Pulpal Status of Hypomineralized Permanent Molars

Meghan Sullivan Walsh October 18, 2010

Literature Review - St. Joseph/LMC Pediatric Dentistry

Pulpal Status of Hypomineralized Permanent Molars

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Pulpal Status of Hypomineralized Permanent Molars

Authors: Helen D. Rodd, BDS, PhD; Fiona M. Boissonade, BDS, PhD; Peter F. Day, BDS, M Paed Dent

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 29:6, 2007, pages 514-520

Major Topic: Determining the pulpal status of Hypomineralized teeth.

Overview of Method of Research: Permanent first molars were obtained from children requiring a routine dental extraction under general anesthesia. 44 children with a mean age of 9.4 years provided the teeth for this study. Of these teeth, 25 were sound and 19 were hypomineralized, (9 with intact enamel and 10 with enamel loss.) The patients were interviewed for sensitivity and of the 19 hypomineralized samples 6 had reported sensitivity and 5 had been asymptomatic. The teeth were sectioned and analyzed for enamel loss. The coronal pulps were removed and prepared for analysis. The pulps were divided into three parts, mesiobuccal pulp horn, occlusal subodontoblastic region between 2 pulp horns and the midcoronal pulp region.

Findings: Pulpal innervation: In hypomineralized teeth both with or without enamel loss, there was an increase in neural density within both the pulp horns as well as the occlusal subodontoblastic region. In hypomineralized samples with intact enamel there was significantly greater innervation density than sound teeth. In the subodontoblastic region, innervation density was significantly greater in the pulps of hypomineralized teeth with enamel loss than was the case for sound teeth. There was no difference in the two groups between the midcoronal region.

Immune cells: In sound samples there were few signs of leukocyte common antigen-immunoreactive cells. However, more LCA-ir cells were found within the pulps of hypomineralized samples with enamel loss compared to sounds teeth or hypomineralized samples with intact enamel surfaces.

Pulpal vascularlty: No significant differences in vascularity between the two samples.

Pain history: For those patients who complained of tooth sensitivity the samples showed greater staining of immune cells discovered in the pulp horn and midcoronal region.

Key Points: Summary:

Frequently young patients with hypomineralized teeth complain of tooth sensitivity even during restorative management and treatment. This study shows evidence that there may be pulpal changes associated with many of these patient’s teeth. Our clinical management is to protect their teeth from caries, and alleviate sensitivity These patients may have an underlying pulpal inflammation as demonstrated by the increase in pulpal innervation density and immune cell accumulation noted in this study. The presence of dentin in many of these subjects may leave the dentin vulnerable to the ‘hydrodynamic theory’ of dentinal fluid movement. In addition exposed dentin may predisposed bacteria and oral irritants into the pulp. This study shows that our treatment and management of these patients may go beyond prevention but instead early intervention and prevention of hypersensitivity. A reliable dental pain history of our young patients should always be obtained.

Assessment of the Article: While the science behind these studies were way over my head, I liked the subject matter and the method of research. The sample size was small and determining pain in a young child is often subjective, nonetheless, I believe there is something significant with these results. Perhaps with further research on prevention and early treatment of these patients with hypomineralized dentition we can prevent our patients from the discomforts of sensitivity at an earlier age.