Molar Incisor Hypomineralisation: Current Knowledge and Practice

Abstract

Background: Molar incisor hypomineralisation (MIH) is a common developmental dental condition that presents in childhood. Areas of poorly formed enamel affect one or more first permanent molars and can cause opacities on the anterior teeth. MIH presents a variety of challenges for the dental team as well as functional and social impacts for affected children.

Objectives: Here, we provide an up-to-date review of the epidemiology, aetiology, diagnosis and clinical management of MIH.

Materials and methods: A review of the contemporary basic science and clinical literature, relating to MIH, was undertaken using information obtained (up to 10 April 2020) from the electronic databases PubMed, Scopus, Web of Science and the Cochrane Library.

Results: There is a growing body of evidence relating to the aetiology, presentation and clinical management of MIH. Current knowledge appears to be focused on potential genetic aspects, as well as the development and validation of indices for the diagnosis and management of MIH. There has also been increasing recognition of the global and individual burden of this common condition.

Conclusions: Dental health professionals should regularly appraise the basic science and clinical MIH literature to ensure that they provide the best possible short- and long-term care for their young patients.

Keywords: Children; Developmental enamel defect; Diagnosis; Management; Molar incisor hypomineralisation.

Fig. 1

Examples of clinical presentations of molar incisor hypomineralisation in children. (a) Ten-year-old girl with severely hypomineralised lower first permanent molars showing posteruptive enamel breakdown. She also has a discrete white opacity on her lower left permanent central incisor. (b) Fourteen-year-old boy with a severely hypomineralised upper-right first permanent molar showing posteruptive enamel breakdown; his upper-left first permanent molar is intact but has yellow/cream enamel opacities. (c) Nine-year-old boy with a large white/cream opacity involving his upper-left permanent central incisor and yellow opacities involving lower permanent lateral incisors. He reportedly would not smile for school photographs. (d) Ten-year-old boy with hypomineralised upper first permanent molars and second primary molars. He also has white opacities evident on his permanent central incisors. (e) Eleven-year-old girl who requested treatment of the ‘white marks’ affecting her upper permanent central incisors. She had previously had preformed metal crowns placed on her hypomineralised first permanent molars. (f) Following treatment of the patient in (e) with resin infiltrant (ICON; DMG), the white opacities became much less visible and she was reportedly much more confident in social interactions.