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

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

Australasian Orthodontic Journal
Volume 41 (2025): Issue 1 (January 2025)
By:  and    
Open Access
|Nov 2025
Figures & tables

Figures & Tables

Table I.

Prevalence of MIH by country

CountryAuthor (date)AgeNCriteria%MIH
ArgentinaBiondi et al. (2011)14111098DDE15.9
BrazilSouza et al. (2013)157 –121151EAPD12.3
BrazilTourino et al. (2016)168 –91181EAPD20.4
BulgariaKukleva et al. (2008)177 –1429603.6
ChileHarz et al. (2023)186 –121270EAPD Mathu-Muju12.8
ChinaYi et al. (2021)1912 –156523EAPD10
JordanHamdan et al. (2020)208 –91412EAPD13.2
GermanyDietrich et al. (2003)2110 –172408mDDE5.6
GermanyPreusser et al. (2007)226 –1210225.9
GermanyPetrou et al. (2014)238 –92395EAPD10.1
GermanyKühnisch et al. (2015)24101048EAPD13.6
GermanyAmend et al. (2020)2510 –172408EAPD5.6
GreeceLygidakis et al. (2008)265.5 –12351810.2
GreeceKevrekidou et al. (2015)278 –142335EAPD21
Hong KongCho et al. (2008)2811 –1426352.8
IndiaParikh et al. (2012)298 –121366EAPD9.2
IndiaMittal et al. (2014)306 –91792EAPD6.3
IndiaKrishnan et al. (2015)319 –144989EAPD7.3
IndiaYannam et al. (2016)328 –122864EAPD9.7
India (Kerala)Emmatty et al. (2020)338 –155318EAPD4.1
IranShojaeepour et al. (2020)348 –122507EAPD5.1
ItalyCondò et al. (2012)354 –151500Unclear7.3
ItalyNisii et al. (2022)367 –83611MIH-SSS18.2
JapanSakurai and Shintani (2014)376 –12175311.9
JapanSaitoh et al. (2018)387 –94496EAPD19.8
JordanZawaideh et al. (2011)397 –9324117.6
KenyaKemoli et al. (2008)406 –83591Visual inspection from photographs13.7
LithuaniaJasulaityte et al. (2007)417 –91277EAPD14.9
NigeriaOyedele et al. (2015)428 –16210712.7
NorwayAfzal et al. (2023)438 –93013EAPD28.2
Saudi ArabiaAlmuallem et al. (2022)448 –121562EAPD short form15.2
SingaporeNg et al. (2014)457 –81083EAPD12.5
SwitzerlandGrieshaber et al. (2022)467.4 –15.71252MIH TNI14.8
SwitzerlandAbdelaziz et al. (2022)474 –1232142Index devised by researchers6.6
SyriaAl-Nerabieah et al. (2023)488 –111138EAPD39.9
TurkeySönmez et al. (2013)497 –1240497.7
TurkeyKoruyucu et al. (2018)508 –111511EAPD14.2
TurkeyKılınç et al. (2019)519 –101237EAPD11.5
UKBalmer et al. (2012)52123233mDDE15.9

1 EAPD, European Academy of Pediatric Dentistry; mDDE, modified developmental defects of enamel; MIH, molar incisor hypomineralisation; MIH-SSS, molar incisor hypomineralisation severity scoring system; N, number; TNI, treatment need index.

Table II.

Prevalence of MIH in Australia and New Zealand

CountryAuthor (date)Children (n)CriteriaMIH (%)
AustraliaGambetta-Tessini, Marino et al. (2018)53327EAPD14.7
New ZealandMahoney and Morrison (2009)54850mDDE14.9
New ZealandMahoney and Morrison (2011)55235mDDE18.8
AustraliaArrow (2008)56550mDDE22
AustraliaBalmer, Laskey et al. (2005)5724mDDE44
New ZealandBeckett, Wheeler et al. (2022)5882EAPD77

1 Aus, Australia; EAPD, European Academy of Pediatric Dentistry; MIH, molar incisor hypomineralisation; N, number.

Figure 1.

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).

Table III.

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

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

1 EAPD, European Academy of Pediatric Dentistry; HSPM, hypomineralisation of second primary molars; MIH, molar incisor hypomineralisation.

Figure 2.

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).

Figure 3.

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).

Table IV.

Classification of MIH60

CategoryCharacteristics
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

1 MIH, molar incisor hypomineralisation.

Table V.

Wurzburg Working Group treatment guide

IndexDescription
0No MIH
1MIH
• No breakdown
• No hypersensitivity
2MIH
• 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
3MIH
• No breakdown
• Hypersensitivity
4MIH
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

1 MIH, molar incisor hypomineralisation; <, less than; >, greater than or equal to.

DOI: https://doi.org/10.2478/aoj-2025-0027 | Journal eISSN: 2207-7480 | Journal ISSN: 2207-7472
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Language: English
Page range: 332 - 345
Submitted on: Feb 1, 2025
Accepted on: Jul 1, 2025
Published on: Nov 4, 2025
Published by: Australian Society of Orthodontists Inc.
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2025 Emilija D. Jensen, Maurice J. Meade, published by Australian Society of Orthodontists Inc.
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 41 (2025): Issue 1 (January 2025)
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