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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