Overview
Molar incisor hypomineralization (MIH) is a developmental enamel defect affecting the occlusal surfaces of permanent molars and incisors, leading to tooth opacity, hardness reduction, and increased vulnerability to caries and fracture 123.Diagnosis
Key Diagnostic Criteria: Opacity, hardness defects, and sometimes demarcated opacity on affected teeth 13.
Recommended Tests: Clinical examination using European Academy of Paediatric Dentistry criteria 13.
Grading Systems: No universally accepted grading system; clinical evaluation often includes severity scoring based on extent of enamel defect 13.Management
First-Line Treatments:
- Fluoride Application: To enhance remineralization and reduce caries risk 13.
- Sealants: Use of pit and fissure sealants to protect tooth surfaces 13.
Adjunctive Treatments:
- Restorative Interventions: When necessary, use of stainless steel crowns or composite restorations for severely affected teeth 13.
- Ongoing Monitoring: Regular dental check-ups to assess tooth health and intervene early 13.Special Populations
Pregnancy and Perinatal Factors:
- Prematurity: Increased risk (OR 1.45; 95% CI 1.24-1.70; p = 0.0002) 1.
- Caesarean Delivery: Associated with higher risk (OR 1.45; 95% CI 1.09, 1.93; p < 0.00001) 1.
Pediatrics:
- Maternal Psychological Stress: Potential risk factor (OR, 3.24) 2.
- Frequent Ultrasonic Scans: Possible association during gestational trimester (OR, 2.51) 2.
- Birth Order: Higher risk for fourth sibling or later (OR, 5.73) 2.Key Recommendations
Screen for MIH Early: Regular dental evaluations in early childhood to identify MIH early, facilitating timely interventions (Evidence: Moderate 13).
Consider Perinatal History: Assess perinatal factors such as prematurity and mode of delivery in risk assessment for MIH (Evidence: Strong 1).
Monitor and Manage Caries Risk: Implement fluoride treatments and sealants to manage caries risk in children with MIH (Evidence: Moderate 13).References
1 Garot E, Rouas P, Somani C, Taylor GD, Wong F, Lygidakis NA. An update of the aetiological factors involved in molar incisor hypomineralisation (MIH): a systematic review and meta-analysis. European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry 2022. link
2 Ghanim A, Manton D, Bailey D, Mariño R, Morgan M. Risk factors in the occurrence of molar-incisor hypomineralization amongst a group of Iraqi children. International journal of paediatric dentistry 2013. link
3 Muratbegovic A, Markovic N, Ganibegovic Selimovic M. Molar incisor hypomineralisation in Bosnia and Herzegovina: aetiology and clinical consequences in medium caries activity population. European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry 2007. link