My Child with M.I.H.

My child has Molar Incisor Hypomineralisation (M.I.H)
See article linked for further information (IDA)

This is the name given to a dental condition where the enamel on children’s first permanent molars (i.e. 6 year molars) and permanent incisors (front teeth) does not form correctly.

“Hypomineralisation” means under-mineralised.

The teeth can look discoloured (e.g. cream/brown marks) and if severe the molars can break down and become quite sensitive. Children may complain of sensitivity when consuming cold foods/drinks or when brushing their teeth. In many cases parents may be the first to notice a “discolouration” of tooth/teeth.

Note: There are a number of other reasons for discolouration or sensitivity of teeth eg. Tooth decay, fracture etc.

It is very important that all tooth discolouration is checked!

1st Permanent Molar (6 year molar)

Mild M.I.H.

Note: this tooth has been fissure sealed.

MIH Mild

1st Permanent Molar (6 year molar)

Mild M.I.H.

Note: this tooth has been fissure sealed.

Small area of defective enamel

1st Permanent Molar (6 year molar)

Moderate M.I.H.

Moderate M.I.H. - defective areaDefective area of enamel.
Moderate M.I.H. - cavityWhen defect / tooth decay removed,
the cavity is much larger.
Moderate M.I.H. - white fillingCavity successfully repaired with a permanent
white filling (composite).
Note: these teeth must be checked regularly
by a dentist.

1st Permanent Molar (6 year molar)

Moderate – Severe M.I.H.

These teeth are too damaged to be successfully restored (long-term) with white fillings. The options for these teeth are restoration with a crown or extraction.

1. Restoration with a stainless steel crown (SSC)

Severe – Before Treatment

M.I.H. defective permanent tooth - beforeDefective permanent tooth.
Healthy primary (baby) tooth.

After Treatment – Stainless Steel Crown

M.I.H. defective permanent tooth - after
Full coverage of tooth with a metal crown protects it for many years.
(These crowns do need to be replaced when patient is in their early twenties).

2. Extraction of some or all four severely hypomineralised first permanent molars (6 year molars)

We find it very helpful to get the opinion of an orthodontist (specialist in braces) before proceeding with extraction of permanent molars.

MIH Extraction

If teeth are very damaged / or affecting the nerve – their long term prognosis is poor – so can be best to extract them.

If done at the correct time, the next molar (12 year molar) will move nicely into the extraction space.

Permanent Incisor – 8 year old child

Mild discolouration of permanent front tooth.

Mild MIH discolouration of permanent front tooth

No Treatment Required

Permanent Incisor – 8 year old child

Moderate discolouration of permanent front tooth in a child with M.I.H.

Appearance can be improved with composite (white filling material); little / no tooth structure is removed.

Moderate Incisor M.I.H. - Before Treatment

Before Treatment

Moderate Incisor M.I.H. - After Treatment

After Treatment
“Masking” with white filling material (composite)

In later years, patient may choose another treatment, e.g. composite / porcelain veneer.