**6. Conclusion**

438 Contemporary Approach to Dental Caries

**MIH** 

Fig. 5. Flow chart illustrated by the authors of clinical management of MIH Children with a history of putative aetiological factors in the first 3 years should be screening at risk for MIH

As suggested by LIGYDIKIS ET AL., 2010 (Lygidakis et al., 2010), when children express their concern on mild discolorations, at late mixed dentition, incisors with whitish-creamy opacities may occasionally respond to bleaching with carbamide peroxide. (Fayle, 2003) Another conservative approach is microabrasion with either 18% hydrochloric acid or 37% phosphoric acid and pumice for 60s. (Lygidakis et al., 2010, Wright, 2002, Gotler & Ratson, 2010, Willmott et al., 2008) More pronounced enamel defects might be dealt with by combining the two methods (Sundfeld et al., 2007a), bleaching and microabrasion. However, bleaching for young children may induce hypersensitivity, mucosal irritation and enamel surface alterations (Joiner, 2006), whilst microabrasion may result in loss of enamel.

c. re-etch and application of fissure sealant over the surface to occlude the porosities

On the other hand, the replacement of micro-abrasion by local enamel thickness reduction,

The others clinical problems for patients with MIH are attrition, exposed dentin, atypical cavities or complete coronal destruction. (Kilpatrick, 2009, Jalevik & Noren, 2000) Moreover, pain experience during dental treatment has led some MIH children to be significantly less compliant and more dentally anxious than their peers.(Jalevik & Klingberg, 2002) In this

appears as another management treatment possibility. (Wright, 2002)

using high-speed headpiece, should be also evaluated by the professional.

(Alaluusua, 2010, Crombie et al., 2009, Fagrell et al., 2011)

(Sundfeld et al., 2007b) An etch-bleach-seal technique by involving:

a. 60 seconds etch with 37% phosphoric acid;

b. bleach with 5% sodium hypochlodite for 5-10 min.

NA – Not applicable

Despite a fall in the prevalence and in the speed of progression of dental caries disease, often, the clinicians and the pedodontics can find first permanent molars and incisors with hypomineralised enamel defected. MIH must be regarded as a public health problem which brings painful consequences, aesthetic and a negative impact on the quality of life of individuals suffering from MIH. A difficult and complex problem resolution, therefore all effort should converge towards the sense of real knowledge of the MIH aetiology to allow more accurate diagnosis and more appropriate treatment. People seized with MIH pathology have made sure that their expectations in relation to intervention proposal is based on high efficiency and effectiveness scientific evidences by ensuring the quality of life not only these people but also of their families. The etiology of MIH as a result of synergistic action of environmental factors and, suddenly genetic expressions leaving disturbances in enamel formation of molars and incisors in the first year of life, is the challenge to be overcome. Ultimately, the discovery of new genes and novel proteins such as amelotin and apin (Nishio, 2008) that they are also produced by ameloblasts, but during the stage of maturation, with important enamel mineralization function in relation to obtaining final hardness of enamel point to a promissory future in relation to knowledge of dental development. Well-being, understanding the genetic sequential and signaling pathways of developmental normal of enamel will provide us with an invaluable tool for understanding the pathways and mechanisms of tissue maintenance, repair and regeneration. It will enable us to manipulate genetic and environmental factors and ultimately, aid in the development of dental develpomental defects of enamel therapy.

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