TOWARDS A D3G GUIDE FOR MANAGING MOLAR HYPOMIN
As noted here, D3G aims to develop guidelines that are both clinically useful and research friendly. Collaborative input is sought from the practitioner community, so please let us know what you think as the nascent ideas take shape. If you haven't already done so, please check out our sections on Terminology, Diagnosis and Grading before dipping in to Treatment/management here.
Again we focus here on basic questions, as might be asked by oral health practitioners, dental students and other newcomers to the challenges of managing Hypomin teeth and affected families. Hopefully we can work towards formulating reasonably "black and white" answers in this section, and refer remaining "grey areas" onto the specialists.
Q1: Should I treat this case myself or refer?
- is there any uncertainty about the diagnosis as Molar Hypomin? – if in doubt, refer it out
- is it a mild case? – you may expect to treat this effectively yourself
- is it a moderate case? – often a tricky decision, so certainly consider outside help
- is it a severe case? – best referred to specialists (paedo & ortho)
Q2: How should a mild case of Molar Hypomin be treated?
- oral hygiene & dietary advice – emphasising high risk for caries and acid erosion
- fluoride-based prevention – fluoride-containing toothpaste, professional fluoride treatments
- CPP-ACP preventives – applied nightly, avoid fluoridated formulation in under-10y.o.
- surface protection while erupting? – use fluoride varnish or GIC
- resin-based prevention once erupted? – use regular fissure-sealing protocols, with bonder
- desensitisation – use regular desensitisation products and/or resin sealants
- regular review – 6 monthly, (as for moderate caries risk) or earlier if partner molars yet to erupt
Q3: How should a moderate case of Molar Hypomin be approached?
- key question: can the moderate opacities be stopped from progressing to breakdown?
- how many opacities and how big? – larger lesions are more prone to breakdown
- what colour? – darker opacities are more prone to breakdown
- location? – cuspal & occlusal opacities are more prone to breakdown
- pain? – likely to hinder oral hygiene?
- oral hygiene & dietary status? – Hypomin enamel is at risk for caries & acid erosion
- compliance? – regular, 3-monthly review required, as for high caries risk
Q4: What are the treatment considerations for a severe case of Molar Hypomin?
- key question: retain or extract the affected teeth?
- number and severity (including sensitivity) of affected teeth?
- caries involvement? – prognosis for pulpal vitality?
- restorability and restorative options? – lifelong perspective
- orthodontic status? – with/without extractions
- patient factors – compliance, affordability, interest in long-term options?