The document discusses molar incisor hypomineralization (MIH), a qualitative defect of enamel characterized by its hypomineralization and association with first permanent molars and incisors. It covers the etiology, prevalence, clinical problems, diagnostic criteria, severity, differential diagnosis, prevention, and treatment of MIH. The prognosis of affected teeth is generally poor due to the compromised enamel quality supporting restorations.

1. Presented by:
Aya Adel Abd El-Hafez
Rana Mohamed EL-Abassery

2. 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

4. Introduction

5. • 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

6. Definition

7. 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.

8. Synonyms
• Hypomineralized permanent first molar.
• Idiopathic enamel hypomineralization.
• Nonfluoride hypomineralization.
• Non-endemic mottling of enamel of permanent first
molars.
• Cheese molars.

9. Etiology

10. Multifactorial
Parentally risks:
infection,
maternal
psychological
stress and
frequent exposure
to ultrasonic scans
Oxygen shortage
combined with low
birth weight
suspected to be
contributing
factor
Respiratory
diseases and
oxygen shortage of
the ameloblasts
Children born
with poor
general health
Children with
systemic
conditions in
their first 3
years

11. Prevalence

12. • 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%)

13. Clinical problems

14. • Hypersensitivity
• Difficult to anaesthetize
• Aesthetic problems
• Tooth breakdown and
restoration problems

15. Clinical presentation

16. • 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.

17. Diagnostic criteria

18. 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.

19. Severity

20. Mild MIH Moderate MIH Severe MIH
•Opacities in non
stress bearing areas
•No caries in affected
enamel
•No hypersensitivity
•Incisor involvement is
usually mild if present
•Demarcated opacities
are present on molars
and incisors
•Post eruptive enamel
breakdown limited to 1
or 2 surfaces without
cuspal involvement
• Normal dental
sensitivity
•Post eruptive enamel
breakdown
•History of dental
sensitivity
•Crown destruction
•Aesthetic concerns

21. Another severity scale was reported by European
Academy of Pediatric Dentistry (EAPD):

23. Differential Diagnosis

24.  Dental caries :
• Previously intact primary dentition.
• White spot lesions are also uncommon
on incisors.
Fluorosis :
Diffuse enamel opacities which
affect more than one tooth

25.  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.

26. Prevention

27. • Risk identification.
• Early diagnosis.
• Remineralization and
desensitization.
• Prevention of caries and post
eruption breakdown.
• Maintenance.

28. Treatment

29. 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

30. 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

31. 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
Severe MIH

32. Prognosis

33. • 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.

34. To sum it up !!
MIH

35. 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.