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Why is the global prevalence of MIH at 12.9%? What does this mean?
Molar incisor hypomineralization (MIH) is an enamel defect affecting the permanent first molars and incisors. According to reports, this developmental disorder has a global prevalence of 12.9% and is usually found in children under 10 years old. This means millions of children could be affected by the disease and could be a symptom of deeper public health problems.
MIH occurs due to insufficient mineralization of enamel during the mature stage, which is related to the functional disruption of the tooth germ. Studies have shown that perinatal and postpartum factors, such as prematurity, certain medical conditions, fever, and antibiotic use, are associated with the development of MIH. In addition, recent studies also suggest that genetic and/or epigenetic changes may be important factors leading to MIH.
The enamel color of MIH may appear yellow, brown, cream, or white, causing these teeth to sometimes be called "cheese molars."
For affected children, MIH can cause cosmetic distress, causing anxiety for them and their parents. Although there is a difference in the enamel transparency of the affected teeth, it is not significantly altered in thickness, unlike enamel hypoplasia. Children with MIH are more susceptible to tooth decay due to insufficient enamel mineralization, and tooth decay develops at a faster rate.
Signs and symptoms
The manifestations of MIH can vary widely. A common phenomenon is that the enamel of the same molar may be affected, while the molar on the opposite side may be unaffected or have only minor defects. Lesions on MIH teeth usually appear as spots of different colors, and these lesions are often asymmetrical and have sharp boundaries.
Later damage
Posterior destruction (PEB) is a common clinical feature in patients with MIH, especially in severely affected cases. The incidence of PEB may be increased due to the pressure exerted on vulnerable enamel during chewing. Because of this condition, damage to teeth affected by MIH is more likely to occur than to healthy teeth.
Tooth decay and sensitivity
MIH teeth are at increased risk for cavities because the properties of their enamel change, becoming more porous and less hard. In addition, due to possible sensitivity during oral hygiene, patients avoid brushing, causing tooth decay to worsen.
Some children may also have teeth affected by MIH that are more difficult to anesthetize, which may make them fearful and anxious while undergoing dental treatment.
Diagnosis and Classification
Diagnosing MIH requires ruling out other causes of enamel opacity, such as tooth decay and fluorosis. The ideal age for diagnosis is eight years of age, when most of the permanent first molars and incisors have erupted. Causative factors include rare perinatal conditions, and many scholars believe that the development of MIH is multifactorial.
Prevention and treatment
Prevention of MIH is important in the early stages of development because damaged teeth are more susceptible to tooth decay and subsequent damage. Proper dietary advice and the use of fluoride toothpaste can help reduce these risks. Specialized ammonium fluoride for reactions to external irritants may also be helpful.
In terms of treatment, MIH-affected young children often require more frequent dental treatments, especially for teeth that may suffer from pain or sensitivity. The choice of treatment is complex and needs to take into account factors such as the severity of the condition and the patient's social background.
Conclusion
In summary, MIH is a public health problem that affects approximately 12.9% of children and may have long-term effects on their physical and mental health. The prevalence of this condition prompted us to think: How can we improve existing prevention and treatment measures to help these children achieve better oral health outcomes?
