What is Molar Hypomineralisation?
Molar Hypomineralisation (also known as Hypomin or MIH), is a developmental disturbance that occurs when the teeth are forming in the third trimester of pregnancy or within the first three years of life. It generally affects the first permanent molar (erupts around age six) and sometimes the front teeth. This can also occur in baby teeth. Hypomineralised enamel contains less minerals than a healthy tooth which results in a weaker tooth that is more prone to breaking, erosion and tooth decay (holes).
Why did this happen?
The cause of enamel hypomineralisation is still unclear, however, it is suspected that although genetic factors may come into play, environmental factors may play a more significant part. Some suspected causes include oxygen starvation, temperature (fevers), respiratory and airway issues in early life, and low birth weight. For many years antibiotic use was blamed for this condition however this is not conclusive. It is important to understand that this condition is NOT a result of lifestyle factors (such as diet, oral hygiene).
Moderate
Hypomineralisation
Severe
Hypomineralisation
What does it look like?
Appearance can vary from a white chalky texture to yellow and brown pitting. Generally, the lesions are classified into 3 different groups: Mild, moderate and severe.
Mild: Intact coloured defects, usually on the biting surface of the tooth.
Moderate: Yellow or brown defects on biting surface and tooth cusps which may have areas of breakdown. Sensitivity is likely.
Severe: Brown or yellow defects with a combination of breakdown on multiple surfaces of the tooth and sensitivity. (Oliver et al, 2014)
Is it common?
Unfortunately, yes. It is estimated that 1 in 5 children experience this condition either on their baby or permanent teeth (D3 group, 2020).
Does it hurt?
Hypersensitivity of these teeth is common. Your child may mention that these teeth are sensitive to hot or cold temperatures which can impact eating, drinking and toothbrushing.
Dental images: ivoclarvivadent
Is there anything I can do at home to help fix it?
As this is a developmental disorder, the condition of the enamel will not improve but should be protected by:
- Brushing twice daily with adult strength fluoride toothpaste (if the child can spit)
- Flossing daily (with parental assistance)
- Limiting acidic and sugary food and drinks
- Applying Tooth Mousse™ (ask your dentist about this)
How can these teeth be treated?
Treating hypomineralised teeth can be tricky as the protective sealant or filling material used does not bond as well to this type of enamel and as a result, it is common for the sealants or the fillings to dislodge.
Stainless steel crowns are a commonly used treatment for molar hypomineralisation to ensure the tooth is completely covered. This means there is more tooth to work with in the future and if the tooth is kept, it can be replaced by a white crown when the patient is in adulthood. White crowns are not often used in childhood as this requires cutting away too much tooth structure.
In some severe cases, extraction of the tooth may be the only option. This is completed with collaboration from an orthodontist who will work with you to close the space at the appropriate time.
Your dentist will assess the extent of molar hypomineralisation and will discuss the most appropriate plan for your child. This plan will consider short term and long term management of the teeth as well as an appropriate treatment delivery method.
For further information on Molar Hypomineralisation and to help your child understand this condition visit:
