-siekaczowa (MIH) – etiologia, obraz kliniczny, leczenie
1Specialist Dental Center Ltd, Medical University of Bialystok
Head of Center: Anna Klimiuk, MD, PhD
2Department of Paediatric Dentistry, Medical University of Bialystok
Head of Department: Grażyna Marczuk-Kolada, MD, PhD
Streszczenie
Wstęp. Hipomineralizacja trzonowcowo-siekaczowa jest zaburzeniem szkliwa zębów pochodzenia systemowego. Dotyczy jednego lub więcej pierwszych zębów trzonowych stałych, często obejmując też siekacze.
Cel pracy. Celem pracy jest przedstawienie poglądów na temat etiologii, diagnostyki oraz metod postępowania profilaktyczno-leczniczego w przypadkach hipomineralizacji trzonowcowo-siekaczowej na podstawie dostępnego piśmiennictwa.
Materiał i metody. Dokonano przeglądu bazy danych PubMed w przedziale lat 2003-2017, kryterium wyszukiwania były frazy: „hipomineralizacja siekaczowo-trzonowcowa”, „hipomineralizacja”, „zęby stałe”.
Wyniki. Etiologia MIH jest złożona i nie do końca wyjaśniona. Autorzy są zgodni, że duży wpływ na rozwój tego schorzenia ma ogólny stan zdrowia dziecka w pierwszych 3-4 latach życia. Obraz kliniczny obejmuje odgraniczone od zdrowych tkanek białe, żółte lub brązowe plamy oraz zwiększenie porowatości szkliwa. Mogą występować też uszkodzenia i ubytki szkliwa. Postępowanie terapeutyczne uzależnione jest od ciężkości schorzenia i obejmuje: intensywne działania profilaktyczne, odbudowę tkanek twardych, ekstrakcje.
Wnioski. W związku z coraz większą powszechnością występowania hipomineralizacji trzonowcowo-siekaczowej należy zwrócić szczególną uwagę na dzieci, których stan zdrowia jest lub był zły w pierwszych 3-4 latach życia. Są one w grupie podwyższonego ryzyka wystąpienia tego schorzenia.
Summary
Introdution. Molar-incisor hypomineralisation is a disorder of dental enamel of a systemic origin. It may affect one or all four first permanent molars, and often involves permanent incisors.
Aim. The aim of this study was to present views on aetiology, clinical picture and treatment of molar-incisor hypomineralisation.
Material and methods. PubMed database was reviewed for years 2003-2017, the search criteria were: “molar incisor”, “hypomineralisation”, “permanent teeth”.
Results. The aetiology of MIH is multifactorial and not fully explained. Authors agree that the general health during the first 3-4 years of life has a major impact on this disorder. The clinical picture includes demarcated white, yellow or brown tissue spots, and increased porosity of the enamel. Enamel damage and defects can also occur. Therapeutic management depends on the severity of the disease and includes intensive prevention, hard tissue reconstruction, and extractions.
Conclusions. Due to the increasing prevalence of this disorder, special attention should be paid to children whose health status is or was bad in the first 3-4 years of life. They are at a higher risk for this condition.
Introduction
Molar-incisor hypomineralisation was described as a clinical entity by Weerheijm in 2001 (1). It is defined as a disturbance of the enamel of a systemic origin. One or more first permanent molars are usually effected; however, incisors are also often involved (1-4). It may vary in severity, and first incisors are usually less involved than molars (2). The global incidence varies, ranging between 2.4 and 40.2% (3, 5-7). The increasing prevalence of this disorder is confirmed by the fact that first permanent molar hypomineralisation is a more common problem than caries of chewing surfaces in Danemark (4). No significant sex-related differences in the prevalence of this pathology have been observed (5, 8). Clinical manifestations of MIH include demarcated, white, yellow or brown lesions. The loss of porous enamel, which may break off upon normal occlusal forces, is also common. Children often avoid brushing hypomineralised teeth due to increased sensitivity, and the increased accumulation of biofilm leads to rapid caries development (7, 9). MIH-related defects may affect the child’s quality of life, and the treatment poses a major challenge for patients, parents and doctors (6).
Aim
The aim of this study was to present views on aetiology, diagnosis and preventive/therapeutic management of molar-incisor hypomineralisation based on the available literature.
Material and methods
PubMed database was reviewed for years 2003-2017. The keywords included ”molar incisor”, ”hypomineralisation”, and ”permanent teeth”. Non-English articles, animal studies and orthodontic papers were excluded from the study. Literature available in text databases of the library of the Medical University of Bialystok was used. A total of 29 positions were selected.
Aetiology
The aetiology of MIH is not fully explained. Studies suggest its complexity. The impact of idiopathic systemic and genetic factors that interfere with amelogenesis is emphasised (2, 10, 11).
Enamel development can be broken down into three stages: secretory, transition and maturation (12). As pointed out by Kuhnisch et al., genetically determined susceptibility may play a role in the development of MIH. Based on 10-year clinical research, the authors identified a gene locus, which may be associated with this disorder. The gene is SCUBE1 located on chromosome 22 (13).
Among other causative factors, the role of environmental and systemic disorders is emphasised. It is suggested that in the case of molar-incisor hypomineralisation, ameloblast dysfunction occurs at the early stage of enamel maturation or late stage of enamel secretion (12, 13). The process of mineralisation of first permanent molars begins during foetal life, and the first 3-4 years of life are a critical period (1, 14).
The effects of damaging factors may occur during pre-, peri- and postnatal life (2, 10, 15-17). In the prenatal period, attention is paid to maternal viral infections, multiple episodes of high fever, hypertension, diabetes, malnutrition and pharmacotherapy (10, 16, 18).
Particular role in the development of MIH in the perinatal period is attributed to factors that induce oxygen deficit during amelogenesis, as well as hypokalaemia, twin pregnancy, prematurity, low birth weight, complications during delivery and caesarean section (10, 16, 18-20).
In the postnatal period, environmental factors, such as exposure to pollution (dioxins), which may penetrate into the child’s body with breast milk, are important (21). Diseases experienced by the child during the first years of life, which often involve high fever and require the use of antibiotics, are also considered. Varicella, measles, respiratory diseases (asthma, bronchitis, pneumonia), otitis media, tonsils, and gastrointestinal diseases are also mentioned (9, 18-23).
Andrade et al. showed in their study in children and adolescents aged between 7 and 15 years that MIH was significantly more common in HIV-positive patients infected by vertical transmission compared to healthy individuals. According to the authors, this is associated with the use of protease inhibitors by these patients (24).
Kuhnisch et al. showed that the child’s vitamin D levels may be also involved. Vitamin D plays a key role in the formation of mineralised tissues, including enamel and dentin. Based on a 10-year observation period, the authors demonstrated that lower serum 25(OH)D levels are associated with an increased risk of MIH. Additionally, higher vitamin D levels correlate with a lower number of carious permanent teeth (25). The authors pointed out that children with poor general health during first 3-4 years of life are more likely to develop MIH than healthy children (9, 18, 19, 21-23).
Clinical picture
Clinical examination should be performed on clean moist teeth (2, 4, 8, 26). The presence or absence of demarcated enamel opacities, post-eruptive breakdown, atypical fillings, and tooth extractions due to MIH is investigated (4).
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Piśmiennictwo
1. Oliveira DC, Oliveira Favretto C, Cunha RF: Molar incisor hypomineralization: Considerations about treatment in a controlled longitudinal case. J Indian Soc Pedod Prev Dent 2015; 33(2): 152-155.
2. Garg N, Jain AK, Saha S, Singh J: Essentiality of Early Diagnosis of Molar Incisor Hypomineralization in Children and Review of its Clinical Presentation, Etiology and Management. Int J Clin Pediatr Dent 2012; 5(3): 190-196.
3. Fragelli CM, Souza JF, Jeremias F et al.: Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth. Braz Oral Res 2015; 29(1): 1-7.
4. Weerheijm KL, Duggal M, Mejàre I et al.: Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003. Eur J Paediatr Dent 2003; 4(3): 110-113.
5. Ng JJ, Eu OC, Nair R, Hong CH: Prevalence of molar incisor hypomineralization (MIH) in Singaporean children. Int J Paediatr Dent 2015; 25(2): 73-78.
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25. Kuhnisch J, Thiering E, Kratzsch J et al.: Elevated Serum 25(OH)-Vitamin D Levels Are Negatively Correlated with Molar-Incisor Hypomineralization. J Dent Res 2015; 94(2): 381-387.
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