PEDODONTICS
Case Reports
MOLAR INCISOR HYPOMINERALIZATION IN MONOZYGOTIC TWINS: A CASE REPORT
Marianna Velissariou 1a *, Neeta Chandwani 2b
1
Pediatric Dentistry Department, European University College, Dubai, UAE
2
Pediatric Dentistry Department, Hamdan bin Mohammed College of Dental Medicine, Dubai, UAE a
DMD, MScD, Specialist Pediatric Dentist b
DMD, MScD, Specialist Pediatric Dentist, Visiting Faculty
Academic Editor: Tamara Tserakhava, DDS, PhD, Professor and Chair, Belarusian State Medical University, Minsk, Belarus
Cite this article: Velissariou M, Chandwani N. Molar incisor hypomineralization in monozygotic twins: a case report. Stoma Edu J. 2017; 4( 3): 218-223.
Received: June 21, 2017
Revised: July 19, 2017 Accepted: August 24, 2017 Published: August 25, 2017
Abstract DOI: 10.25241 / stomaeduj. 2017.4( 3). art. 7
Aim: The aim of this case report is to discuss the features of molar incisor hypomineralization( MIH), a developmental enamel defect, which was noted in a set of monozygotic twin males. Summary: MIH is the hypomineralization of one to four first permanent molars( FPMs) frequently associated with affected incisors and varies in clinical severity. Early diagnosis and management of the condition is paramount and will avoid the premature loss of the molars. Key learning points: The clinical characteristics, as well as the short and long term management of this condition are discussed. Keywords: molar incisor hypomineralization( MIH), prevalence, diagnosis, management.
1. Introduction Molar incisor hypomineralization( MIH) is a developmental qualitative enamel defect that was first defined by Weerheijm et al. in 2001 1 as“ hypomineralization of systemic origin of 1-4 First Permanent Molars( FPMs), frequently associated with affected incisors”. Clinically, the hypomineralized areas appear as well demarcated opacities affecting the FPMs and incisors. These demarcated areas are abnormalities in the translucency of the enamel and may vary in color from white to yellow to brown. They are often associated with post eruptive enamel breakdown in the molars due to the teeth being subjected to masticatory forces and are also more severely involved than the incisors. 2 The exact etiology of the condition remains unknown, however many factors that affect the stages of ameloblast formation during the prenatal, perinatal and postnatal periods were found to be possibly linked with MIH. Some of these potential risk factors include urinary tract infection during pregnancy, Caesarian section, premature delivery, exposure to environmental toxins, such as dioxin, childhood illnesses, asthma, pneumonia, high fever and antibiotic treatment especially during the first year of life. It is strongly believed that these factors act synergistically since none of them has a definite causative relation to the condition. 3, 4, 5 The prevalence of MIH has been studied extensively and it varies greatly from 2.4 % in Germany and Bulgaria to 40.2 % in Brazil. 6 The condition shows no gender predilection and the maxillary teeth, most specifically the molars, are most commonly affected. 7 The FPMs may not be affected to the same degree in an individual and some molars could be relatively unaffected. 8 Hypomineralized teeth were initially classified into three groups, based on the severity of the enamel defect: mild( white, yellow or brown discoloration of the enamel), moderate( enamel loss only) and severe( loss of enamel in combination with affected dentin). 9 Due to some similarities in the clinical appearance of the moderate and severe cases, Lygidakis et al. 8 suggested the use of only two categories: mild and moderate-severe. The mild cases include demarcated enamel opacities with intact surfaces, occasional sensitivity and mild esthetic concerns. In moderate-severe cases, there is enamel surface breakdown, persistent or spontaneous hypersensitivity with major esthetic concerns. 8 The aim of this case report is to discuss the features and management of MIH in a set of healthy monozygotic twin males.
2. Case Report Two healthy monozygotic twin males, MB and SB, 9.6 years of age, presented with their father to the department of pediatric dentistry for a routine checkup with no major complaints.
* Corresponding author: Dr Marianna Velissariou, DMD, MScD, Specialist Pediatric Dentist European University College, PO Box 53382, Dubai, UAE Tel / Fax: + 971 4 3624788, e-mail: marianna. velissariou @ euc. ac. ae
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Stoma Edu J. 2017; 4( 3): 218-223 http:// www. stomaeduj. com