# The ARM-ER® Approach for Management of Hypomineralised Posterior Teeth

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## Significant Hypomineralised Appearance After Treatment
Following placement of GIC enamel defect with silver fluoride restoration.

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## Hypomineralised Enamel Appearance After Treatment
Following placement of GIC with no significant breakdown with silver fluoride protection.

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## Using Silver Fluorides to:
- Assess caries (decay)
- Redefine mineralisation and reduce sensitivity
- Manage —
  - Educate and then
    - Review?
    - Repeat?
    - Restore?
    - Re-establish?
    - Rehabilitate?

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### How Does It Work? When Can It Be Used? Why Is It Beneficial?

Silver and fluoride ions are absorbed into the affected part of the tooth and continue to protect against ongoing bacterial activity on a hardened tooth surface.

Graphic courtesy Dr Jeremy Horst, WRDC 2017

The use of silver fluorides to address the concerns of the hypomineralised or ’chalky’ tooth is an easy, safe, and very effective option.

With an assessment of the decay status and a significant reduction in sensitivity following the application of silver fluoride, it often means that immediate and future treatment recommendations for these typically highly sensitive teeth can be addressed with little to no discomfort to the patient and in a conservative manner. As the child moves into adulthood, the tooth can then be treated in a more appropriate manner for long-term retention.

Hypomineralisation occurs when the tooth is forming, and well before it erupts into the mouth. The most commonly affected teeth are the 2-year-old molars (baby teeth which should be in place till the age of 12) and the 6-year-old molars (first permanent molars). For this reason, it is important to treat these teeth early and conserve as much of the tooth structure as possible. A deficiency in the formation of the tooth means that these teeth have less mineral content and as a result, they are weaker, can decay quickly, and are often extremely sensitive for a child when eating, drinking, and during dental treatment even for simple procedures. Traditionally, ‘hypomin’ teeth require more frequent dental care and can be a significant source of dental anxiety in children due to their sensitive nature.