A child’s small, pale, chalk-white baby teeth fall out and are replaced by yellow-brown, fragile teeth, often catching parents by surprise.
This dental condition, known as molar incisor hypomineralisation (MIH), is nearly as common as tooth decay, yet it remains largely unfamiliar outside dentistry and is sometimes misdiagnosed even by professionals.
MIH affects the development of certain permanent teeth during early childhood. It is not caused by poor brushing, high sugar intake, or inadequate dental hygiene. Instead, it results from a disruption in enamel formation before the teeth emerge.
At the teaching clinic at the University of Copenhagen’s dental hospital, we frequently treat children and adolescents affected by this condition.
It impacts about 28% of children in Scandinavia, making it one of the most prevalent dental disorders. Research shows it is common across Europe but appears less prevalent in parts of Africa and Asia.
Researchers are still working to understand why this variation occurs, but it is thought to be linked to differences in diagnosis and reporting, as well as rates of early childhood illness and genetic influences.
At present, MIH remains somewhat of a mystery in dentistry. It is known to affect a large number of children and can permanently weaken and discolor their adult teeth.
However, it is still unclear why some children develop the condition while others do not. What is certain is that it is far more common than many people realize.
Here is what current research has revealed so far.
What is MIH?
Enamel is the thin outer covering of teeth and the hardest substance in the human body. In children with MIH, however, enamel formation is disrupted, resulting in enamel that contains fewer minerals.
This disturbance happens early in life, while teeth are still developing within the jaw—usually from birth up to around age two.
As a consequence, the affected teeth may appear unusual and are more prone to damage and breakage.
The condition most commonly involves the first permanent molars (often called six-year molars) as well as the front teeth.
Beyond visible changes, children may avoid brushing due to pain and feel sensitivity when eating or drinking hot or cold foods and drinks.
Research has identified several factors that may contribute to MIH, including:
- Prolonged illness during early childhood, such as fevers, infections, or recurrent bouts of sickness.
- Extended use of antibiotics.
- Pregnancy or birth complications, including premature birth or reduced oxygen supply during delivery.
- Environmental factors such as air pollution and low vitamin D levels can impair healthy enamel formation.
- A potential genetic predisposition, making some children more vulnerable to developing MIH than others.
What steps can parents take?
First, it’s important to understand that, based on current scientific knowledge, MIH cannot be prevented. Parents cannot take any specific action to stop the condition from developing.
However, there are steps that can help protect affected teeth. One of the most important is maintaining good oral hygiene through regular tooth brushing with fluoride toothpaste. This is especially important because MIH-affected enamel is weaker, harder to clean, and more prone to cavities..
It is also important to encourage a positive relationship between your child and the dentist. Talking reassuringly about dental visits can help by explaining that dentists protect teeth and keep them strong and healthy.
It is also important to encourage your child to explain clearly if a tooth hurts and to describe where the pain is and what it feels like.
What Actions Can the Dentist Take?
If a child has MIH, the dentist first assesses how widespread it is and classifies affected teeth as mild, moderate, or severe. Mild MIH is usually treated with high-strength fluoride gel, a protective sealant, or both to reduce cavity risk.
Moderate MIH is usually treated with temporary fillings, often under local anesthesia due to sensitivity.
Severe MIH molars are treated with fillings or, in advanced cases, stainless steel crowns. This protective metal cap helps prevent tooth breakage and reduces cavity risk and pain.
In uncommon situations, a dentist may recommend extracting the tooth if its long-term outlook is very poor. This is usually considered when children are around eight to ten years old.
Front teeth generally present with only mild to moderate MIH, so they are often not treated right away.
As children with MIH grow older, they often begin to request treatments that improve appearance. These may include whitening procedures combined with newer techniques, such as infiltrating a thin, low-viscosity resin into the enamel.
The resin works by filling the gaps within the enamel, which helps reduce or eliminate the visible discoloration and restores a more natural, smooth tooth appearance.
In adulthood, molars that are severely affected may be treated with a crown or a porcelain inlay for added strength and protection.
What Should be Done Next?
To effectively address this condition and its impact on children’s teeth, a clearer understanding of how common it is is needed. This requires more robust and consistent research, as well as greater agreement within the dental field on how MIH should be diagnosed and documented.
At the same time, researchers are still trying to understand some of the most fundamental questions: what triggers this condition, and why do some children develop it while others do not.
In the long term, continued research will not only lead to better treatment options but also help prevent long-term dental complications, ultimately reducing the need for repeated and often complex dental care in both children and adults.
Read the original article on: Sciencealert
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