National clinical guidelines for the extraction of first permanent molars in children

Treatment decisions on Molar-Incisor Hypomineralization (MIH) by Norwegian dentists - a questionnaire study

Background

The study aimed to explore the variability between the treatment decisions dentists make for MIH-affected teeth.

Methods

In 2009, a pre-coded questionnaire was sent electronically to all dentists employed by the Public Dental Service (PDS) in Norway (n = 1061). The questions were related to treatment of MIH-affected teeth, including three patient cases illustrated by photographs and written case descriptions.

Results

Replies were obtained from 61.5 % of the respondents after two reminders. In the first case, showing a newly erupted first permanent molar with moderate hypomineralization and no disintegration of the surface enamel, the preferred treatment among the majority of the respondents (53.5 %) was application of fluoride varnish, while 19.6 % would seal the fissure with GIC material. In the second case, showing a severely damaged first permanent molar in a six year old child, more than half of the respondents (57.5 %) would place a conventional glass ionomer restoration and 10.5 % would use a stainless steel crown (SSC). In the third case, showing a severely damaged permanent first molar in a nine year old child, 43.8 % of the dentists would remove only the parts with soft, damaged enamel; while 35.2 % would remove more and 21.0 % would remove all affected enamel and leave the cavity margins in sound enamel.

Conclusions

The survey shows that there is a wide disparity between clinicians’ views on how MIH affected teeth should be treated. In a severely affected first permanent molar, only a minority of dentists would remove as much tooth substance as needed to get the full benefit of the acid etch pattern in sound enamel.