Can we Prevent Molar-Incisor-Hypomineralisation (MIH)?

The main clinical characteristics of MIH-lesions are demarcated brownish or chalky white opacities of enamel, atypical restorations, post-eruptive breakdown of enamel, and extractions due to MIH. Microscopically, the opacities reveal reduced microhardness, reduced mineral content, large areas with porosities, and defective enamel rod and surface ultrastructure. Some of the MIH-molars are highly sensitive to tooth-brushing and instrumentation. Moreover, children with severe MIH-lesions are at risk of developing severe dental fear and anxiety due to repeated exposure to restorative and operative dental care. MIH-lesions are most common among first permanent molars and incisors, but are also seen in deciduous second molars.

The overall prevalence of MIH is about 13-14%, ranging between 2.8 and 21.8%. The problem seems to be fairly common not only in Europe but in Australia, New Zealand, India, China and South America as well.  

In spite of extensive research and publications, the etiology of MIH-lesions is far from clear. Several reasons like prematurity, gastrointestinal problems, pneumonia, frequent fever episodes, measles, chicken pox, bronchitis, hypoxia, hypocalcemia, and exposure to antibiotics and dioxin have been linked to MIH-lesions.

Due to the still unknown etiology, all levels of prevention should be exercised and combined with meticulous restorative dental care of these pediatric patients. Local anesthesia may be problematic in hypersensitive MIH-molars, and adhesive techniques in restorative care of severe MIH-lesions can be challenging due to the defective ultrastructure of enamel. Moreover, extending borders of the restoration to areas where no further risk of tissue breakdown exist can also be challenging.