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MOLAR-INCISOR HYPOMINERALISA - TION (MIH). Over the past 15 years, dentists have increasingly seen a different type of enamel defect where the enamel is soft and discoloured, and may be absent. This is known as molar-incisor hypomineralisation (MIH). MIH teeth are typically discoloured, with an uneven surface (due to loss of enamel) and irregular shape. The cause of MIH is unknown. Researchers are trying to discover more about MIH and its cause. Hope- fully, this may lead to prevention of MIH. Amelogenesis imperfecta: If every primary and permanent tooth has abnormal enamel formation, the enamel defect is inherited and is called amelogenesis imperfecta (AI). One type of AI looks very similar to MIH. T he aim of this pamphlet is to provide you with general information. It is not a substitute for advice from your dentist and does not contain all the known facts about enamel defects or every possible side effect of treatment. Use this pamphlet only in consultation with your dentist. Some terms in this pamphlet may need further explanation by your dentist who will be pleased to answer questions. Your dentist cannot guarantee that treatment will meet all of your expectations or that treatment has no risks. If you are uncertain about the advice you have been given, you may wish to seek a second opinion from another dentist. Consent form: If you decide to undergo treatment, the dentist will seek your consent and may ask you to sign a consent form. Read it carefully. If you have any questions about the consent form, the procedure, risks or anything else, ask your dentist. AUSTRALIAN DENTAL ASSOCIATION INC. E namel is a protective glass-like outer layer on the visible part of the tooth (crown). Normal tooth enamel is harder than bone. The formation of enamel is very sensitive to any disturbances or disorders during the growth of a foetus or an infant. Enamel defects can occur during the early stages of tooth development, affecting the primary (baby) teeth or permanent teeth. For primary teeth, enamel defects may result from factors occurring from the third month of pregnancy. For permanent teeth, enamel defects may result from factors occurring at or soon after birth. Enamel Crown of tooth Dentine Pulp Gum Bone Cementum Root end opening Nerves and blood vessels A normally developed tooth has an outer layer of enamel, which is hard, protective, regular in shape and is nearly transparent. The dentine is a bone-like layer and is sensitive to temper- ature if exposed. A tooth’s centre contains the pulp, nerves and blood vessels. TYPES OF ENAMEL DEFECTS Enamel hypoplasia Enamel opacities Molar-incisor hypomineralisation (MIH) TALK TO YOUR DENTIST Tooth Enamel Defects A guide on enamel hypoplasia, opacity defects and molar-incisor hypomineralisation (MIH) Risk factors More than 120 different risk factors have been linked to enamel defects. The most common risk factors include: Mother’s health during pregnancy; a severely deficient diet or certain illnesses. Prematurity – enamel defects are four times more likely in premature babies than in full-term babies. Birth difficulties, especially with any breathing problem or blood disorder. Certain medications given to the mother prior to birth or to the baby after birth. Childhood diseases – illnesses during the child’s first year that result in high fever (such as pneumonia or middle-ear infection) and later viral infections such as measles or chicken pox. Chronic or frequent childhood illness during a child’s first four years. Childhood nutrition – a poor and deficient diet, particularly during the first three years of life. Adequate ENAMEL HYPOPLASIA: This is seen as smooth-edged surface defects (pits, lines or missing enamel). This type of defect can be related to a specific time of development. ENAMEL OPACITIES: These are opaque, white or yellow areas of enamel on or below the surface. The opacities may be “discrete” (localised areas) or “diffuse” (widespread). Restored tooth MIH SAMPLE ONLY NOT TO BE REPRODUCED

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Page 1: Tooth Enamel Defects

❖ MOLAR-INCISOR HYPOMINERALISA-TION (MIH). Over the past 15 years, dentists have increasingly seen a different type of enamel defect wherethe enamel is soft and discoloured, andmay be absent. This is known asmolar-incisor hypomineralisation(MIH). MIH teeth are typically discoloured, with an uneven surface(due to loss of enamel) and irregularshape. The cause of MIH is unknown.Researchers are trying to discovermore about MIH and its cause. Hope-fully, this may lead to prevention ofMIH.

❖ Amelogenesis imperfecta: If every primary and permanent tooth has abnormal enamel formation, theenamel defect is inherited and is calledamelogenesis imperfecta (AI). Onetype of AI looks very similar to MIH.

The aim of this pamphlet is to provide you with general information. It is not a substitute for advice from your dentist and does not contain all the known facts

about enamel defects or every possible side effect of treatment. Use this pamphlet onlyin consultation with your dentist. Some terms in this pamphlet may need further explanation by your dentist who will be pleased to answer questions. Your dentist cannot guarantee that treatment will meet all of your expectations or that treatmenthas no risks. If you are uncertain about the advice you have been given, you may wishto seek a second opinion from another dentist.Consent form: If you decide to undergo treatment, the dentist will seek your consentand may ask you to sign a consent form. Read it carefully. If you have any questionsabout the consent form, the procedure, risks or anything else, ask your dentist.

AUSTRALIAN DENTAL ASSOCIATION INC.

Enamel is a protective glass-like outer layer on the visible part of the tooth(crown). Normal tooth enamel is harder than bone. The formation of enamelis very sensitive to any disturbances or disorders during the growth of a

foetus or an infant. Enamel defects can occur during the early stages of tooth development, affecting the primary (baby) teeth or permanent teeth.

For primary teeth, enamel defects may result from factors occurring from thethird month of pregnancy. For permanent teeth, enamel defects may result fromfactors occurring at or soon after birth.

Enamel

Cro

wn

of

too

th

Dentine

Pulp

Gum

Bone

Cementum

Root endopening

Nerves and blood vessels

A normally developed tooth has an outer layerof enamel, which is hard, protective, regularin shape and is nearly transparent. The dentineis a bone-like layer and is sensitive to temper-ature if exposed. A tooth’s centre contains thepulp, nerves and blood vessels.

TYPES OF ENAMEL DEFECTS

Enamel hypoplasia

Enamel opacities

Molar-incisor hypomineralisation (MIH)

TALK TO YOUR DENTIST

Tooth Enamel DefectsA guide on enamel hypoplasia, opacity defects and molar-incisor hypomineralisation (MIH)

Risk factorsMore than 120 different risk factorshave been linked to enamel defects.The most common risk factors include:■ Mother’s health during pregnancy;a severely deficient diet or certain illnesses.■ Prematurity – enamel defects arefour times more likely in prematurebabies than in full-term babies.■ Birth difficulties, especially withany breathing problem or blood disorder.■ Certain medications given to themother prior to birth or to the babyafter birth.■ Childhood diseases – illnesses during the child’s first year that resultin high fever (such as pneumonia or middle-ear infection) and later viral infections such as measles orchicken pox. ■ Chronic or frequent childhood illness during a child’s first four years.■ Childhood nutrition – a poor and deficient diet, particularly duringthe first three years of life. Adequate

❖ ENAMEL HYPOPLASIA: This is seen assmooth-edged surface defects (pits,lines or missing enamel). This type ofdefect can be related to a specific timeof development.

❖ ENAMEL OPACITIES: These areopaque, white or yellow areas ofenamel on or below the surface. Theopacities may be “discrete” (localisedareas) or “diffuse” (widespread).

Restoredtooth

MIH

S A M P L E O N L Y N O T T O B E R E P R O D U C E D

Page 2: Tooth Enamel Defects

Treatment options

The aim of dental treatment is to reduce tooth sensitivity, strengthen

teeth and improve their appearance. Repeated visits to your dentist for professional treatment may be needed toachieve this outcome.

While the permanent molars areerupting, children with enamel defectsshould see their dentist regularly (atleast six-monthly).

The dentist will give instructions onhow best to care for the teeth at homeand may suggest referral to a paediatricdentist.

FLUORIDE TREATMENTFluoride treatment in children strength-ens enamel, which reduces tooth sensitivity and protects against decay.Various fluoride treatments are availableat the dental surgery. For example, anapplicator tray that is contoured to fitaround the teeth can be lined with fluoride gel and put inside the patient’smouth or a fluoride “varnish” may be applied to the teeth by the dentist.

The dentist may prescribe a fluoriderinse to be used either daily or weeklywhen your child is over six years of ageand able to spit out properly. The rinseshould not be swallowed. Use strictly asdirected. Keep fluoride medicines out ofthe reach of children.

Your dentist may also recommendthe use of a remineralising cream, whichcan be applied at home by rubbing it onthe teeth with a finger.

Discuss with your dentist yourchild’s need for fluoride and remineralis-ing cream.

RESTORATION OPTIONSThe dentist may suggest some of the following restoration options to improvethe look and function of the teeth. Verybadly formed or decayed teeth may needto be extracted.

However, before extraction, yourdentist may recommend that an orthodontist provide an opinion aboutthe effect of such extractions on the occlusion (“bite”).

Restoration options include:■ DIRECT TOOTH COLOURED – an adhesive restoration that is bonded directly onto the tooth surface.■ VENEER – a thin sheet of plastic orporcelain is individually shaped in thelaboratory to fit the front surface of thetooth. The dentist bonds the veneer ontothe tooth. ■ CROWN – the dentist prepares thenatural tooth so that an artificial crownfits snugly over it. Crowns are strongand have a long life. ■ BRIDGE – an artificial tooth is permanently fixed between adjacentcrowns if a tooth is missing or has hadto be extracted.■ DENTAL IMPLANT – an artificial toothroot is inserted into the jawbone. Afterhealing, a crown is fitted on top. Thistreatment is usually for people olderthan 18 years who have had one or moreteeth extracted.

Not every dental restoration yields aperfect result. Some restorations arechallenging for the dentist, and the outcome may be less satisfying thanhoped for. This may be due to, for example, a tooth’s dark colour or the

poor quality of its structure. Discuss your expectations with the

dentist and make sure you have a realistic understanding of the benefits,risks and limitations of the treatmentand restoration.

The following ADA patient education pamphlets on these topicscontain more detailed information andare available from your dentist:❖ Veneers, bonding, bleaching and

composites❖ Crowns and bridges❖ Dental extractions❖ The fitting and care of dentures❖ Dental implants.

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Costs of Treatment

You should ask for an estimate offees before agreeing to the proce-

dures. The estimate will include dentalfees, medical and hospital fees, andother items. If applicable, ask yourhealth insurer or dentist about whichcosts receive a rebate. As the actualtreatment may differ from the proposed treatment, the final accountmay vary from the estimate. It is better to discuss costs with your dentist before treatment rather thanafterwards.

calcium, phosphate and vitamins A, C

and D are needed for healthy tooth

development.

■ Trauma – injury to the mouth maydamage the enamel of one or more

unerupted primary teeth. Injury to an

older child’s primary teeth or gums may

result in localised defects of the enamel

of the developing permanent teeth. If left untreated, enamel defects

(especially MIH) can cause a range ofproblems, including:

❖ Affected teeth can be fragile and maywear or lose enamel easily.

❖ The risk of tooth decay and abscessis often increased because enamel is

an important defence against cavity-causing bacteria.

❖ Hot or cold foods and drinks maycause pain (“tooth sensitivity”) dueto the porosity of the enamel or if theunderlying dentine layer is exposed.

❖ Socially, the person may feel embar-rassed to smile.

DENTAL AND MEDICAL HISTORYThe dentist will inspect the patient’steeth and may take X-ray films. Tell thedentist the patient’s medical and dentalhistory, including:

■ whether other present or past family members have had similar dental problems

■ any infection, severe cold (viral infection) or other abnormal event thataffected the mother of the patient during pregnancy or the patient at birth,or during the first year of life■ childhood diseases■ use of products that stain teeth suchas coffee, tea and cigarettes

■ the patient’s dietary habits■ the patient’s dental hygiene habits ■ previous dental trauma ■ prior dental treatment.

This confidential information helpsthe dentist to diagnose the cause ofenamel problems, which may influencedecisions on treatment.

This pamphlet, or portions of it, should not be photocopied and handed out, nor reproduced in any electronic format. ©

YOUR DENTIST

AUSTRALIAN DENTAL ASSOCIATION INC.