Molar incisor hypomineralization (MIH)

Clinical appearance of enamel hypomineralization of systemic origin affecting one or more permanent first molars (PFM) that are frequently associated with incisors


  • Oxygen shortage + low birth weight
  • Parental risks – infection, maternal psychological stress
  • Complications during delivery
  • Respiratory diseases and oxygen shortage of ameloblasts
  • Children born with poor general health
  • Childhood febrile disease


  • Demarcated opacities
  • Post eruption breakdown

Criteria for MIH severity:

Differential diagnosis

Challenges in treatment:

  • Sensitivity and rapid development of caries
  • Limited co-operation of a young child
  • Difficulty achieving anesthesia – enamel is porous so exposed dentine results in chronic pulp inflammation
  • Repeated marginal breakdown of restorations


  • Early – Stainless steel crowns
  • Moderate – Restoration
  • Late – Extract PFM
  • Fissure sealants
  • Topical fluoride – toothpaste, fluoride varnish, fluoride gel