Molar incisor hypomineralization

Question :


My 10-year-old daughter’s last 4 molars present a decalcification problem. One is particularly severely affected.

This tooth has cavities all the time. Fillings are performed, and another cavity appears a few months later.

Last time, it was impossible to fix it because my daughter did not become numb. The dentist tried to inject the anesthetic about 5 times and she was still in pain.

The dentist suggests to extract this tooth since it is really damaged. I know that this implies some problems… deviation that is surely imminent, etc.

But on the other side, do I make my daughter suffer each time every 6 months… until she is 18 years old in order to finally be able to replace the crown on this tooth? What do you suggest me to do?


Réponse :

I answered a similar question on November 9, 2013 (in French) and on June 17, 2014 (in French).

28-08-2014 Enamel hypomineralization-Dr Chamberland orthodontist in Quebec CityIt is normal to see this tooth becoming hypersensitive and harder to anesthetize. I can understand your dentist’s suggestion regarding the extraction of this tooth. However, I would consult an orthodontist beforehand to find out what kind of orthodontic treatment will be required for your daughter and more particularly, how he will manage the extraction of the molar and prevent the deviations and asymmetries that could result from this procedure.

I present you a case on the image on the left where an orthodontic treatment with dental extraction was required. I modified the extraction plan and instead of the four second premolars, I extracted the upper left first molar instead of the second premolar in the maxilla (teeth marked with an X) and the lower second premolars.

I cannot tell you exactly what to do. It is reasonable to think about extracting the hypocalcified tooth.

I recently recommended, to 2 different patients, the extraction of their four first molars. It was the best thing to do for these young patients.


Patient 1

Molar incisor hypomineralization EtSav-Dr Chamberland orthodontist in Quebec City

Young boy of 7 years and 6 months of age. The four first molars are affected by hypomineralization and 3 teeth show significant destruction of their crown. This means that numerous repairs are to come during his life. I came to an agreement, with Dr Bruno Ouellet, specialist in pedodontics, that extracting the four first molars had to be done as soon as possible, which was done.

Patient 2

Molar incisor hypomineralization MaBri-Dr Chamberland orthodontist in Quebec City

Young girl of 10 years and 5 months of age whose four first molars are affected by hypomineralization. Extensive restorations are present on four molars. The lower left molar, that shows a grey amalgam filling, shows a periapical lesion. Therefore, a root canal treatment will have to be performed if we want to save the tooth. This represents significant costs for this tooth and for the other teeth throughout the patient’s life. The decision, always in agreement with the pedodontist Dr Bruno Ouellet, was to extract the 4 first molars.


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