2008

4:

(a) Define Molar Incisor Hypomineralisation (MIH)

(b) What advice should be given to parents of a child with mild MIH?
(c) The parents believed that frequent antibiotics in childhood caused this condition.
Discuss the current evidence.

(A) MIH is a term used to describe the clinical appearance of enamel hypomineralisation
of systemic origin affecting one or more of the first permanent molars that are
associated frequently with affected incisors. Weerheijm 2001
(B) (Mild: White/creamy demarcated opacities. No enamel surface breakdown)
Warm parents that MIH diagnosis usually indicates a high treatment need, teeth will
be very susceptible to caries and erosion. Affected teeth can be hypersensitive which
can lead to inadequate anaesthesia and subsequent management problems.
Mild MIH will initially be treatment by preventative measures: dietary advice, oral
hygiene advice. Topical application of fluoride and use of desensitising toothpaste.
Tooth Mousse: CPP-ACP (Not if lactose intolerant). Duraphat. (2.26% F).
(C) At present the definitive aetiology of MIH is unclear.
A recent literature review by Crombie et al in 2009 concluded that there is currently
insufficient evidence in the literature to establish aetiological factor/s relevant for MIH.
There is moderate evidence that polychlorinated biphenyl/dioxin exposure is involved in
the aetiology of MIH; weak evidence for the role of nutrition, birth and neonatal factors,
and acute or chronic childhood illness/treatment; and very weak evidence to implicate
fluoride or breastfeeding.

Aetiology of molar-incisor hypomineralization: a critical review. Crombie F, Manton

D, Kilpatrick N. Int J Paediatr Dent. 2009 Mar;19(2):73-83.