Paediatric Restorative Dentistry

Hypomineralisation or “weak enamel”

Molar Incisor Hypomineralisation (MIH) is a dental condition affecting the enamel of adult first molar and incisor teeth. It can affect one or all four first molar teeth and/or one or all of the incisor (front) teeth. The more teeth affected, the higher the possibility of a more severe expression of the condition. The cause still remains unclear. Some possible sources that have been suggested include preterm birth, childhood illnesses and medications. What we understand so far is that there is a disturbance of the normal production of enamel while the teeth are still developing inside the jaws around the first year of a child’s life.

Enamel on affected teeth has marked areas with less mineral content than normal enamel. The defects may present as marks on the teeth, whitish –yellow or yellow- brown in colour. Affected enamel is also softer and therefore more likely to break off under normal biting forces. This means that teeth can often start crumbling quite soon after they come through in the mouth. The first molar teeth come through at around six years of age and the incisor teeth around seven. This leads to extensive restorations and/or early loss of adult teeth.

Restorative treatment options and overall management of Molar Incisor Hypomineralisation (MIH) depend on the degree of affected teeth, potential for breakdown of tooth structure, sensitivity, severity and quality of the dental defect in addition to children/ parent preferences and developmental stage.

Why Are Baby Teeth Important

It’s a common misconception that many people believe: baby teeth don’t matter because they’re going to fall out anyway. Your child’s baby teeth play an important role in their oral health and their overall development. Healthy baby teeth:

• Allow your child to eat a healthy, well-balanced diet

• Reserve space for permanent teeth and help guide them into place

• Aid in the proper development of the jaw, facial bones, and muscles

• Help your child have normal speech patterns

Even in the best of circumstances, baby teeth can still suffer decay or other damage. If left untreated, a broken baby tooth can cause your child a great deal of pain. Depending on the extent of the damage, it may make it difficult for your child to eat certain foods and speak properly. They may feel embarrassed to smile and self-conscious about their appearance. When a cavity is untreated, it can also cause pain and tooth sensitivity, particularly when your child bites down. If decay reaches the pulp of the tooth, the pain can be so intense that children cannot eat or sleep. As decay spreads throughout the tooth, it can lead to an infection or an abscess.

Treatment Options for primary molars

1. Paediatric white fillings

   White composite fillings are the most common restorative option for minor tooth decay and small cavities. The decay is drilled out and the space is filled with a tooth-coloured composite material that is hardened and will strengthen the tooth.

2. Paediatric crowns

   Preformed metal crowns (PMC), also known as stainless steel crowns (SSC) are pre- fabricated crown forms that are adapted to individual teeth. They are indicated for the restoration of primary and permanent teeth with extensive cavities, developmental defects (e.g., hypoplasia, hypocalcification), when failure of other available restorative materials is likely, following pulpotomy or pulpectomy.

   White (zirconia) crowns are an option that has been used by paediatric dentists and can be considered instead of SSC to due to aesthetic preferences.

3. Pulpotomy

   A pulpotomy (“mini root canal”) is performed in a baby tooth when the cavity extends into the pulp (“nerve”) of the tooth, but there is no sign of infection or pathologic resorption. A pulpectomy is a root canal procedure for pulp (nerve) tissue that is irreversibly inflamed or necrotic due to caries or trauma.

What is a sealant?

It's a tooth- coloured material that protects the grooved & pitted surfaces of the teeth, especially chewing surfaces of back teeth where most cavities are found. They can decrease the risk of tooth decay by nearly 80% in molars!

How do they work?

Food & bacteria can build up in the tiny crevices on teeth, placing your child in danger of tooth decay. Sealants "seal out" food and plaque, reducing the risk of decay by acting like a barrier. They can last for many years if properly cared for. Your paediatric dentist will check the sealants during routine dental visits and recommend re-application or repair when necessary. The application is simple and painless. First the tooth is cleaned, conditioned, then dried. The sealant is then flowed onto the grooves of the tooth and allowed to harden with a special light. Your child will be able to eat and drink right after the appointment!

What Parents of Our Patients Think

My daughter was terrified of going to the dentist due to poorly formed teeth that caused her pain. Maria Kalkani and her team were all wonderful. They took time with my daughter, were kind, gentle and extremely knowledgeable. My daughter has had an operation with Maria Kalkani and now will go back for regular appointments without the fear that she previously had and in a much more relaxed state. We shall be staying with Maria and her team until my daughter is too old to go to her anymore. I cannot recommend her enough.

— Mrs S./Mother of J.S.