What is Hypomineralisation?
Hypomineralisation is a disturbance in the development of the outer layer (enamel) of teeth. The affected enamel has less mineral content. Multiple possible causes have been suggested although ongoing research is still required. Childhood diseases such as pneumonia and asthma, fever and the use of antibiotics especially during the first three to four years of life and during pregnancy has been associated with hypomineralisation. It has also been suggested that there may also be a small genetic element.
Hypomineralisation causes teeth to be softer than usual and can range from a white-creamy to a yellow-brown opacity. Other most reported clinical problems include breakage of the enamel after these teeth erupt which will lead to exposure of the underlying dentine layer. The broken-down teeth become very sensitive and sometime present with the difficulty to numb-up before any restorative procedures. Tooth sensitivity may also lead to poor oral hygiene at home and increases the risk of dental caries development.
Which teeth are affected?
When hypomineralisation is present on second primary molars, it is most likely that some of the adult first molars and front teeth be affected. Depending on the severity, biting forces on the back teeth may lead to the hypomineralised molars breaking down quickly and the front incisors may create aesthetic problems due to the appearance. Canines are only occasionally affected.
What treatment options are available?
A full clinical examination is carried out and radiographs are taken to provide an accurate diagnosis. Several treatment options are available depending on how severely the teeth are affected. Sensitive teeth will benefit from a toothpaste with a higher fluoride concentration including fluoride varnish application within the dental clinic. Another product, called Tooth Mousse, helps teeth to be more resistant to decay. The high content of calcium and phosphate in combination with the use of a fluoridated toothpaste assists in strengthening and protecting teeth.
When primary teeth are a bit more brittle, a preformed metal crown can be recommended. White fillings do not bond well to teeth affected by hypomineralisation and can risk even further breakdown. Adult and primary molars can benefit from fissure sealants, fissure protections, fluoride varnish applications and fillings, however, severely broken-down teeth may be considered for extraction. The front teeth tend to break down less and any problems can be purely cosmetic. Options here include micro-abrasion, resin infiltration, bleaching or restorations. The best recommendation for treatment can be determined after a thorough assessment as some options are appropriate and some are not recommended.
Resources
Bekes, K. (2020). Molar incisor hypomineralization: A clinical guide to diagnosis and treatment.
Springer. British Society of Pediatric Dentistry. 2020.
https://www.bspd.co.uk/Portals/0/MIH%20statement%20final%20Jan%202020.pdf