Molar-incisor hypomineralisation is a qualitative enamel defect affecting at least one first permanent molar and often permanent incisors. Management is severity-based: control sensitivity and caries risk, protect erupting teeth, restore maintainable defects and coordinate extraction of poor-prognosis molars when appropriate.
Contents
How is MIH diagnosed?
MIH presents as demarcated opacities in one or more first permanent molars; permanent incisors may also be affected. Colour ranges from white or cream to yellow-brown. Severe teeth may show posteruptive breakdown, hypersensitivity, rapid caries or atypical restorations.
Differential diagnosis includes fluorosis, amelogenesis imperfecta, hypoplasia, early caries and local developmental injury.
Clinical assessment
- Number and surfaces of affected teeth.
- Opacity colour and extent.
- Posteruptive breakdown and caries.
- Hypersensitivity and anaesthetic difficulty.
- Age, cooperation and quality-of-life effect.
- Restorability, eruption and occlusal development.
MIH management table
| Presentation | Objective | Options |
|---|---|---|
| Mild opacity | Prevention | Fluoride, sensitivity control, sealant and review |
| Early breakdown | Protect enamel | Sealant, interim or adhesive restoration |
| Moderate loss | Restore function | Composite, preformed metal crown or indirect restoration |
| Poor-prognosis molar | Long-term occlusion | Multidisciplinary restoration-versus-extraction planning |
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Frequently asked questions
Is MIH caused by poor brushing?
No. MIH is a developmental enamel defect. Plaque can worsen caries and breakdown but does not create the original defect.
Can every MIH molar be restored?
No. Restorability depends on severity, remaining structure, sensitivity, eruption, cooperation and expected longevity.
When should extraction be considered?
Consider extraction for a poor-prognosis first permanent molar after paediatric, restorative and orthodontic assessment.
