Presented by:

Aya Adel Abd El-Hafez

Rana Mohamed EL-Abassery
 Objectives
• Identify the definition of MIH and its synonyms
• Know the etiology and prevalence of MIH
• Identify the clinical problems related to MIH
• Clinical presentation, diagnosis& severity of
MIH
• What is the differential diagnosis of MIH ?
• How to Prevent and Treat MIH ?
• Identify the Prognosis of MIH affected teeth
Introduction
• Enamel is the hardest tissue in human
body and contains the highest percentage
of minerals.

The defect caused during enamel

formation (Amelogenesis) is permanent as
the enamel lacks the ability to remodel
Definition
The Molar Incisor Hypomineralization (MIH) is defined as a
qualitative defect of enamel.

• Characterized by progressive hypomineralization of enamel

structure of the first permanent molars.

• May be associated with incisors.

 Synonyms
• Hypomineralized permanent first molar.

• Idiopathic enamel hypomineralization.

• Nonfluoride hypomineralization.

• Non-endemic mottling of enamel of permanent first

molars.

• Cheese molars.
Etiology
 Oxygen shortage
combined with low Parentally risks:
birth weight infection,
Children with suspected to be maternal
systemic contributing psychological
conditions in factor stress and
their first 3 frequent exposure
years to ultrasonic scans

Multifactorial

Children born
with poor
general health

Respiratory
diseases and
oxygen shortage of
the ameloblasts
Prevalence
• Worldwide ranges from 3.6% to 40.2%

• Difference is due to lack of classification

index and standardized methodology of
assessment

• Most of the studies carried out in the

European countries

• NO gender difference in multiple studies

• Some studies reported that post eruptive

breakdown occurs more frequently in
boys

• Children under the age of 10 are more

highly affected by the disease (15.1%)
Clinical problems
• Hypersensitivity

• Difficult to anaesthetize

• Aesthetic problems

• Tooth breakdown and

restoration problems
Clinical presentation
• Enamel soft, porous, or resembling
discolored chalk enamel.

• Easily chip off under masticatory forces.

• Color vary from white to yellow to brown

demarcated opacities.

• The characteristic features of MIH:

1. Clear demarcation between the affected
and sound enamel.
2. Asymmetry of defects present in the
molars and incisors.

• The second permanent molars and

bicuspids are rarely affected by these
enamel defects.
Diagnostic criteria
According to European Academy of Pediatric Dentistry
(EAPD), published in 2003:

 Demarcated opacities: clearly demarcated opacities at the

occlusal and buccal surfaces of the crown.

 Enamel disintegration: Post eruptive enamel breakdown.

 Tooth sensitivity: ranging from a mild response to

spontaneous hypersensitivity.

 Affect Permanent first molars and incisors

 Examination: performed on wet teeth after cleaning.

Severity
 Mild MIH Moderate MIH Severe MIH

•Opacities in non •Demarcated opacities •Post eruptive enamel

stress bearing areas are present on molars breakdown
and incisors
•No caries in affected •History of dental
enamel •Post eruptive enamel sensitivity
breakdown limited to 1
•No hypersensitivity or 2 surfaces without •Crown destruction
cuspal involvement
•Incisor involvement is •Aesthetic concerns
usually mild if present • Normal dental
sensitivity
Another severity scale was reported by European
Academy of Pediatric Dentistry (EAPD):
Differential Diagnosis
 Dental caries :
• Previously intact primary dentition.
• White spot lesions are also uncommon
on incisors.

Fluorosis :
Diffuse enamel opacities which
affect more than one tooth
 Enamel hypoplasia:
The edge of enamel is smooth while in MIH
the post eruptive loss of enamel renders the
enamel edges sharper and more irregular.

Amelogenesis imperfecta:
•More symmetrical than MIH .
•Affect both sets of dentition.

Hypomineralization defect:
Etiological factors are due to local causes
like trauma or infection of the primary
predecessors.
Prevention
• Risk identification.

• Early diagnosis.

• Remineralization and
desensitization.

• Prevention of caries and post

eruption breakdown.

• Maintenance.
Treatment
 Mild MIH
• Fissure sealants
( problem in retention) ??
N.B. Pretreatment of the pits and
fissures with 5% sodium
hypochlorite
• Resin infiltration (ICON)
• GI in difficult isolated or
partially erupted teeth
 Moderate MIH
• extensive areas more
fracture
• If no enamel loss .. Ttt like
mild cases
• If enamel loss :
• Composite or GI
restoration .. Same
technique for sealants
• Amalgam could also be
used but not end on
severely affected areas
 Severe MIH
The most challenging to treat
??
• Extreme sensitivity
Treated by chemical or light-cured
or resin-modified GI as temporary
restoration till full eruption of teeth
Provide effective barrier to thermal
and chemical stimulation
• Later SCC or Cast crowns
• RCT or apexification
• Extraction
Prognosis
• The quality of enamel supporting the restoration is fail so the
prognosis of restorations is poor.

• The need for evaluating restoration at regular intervals becomes

mandatory.

• However, failing restorations always necessitate treatment

planning for techniques and materials that last longer.
To sum it up !!
MIH
 References
• Alaluusua, S., Aetiology of molar-incisor hypomineralisation: a systematic review.
European Archives of Paediatric Dentistry, 2010. 11(2): p. 53-58.
• Kirthiga, M., et al., Prevalence and severity of molar incisor hypomineralization in
children aged 11-16 years of a city in Karnataka, Davangere. J Indian Soc Pedod
Prev Dent, 2015. 33(3): p. 213-7.
• Murali, H., et al., Molar Incisor Hypomineralization. The journal of contemporary
dental practice, 2016. 17(7): p. 609-613.
• Jälevik, B., Prevalence and diagnosis of molar-incisor-hypomineralisation (MIH): a
systematic review. European archives of paediatric dentistry, 2010. 11(2): p. 59-64.
• Weerheijm, K.L. and I. Mejàre, Molar incisor hypomineralization: a questionnaire
inventory of its occurrence in member countries of the European Academy of
Paediatric Dentistry (EAPD). International Journal of Paediatric Dentistry, 2003.
13(6): p. 411-416.
• Allazzam, S.M., S.M. Alaki, and O.A. El Meligy, Molar incisor hypomineralization,
prevalence, and etiology. Int J Dent, 2014. 2014: p. 234508.