Treating of Molar Incisor Hypomineralisation (MIH) – alleviating sensitivty & remineralising enamel
Restoring weakened tooth enamel is crucial for addressing and alleviating symptoms of molar incisor hypomineralisation (MIH), a condition increasingly affecting young children. BioMin can significantly contribute to reducing sensitivity caused by MIH and improving compromised tooth enamel.
Molar incisor hypomineralisation (MIH) is a developmental dental issue that impacts the enamel of permanent teeth, often emerging as children’s adult teeth begin to erupt. This condition primarily affects molars, incisors, and occasionally adult canines.
MIH tends to manifest on the initial four adult molars, situated at each rear corner of the child’s mouth. Affected teeth typically exhibit enamel of inferior quality, displaying white, yellow, or brown discoloration. This compromised enamel is more prone to crumbling and decay.
The extent of these enamel abnormalities can vary greatly. In its mildest form, MIH may go unnoticed by parents, with only a dentist able to detect its subtle indicators. However, in severe cases, affected teeth may experience breakdown, leading to heightened sensitivity, decay, and potentially tooth loss.
The problem is on the rise; it is thought to affect about 15% of Caucasian children, ‘In our clinic at the Dental Hospital we see two or three patients every session,’ explained Dr Greig Taylor, an expert in MIH. The research suggests that about one in seven UK children are affected, in line with other European countries.
The problem is first seen when the adult teeth start to come through, between the ages of around 7 and 11 years, and the main symptoms include:
- Sensitive teeth
- Atypical carious lesions (visible macroscopic breakdown in the tooth surface)
- Post-eruptive breakdown – crumbling of posterior teeth
- Aesthetic concerns – brown or yellow discoloration
- Reduction in quality of life.
‘Younger children aged around 8-10 usually come in due to the back teeth crumbling, because of the hypomineralised enamel,’ explained Dr Taylor. ‘This leads to pain and sensitivity, especially with cold foods – ice cream or cold drinks. By the time they reach 12 or 13 they are becoming more aware of the look of their teeth and may become concerned about the discoloration.’ The crumbling usually starts to tail off after about the age of 9 or 10, and the discoloration of front teeth can improve slightly over time.
The exact cause of MIH remains uncertain, but it is speculated that it could result from a difficult birth, infection, or trauma during the first year of life, a crucial period for the formation of these teeth.
Management of molar incisor hypomineralisation.
The management of MIH varies based on its severity, with protecting the enamel and alleviating hypersensitivity being the primary approach. ‘It’s important to get something on the teeth as soon as possible,’ said Dr Taylor. We prefer not to extract teeth too early, so we frequently use a sensitivity paste and bide our time,’ he said. ‘If we can delay treatment to the front teeth, it can make the cosmetic judgement better. We try to be minimally invasive.’ Sometimes, however, extraction of crumbling back teeth can be unavoidable, especially if the child’s quality of life is being affected.
Ferranti Wong, Professor of Paediatric Dentistry at Queen Mary University London and another expert in MIH, agrees, and considers the management of sensitivity essential. Many of his young patients are referred to him by their dentists who have recommended mainstream sensitivity brands without success.
‘We take a conservative approach,’ he explained. ‘We have found that BioMin F is very effective in calming down the sensitivity.’ It is believed that the defects in the enamel mineral create a channel through which the dentine is exposed to external stimuli causing the sensitivity. ‘We want to strengthen the enamel, by replenishing the mineral,’ explained Prof Wong. ‘BioMin F creates an environment where calcium, phosphate and fluoride are released slowly and continuously over several hours, working with the saliva to form fluorapatite.’ This remineralises the tooth enamel and blocks the open tubules to reduce sensitivity.
Dr Greig Taylor added: ‘It would be fantastic if you could slow down or in some cases prevent breakdown of the enamel. The benefit of a remineralising agent is that it improves the sensitivity as well as making the teeth less susceptible to breakdown. An agent that could remineralise, reduce sensitivity and also improve the aesthetics would be a win-win
Treatment of molar incisor hypomineralisation (MIH)
Looking ahead, there’s ongoing development of new composite restorative materials that not only fill cavities but actively promote remineralization in the surrounding area. BioMin Technologies is exploring ways to leverage its distinctive bioactive glass technology for this purpose, a prospect that excites Professor Wong.
In the meantime, BioMin F toothpaste is giving dental professionals a solution to tackle the problem of sensitivity in MIH. Nathan Smith, a clinician in East Molesey, Surrey, has been recommending BioMin to his MIH patients for the last few years. ‘I have seen tremendous results in remineralisation and the reduction of sensitivity,’ he said. ‘BioMin F is always my go-to for children with MIH. The reduction in sensitivity is life changing for the patient. The clinical benefits of BioMin in the treatment of MIH are outstanding.’