Diagnosis and management of molar incisor hypomineralisation in children: An evidence-based overview

Jensen, Emilija D.; Meade, Maurice J.

doi:10.2478/aoj-2025-0027

Figures & Tables

Clinical photographs of (A) upper second primary molars affected with mild hypomineralisation of yellow/white demarcated defects and previous atypical restorations (white arrows) with affected first permanent molars and (B) lower first primary molars with large, atypical caries affecting the occlusal, buccal and lingual surfaces (black arrows).

Clinical photographs of (A) hypoplastic quantitative defect on the upper left central incisor and diffuse defect across all other maxillary teeth (black dashed arrows), (B) fluorosis with diffuse, opaque defects (white arrows) affecting all of the lower permanent dentition, (C) amelogenesis imperfecta with diffuse areas of white and brown defects (white dashed arrow) affecting all permanent dentition, (D) white-spot caries lesions at the gingival margins of multiple teeth (black arrows).

Clinical photographs of (A) upper central incisors with white (black arrow) and yellow (black dashed arrow) demarcated defects and (A) lower first and second permanent molars with posteruptive breakdown of the occlusal and buccal surfaces (white arrow) and an atypical restoration (white dashed arrow).

Wurzburg Working Group treatment guide

Index	Description
0	No MIH
1	MIH
	• No breakdown
	• No hypersensitivity
2	MIH
	• Breakdown
	• No hypersensitivity
2a	• Extension of defect < 1/3
2b	• Extension of defect e 1/3 to < 2/3
2c	• Extension of defect ≥ 2/3 or/and defect close to the pulp or extraction or atypical restoration
3	MIH
	• No breakdown
	• Hypersensitivity
4	MIH
4a	• No breakdown
4b	• Hypersensitivity
4c	• Extension of defect < 1/3
	• Extension of defect ≥ 1/3 to < 2/3
	• Extension of defect ≥ 2/3 or/and defect close to the pulp or extraction or atypical restoration

Classification of MIH60

Category	Characteristics
Mild	• Defined areas of hypomineralisation • Non-stress bearing areas of molar with isolated enamel loss • No caries • Minimal sensitivity • Minimal aesthetic concerns
Moderate	• Atypical restoration or extension of affected enamel on occlusal and incisal third of teeth • Posteruptive breakdown limited to one or two surfaces without involvement of cusps • Minimal sensitivity • Some aesthetics concerns
Severe	• Posteruptive breakdown of enamel – possibly rapid as the tooth erupts • Widespread caries associated with the affected enamel • Sensitive dentine • Aesthetic concerns

A proposed charting system to record observation as per the EAPD diagnostic criteria_ (Adapted from59)

Criteria
0	No visible enamel defect
1	Enamel defect, not MIH/HSPM
11	Diffuse opacities
12	Hypoplasia
13	Amelogenesis imperfecta
14	Hypomineralisation defect (not MIH/HSPM)
2	Demarcated opacities
21	White or creamy demarcated opacities
22	Yellow or brown demarcated opacities
3	Post eruptive breakdown
4	Atypical restoration
5	Atypical caries
6	Missing due to MIH/HSPM
7	Cannot be scored

Prevalence of MIH by country

Country	Author (date)	Age	N	Criteria	%MIH
Argentina	Biondi et al. (2011)¹⁴	11	1098	DDE	15.9
Brazil	Souza et al. (2013)¹⁵	7 –12	1151	EAPD	12.3
Brazil	Tourino et al. (2016)¹⁶	8 –9	1181	EAPD	20.4
Bulgaria	Kukleva et al. (2008)¹⁷	7 –14	2960		3.6
Chile	Harz et al. (2023)¹⁸	6 –12	1270	EAPD Mathu-Muju	12.8
China	Yi et al. (2021)¹⁹	12 –15	6523	EAPD	10
Jordan	Hamdan et al. (2020)²⁰	8 –9	1412	EAPD	13.2
Germany	Dietrich et al. (2003)²¹	10 –17	2408	mDDE	5.6
Germany	Preusser et al. (2007)²²	6 –12	1022		5.9
Germany	Petrou et al. (2014)²³	8 –9	2395	EAPD	10.1
Germany	Kühnisch et al. (2015)²⁴	10	1048	EAPD	13.6
Germany	Amend et al. (2020)²⁵	10 –17	2408	EAPD	5.6
Greece	Lygidakis et al. (2008)²⁶	5.5 –12	3518		10.2
Greece	Kevrekidou et al. (2015)²⁷	8 –14	2335	EAPD	21
Hong Kong	Cho et al. (2008)²⁸	11 –14	2635		2.8
India	Parikh et al. (2012)²⁹	8 –12	1366	EAPD	9.2
India	Mittal et al. (2014)³⁰	6 –9	1792	EAPD	6.3
India	Krishnan et al. (2015)³¹	9 –14	4989	EAPD	7.3
India	Yannam et al. (2016)³²	8 –12	2864	EAPD	9.7
India (Kerala)	Emmatty et al. (2020)³³	8 –15	5318	EAPD	4.1
Iran	Shojaeepour et al. (2020)³⁴	8 –12	2507	EAPD	5.1
Italy	Condò et al. (2012)³⁵	4 –15	1500	Unclear	7.3
Italy	Nisii et al. (2022)³⁶	7 –8	3611	MIH-SSS	18.2
Japan	Sakurai and Shintani (2014)³⁷	6 –12	1753		11.9
Japan	Saitoh et al. (2018)³⁸	7 –9	4496	EAPD	19.8
Jordan	Zawaideh et al. (2011)³⁹	7 –9	3241		17.6
Kenya	Kemoli et al. (2008)⁴⁰	6 –8	3591	Visual inspection from photographs	13.7
Lithuania	Jasulaityte et al. (2007)⁴¹	7 –9	1277	EAPD	14.9
Nigeria	Oyedele et al. (2015)⁴²	8 –16	2107		12.7
Norway	Afzal et al. (2023)⁴³	8 –9	3013	EAPD	28.2
Saudi Arabia	Almuallem et al. (2022)⁴⁴	8 –12	1562	EAPD short form	15.2
Singapore	Ng et al. (2014)⁴⁵	7 –8	1083	EAPD	12.5
Switzerland	Grieshaber et al. (2022)⁴⁶	7.4 –15.7	1252	MIH TNI	14.8
Switzerland	Abdelaziz et al. (2022)⁴⁷	4 –12	32142	Index devised by researchers	6.6
Syria	Al-Nerabieah et al. (2023)⁴⁸	8 –11	1138	EAPD	39.9
Turkey	Sönmez et al. (2013)⁴⁹	7 –12	4049		7.7
Turkey	Koruyucu et al. (2018)⁵⁰	8 –11	1511	EAPD	14.2
Turkey	Kılınç et al. (2019)⁵¹	9 –10	1237	EAPD	11.5
UK	Balmer et al. (2012)⁵²	12	3233	mDDE	15.9

Prevalence of MIH in Australia and New Zealand

Country	Author (date)	Children (n)	Criteria	MIH (%)
Australia	Gambetta-Tessini, Marino et al. (2018)⁵³	327	EAPD	14.7
New Zealand	Mahoney and Morrison (2009)⁵⁴	850	mDDE	14.9
New Zealand	Mahoney and Morrison (2011)⁵⁵	235	mDDE	18.8
Australia	Arrow (2008)⁵⁶	550	mDDE	22
Australia	Balmer, Laskey et al. (2005)⁵⁷	24	mDDE	44
New Zealand	Beckett, Wheeler et al. (2022)⁵⁸	82	EAPD	77

Diagnosis and management of molar incisor hypomineralisation in children: An evidence-based overview

Figures & Tables

Figure 1.

Figure 2.

Figure 3.

Wurzburg Working Group treatment guide

Classification of MIH60

A proposed charting system to record observation as per the EAPD diagnostic criteria_ (Adapted from59)

Prevalence of MIH by country

Prevalence of MIH in Australia and New Zealand

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