Molar-incisor hypomineralization is a dental condition almost as common as cavities, but still little talked about and little diagnosed.
Your child’s baby teeth, small, delicate, and chalky white, fall out. In their place, they are born yellowed or brownish and brittle teeth – to everyone’s surprise.
This is the dental condition called molar-incisor hypomineralization (MIH), a condition almost as common as tooth decay, although little known outside the dental world – and even so, often misdiagnosed.
The condition affects the formation of certain permanent teeth in early childhood. It is not caused by lack of brushing, sugar or poor oral hygiene habits, but rather by something that interrupts the formation of enamel even before the tooth erupts.
It affects around 28% of children in Scandinavia and is one of the most common dental conditions. Studies show that is very common throughout Europewhile it appears to be less common in Africa and Asia.
Researchers are still trying to figure out why this happens, although they suspect it is largely due to differences in diagnosis and reportingalong with the prevalence of early childhood diseases and genetic factors.
At present, MIH is still an enigma for dentistry. We know it affects a significant number of children and can leave your permanent teeth weakened and discolored.
But we don’t fully understand why some children develop the disease while others do not. What is clear, however, is that it is more common than many people realize.
Here’s what we know so far based on current research.
What is MIH?
Enamel is the thin outer layer of our teeth and the hardest material in the body. But in children with MIH, tooth enamel development is disrupted, leaving them with fewer minerals.
This interruption occurs early in the child’s life, while teeth are forming inside the jaw. Normally, this happens from birth to around two years of age.
As a result, teeth look different and break more easily.
Most often, the enamel of the first permanent molars, the so-called six-year molars, and the front teeth are affected.
In addition to visible signs, children can also avoid brushing your teeth because of pain – and may notice that hot or cold foods or drinks cause tooth sensitivity.
Research points to five possible causes of MIH. This includes:
- long-term illnesses in early childhoodsuch as fever, infections, or repeated periods of illness
- long-term use of antibiotics;
- complications during pregnancy or childbirthsuch as oxygen deprivation or premature birth;
- environmental factorssuch as air pollution, and deficiencies of, for example, vitamin D, which can affect the body’s ability to form strong enamel;
- a possible genetic vulnerabilitymeaning some children may be more susceptible than others.
What can parents do?
Firstly, it is important to know that, with the knowledge we have today, MIH itself cannot be prevented. So, as parents, there is nothing you can do to prevent the condition from occurring.
That said, there are things they can do to help. The most obvious is brushing your teeth and use of toothpaste with fluoride. This is extremely important because tooth enamel is softer in young children, making teeth more difficult to clean and increasing the risk of cavities.
It is also important to help your child develop a good relationship with the dentist. It helps to talk positively about what dentists do for your teeth: mainly, help protect them better so they don’t hurt or break. It’s also important to tell your child that they should tell you where and how a tooth hurts, if it does.
What can the dentist do?
If your child has MIH, the dentist will assess the extent of the condition and classify the affected teeth as mild, moderate or severe.
Molars with mild MIH are treated with concentrated fluoride gel or sealed with a layer of clear plastic to help protect them from cavities, or both.
Molars with moderate MIH will receive provisional restorations and, as the tooth is very sensitive, anesthesia will be required.
Molars with severe MIH will receive restorations and, in more severe cases, a stainless steel crown. It is a type of protective cover that prevents fractures, cavities and pain.
In rare cases, the dentist may suggest tooth extraction if the long-term prognosis is very unfavorable. This usually occurs between the ages of eight and ten.
Front teeth often have mild to moderate MIH and are therefore often not treated initially.
When children with MIH get a little older, they often request more cosmetic treatment. This typically involves bleaching combined with a newer type of treatment in which a thin, fluid resin is infiltrated into the enamel.
A resin fills the empty spaces in the enamel structure and thus the apparent discoloration disappears, leaving the tooth with a normal, smooth color at the crown.
In adulthood, severely affected molars may benefit from a crown or porcelain inlay.
And now?
To truly combat this condition and its effect on children’s teeth, we first need a clearer picture of its true scope. This means more robust and consistent studies — and a greater consensus among professionals in the field about the way the disease is diagnosed and recorded.
At the same time, researchers are still working to answer some of the most basic questions: What are the main triggers? And why do some children develop the condition while others do not?
In the long term, more research will not only improve treatment, but also help prevent the disease from causing permanent dental problems, thus reducing the need for repeated and often difficult dental care in children (and adults).
