Recognising the problem: MIH phenomenon
Drs David Manton and Felicity Crombie from the School of Dental Science at the University of Melbourne, Australia, recently conducted a study among dentists in Australia and New Zealand on the perceptions and treatment of molar incisor hypomineralisation (MIH). They spoke to Dental Learning Hub about the significance of the results.
Dental Learning Hub: Despite its prevalence worldwide, what reasons do you attribute to the lack of information on the aetiology and management of MIH available to dentists?
Manton and Crombie: Until the condition is widely recognised and accepted as a separate clinical phenomenon with a consistent definition and criteria for diagnosis and classification, it is not possible to collect valid and reliable data on either the aetiology or management of MIH. The development of an animal model to replicate the defect has proved problematic, so this has also limited research.
Dental Learning Hub: How was your survey adapted from the previous European study and why?
Manton and Crombie: The European questionnaire was limited to the recognition of MIH in the populations treated by the respondents, knowledge of prevalence data and opinion of the value of collecting further prevalence data. In the European study the authors noted that some respondents had mentioned they felt the prevalence was increasing recently so we added a question to that effect in our questionnaire.
In the literature regarding MIH, several clinical challenges presented by these teeth have been reported, however these are predominantly based on anecdotal information. The aetiology of these lesions has also not been established in the literature. Questions regarding clinical problems, aetiology and management were therefore added to our questionnaire in order to obtain information not just regarding the current knowledge of MIH but also a broader clinical picture of the condition.
Dental Learning Hub: What were the most interesting trends that emerged from the survey answers?
Manton and Crombie: Interestingly despite the difficulties in defining and creating a classification for MIH, over 70% of respondents reported that diagnosing the condition was not a problem for them. Similarly there has been some controversy over whether to include the incisors as part of MIH, yet nearly 90% of clinicians reported experiencing problems with aesthetics in association with these teeth. It was also interesting that, even though there is no scientific evidence to support it, remineralisation potential of restorative materials had an influence on material choice for two thirds of clinicians.
Dental Learning Hub: Did your results indicate any similarities with European counterparts from the previous study?
Manton and Crombie: Overall the results of both questionnaires were similar. The majority of respondents were familiar with these teeth (98.5% in the present study, 97% in the European study) and believed further investigation of the prevalence would be worthwhile (96.9% in the present study, 90% in the European study). Australian clinicians were more likely to identify these teeth as posing a problem (96.9% compared to 83%). Our results also provide some support for the comment made by some European respondents that the prevalence seemed to be increasing recently, as 53% of Australian clinicians were of the same opinion. Clinicians treating children only were more likely to report this trend in our study. It should be noted that the demographics of the two questionnaires differed with the European questionnaire being sent only to paediatric dentists across 30 countries.
Dental Learning Hub: In your opinion, what can be done to address the inconsistent management strategies of MIH among dentists in Australia and New Zealand?
Manton and Crombie: MIH must first be established as a separate clinical condition and continuing education promoting the importance of recognising and managing these teeth in a manner distinct to caries should be provided. Currently there is little scientific evidence available to justify any particular clinical management strategy, so basic in vitro materials research is required followed by a randomised prospective clinical trial investigating the performance of different restorative materials.
Dental Learning Hub: Will you be conducting further research on this topic?
Manton and Crombie: We have conducted a review of the literature surrounding the aetiology of defects potentially consistent with MIH. Laboratory studies of the characteristics and remineralisation behaviour of tissues affected by MIH are planned.
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Full article
'Molar incisor hypomineralization: a survey of members of the Australian and New Zealand Society of Paediatric Dentistry'
Australian Dental Journal, 53 (2), 160–166, June 2008
Authors: FA Crombie, DJ Manton, KL Weerheijm, NM Kilpatrick
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Drs David Manton and Felicity Crombie from the School of Dental Science at the University of Melbourne, Australia, recently conducted a study among dentists in Australia and New Zealand on the perceptions and treatment of molar incisor hypomineralisation (MIH). They spoke to Dental Learning Hub about the significance of the results.
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