MIH defects for a specific arch (upper/lower)/ Clinical features in MIH syndrome
hemiarch (right/left) [9,16-19].
Clinical examination should be undertaken on
Etiology of MIH syndrome clean, wet teeth. The optimum age for examination
is 8 years, as the four permanent molars and the
The syndrome has a multifactorial etiology permanent central incisors are erupted at least
(environmental, medical, genetic, systemic by half. At the clinical exam, the paediatric
factors), all etiological elements acting dentist can notice the following elements:
additionally or even synergistically [20-22], with ¾ ¾ limited opacities at permanent molar/
genetic predisposition (due to the fact that tooth molars level and/or incisor level
development is under a strict genetic control). ¾ ¾ variation in enamel color: white à yellow à
Even if no conclusive data concerning a brownish
specific etiology of MIH syndrome are available, ¾ ¾ enamel loss in permanent molars
it seems that the etiological factors may be related ¾ ¾ hypomineralised enamel is soft, porous,
to prenatal, perinatal and postnatal periods of brittle, chalk like, old Dutch cheese-like
child development, as follows: ¾ ¾ post eruptive enamel breakdown (PEB) à
image of hypoplasia, yet the borders to normal
A. Prenatal factorsà maternal disorders and
enamel are irregular
infections, such as [20, 23-25]:
¾ ¾ sharp demarcation between sound and
√√ Hypocalcemia affected enamel
√√ A and D hypovitaminosis ¾ ¾ dental sensitivity or hypersensitivity to
√√ Diabetes mellitus cold food, cold temperature, brushing à pain
√√ Rubella ¾ ¾ poor oral hygiene
√√ Urinary tract infections ¾ ¾ caries
B. Perinatal factors [20,23,25-27]: ¾ ¾ pulp involvement
¾ ¾ aesthetic problems
√√ Caesarian section
According to the European Academy of
√√ Prolonged delivery
Paediatric Dentistry (EAPD) (2010), MIH it can
√√ Premature birth
be classified into the following forms [15]:
√√ Twin delivery
√√ Infant hypoxia ¾ ¾ Mild
√√ Very low birth weight -- isolated opacities
√√ Neonatal hypocalcemia -- discoloration of permanent incisors
√√ Cyanosis, etc. -- demarcated enamel opacities without
C. Postnatal factors [7,20,24-26,28,29]: breakdown of the enamel
-- sensitivity to external stimuli occasionally
√√ Children with a general disease present (e.g. sensitivity to air/water but not to
√√ Prolonged breast feeding (exposure to brushing)
dioxin) -- aesthetic concerns from the part of the
√√ Hypocalcemia parent/child are mild
√√ Nutrition problems
√√ Chicken pox, measles, rubella and other ¾ ¾ Severe
viral infections with high fever development -- demarcated enamel opacities with
√√ Respiratory diseases (asthma, lung breakdown of the enamel
problems) -- hypersensitivity – persistent/spontaneous
√√ Antibiotics administration (e.g., amoxicillin) -- caries
√√ Anti-asthmatic medication -- crown destruction à pulp involvement
√√ Otitis media -- function alteration
√√ Thyroid and parathyroid disturbances -- intense aesthetic concerns from the part of
the parent/child à psycho-social impact
5. Koch G, Hallonsten AG, Ludvigsson N, Hansson first molars in a group of Swedish children. Acta
BO, Holst A, Ullbro C. Epidemiological study of Odontol Scand. 2001; 59(5):255-60.
idiopathic enamel hypomineralisation in permanent 17. Chawla N, Messer LB, Silva M. Clinical studies on
teeth of Swedish children. Community Dentistry molar-incisor-hypomineralisation part 1:
and Oral Epidemiology. 1987;15(5):279-85. distribution and putative associations. Eur Arch
6. Weerkheijm KL, Jalevik B, Alaluusua S. Molar- Paediatr Dent. 2008;9(4):180-90.
incisor-hypomineralisation. Caries Research. 2001b; 18. Weerkheijm KL, Groen HJ, Beentjes VE, Poorterman
35(5):390-1. JH. Prevalence of cheese molars in eleven-year-old
7. Wogelius P, Haubek D, Poulsen S. Prevalence Dutch children. ASDC J Dent Child.2001;68(4):259-
and distribution of demarcated opacities in 62, 229.
permanent first molars and incisors in 6 to 8 19. Weerheijm KL. Molar Incisor Hypomineralisation
years old Danish Children. ActaOdontol Scand. (MIH). European Journal of Paediatric Dentistry.
2008; 66(1):58-64. 2003;4(3):115-20.
8. Alaluusua S, Lukinmaa PL, Koskimies M, Pirinen S, 20. Alaluusua S. Aetiology of Molar-Incisor
Hölttä P, Kallio M, Holttinen T, Salmenperä L. Hypomineralisation: A systematic review. Eur arch
Developmental dental defects associated with long Paediatr Dent. 2010;11(2):53-58.
breast feeding. Eur J Oral Sci. 1996;104(5-6):493-97. 21. Crombie F, Manton D, Kilpatrick N. Etiology of
9. Leppaniemi A, Lukinmma PL, Alaluusua S. molar incisor hypomineralisation: a critical review.
Nonfluoride hypomineralisation in permanent first Int J Paediatr Dent. 2009;19(2):73-83.
molars and their impact on treatment need. Caries 22. Fagrell TG, Ludvigsson J, Ullbro C, Lundin SA,
Res. 2001;35(1):36-40. Koch G. Etiology of severe demarcated enamel
10. Calderara PG, Gerthoux PM, Macarelli P, Lukinmaa opacities – an evaluation based on prospective
PL, Tramacere PL, Alaluusua S. The prevalence of medical and social data from 17,000 children. Swed
molar incisor hypomineralisation (MIH) in a group Dent J. 2011;35(2):57-67.
of Italian schoolchildren. Eur J Paediatr Dent. 23. Lygidakis NA, Dimou G, Briseniou E. Molar-Incisor-
2005;6(2):79-83. Hypomineralisation (MIH)retrospective clinical
11. Păsăreanu M, Mocanu RM, Bălan A. The syndrome study in Greek children. Eur Arch Paediatr Dent.
MIH systemic impact in children and adolescents: 2008;9(4):200-6.
relevance area. Romanian Journal of Oral 24. Whatling R, Fearne JM. Molar incisor
Rehabilitation. 2012;4(2):82-89. hypomineralisation: a study of aetiological factors
12. Cho SY, Ki Y, Chu V. Molar incisor hypomineralisation in a group of IK children. Int J Paediatr Dent.
in Hong Kong children. Int J Paed Dent. 2008;18(3):155-62.
2008;18(5):348-52. 25. Jontell M, Linde A. Nutritional aspects on tooth
13. Balmer RC, Laskey D, Mahony E, Toumba KJ. formation. World Rev Nutr Diet. 1986; 48:114-36.
Prevalence of enamel defects and MIH in non- 26. Beentjes VE, Weerheijm KL, Groen HJ. Factors
fluoridated and fluoridated communities. Eur J involved in aetiology of molar-incisor
Paediatr Dent. 2005;6(4):209-12. hypomineralisation. Eur J.Paediatr Dent. 2002;3(1):9-
14. Jalevik B. Prevalence and diagnosis of molar-incisor- 13.
hypomineralisation (MIH): a systematic review. 27. Seow WK. A study of the development of the
EurArch Paediatr Dent. 2010;11(2):59-64. permanent dentition in very low birthweight
15. Lygidakis NA, Wong F, Jalevik B, Vierrou AM, children. Pediatr Dent. 1996;18(5):379-84.
Alaluusua S, Espelid I. Best Clinical Practice 28. Laisi S, Ess A, Sahlberg C, Arvio P, Lukinmma PL,
Guidance for Clinicians dealing with children Alaluusua S. Amoxicilin may cause molar incisor
presenting with Molar-Incisor-Hypomineralisation hypomineralisation. J Dent Res. 2009;88(2):132-6.
(MIH) – An EAPD Policy Document. European 29. Alaluusua S1, Lukinmaa PL, Vartiainen T, Partanen
Archives of Paediatric Dentistry. 2010;11(2): 75-81. M, Torppa J, Tuomisto J. Polychlorinated dibenzo-
16. Jalevik B, Klingberg G, Barregard L, Noren JG. The p-dioxins and dibenzofurans via mother’s milk may
prevalence of the demarcated opacities in permanent cause developmental defects in child’s teeth.
Environ Toxicol Pharmacol. 1996;1(3):193-7.
30. Oliver K, Messer LB, Manton DJ, Kan K, Ng F, Olsen
C, Sheahan J, Silva M, Chawla N. Distribution and
severity of molar hypomineralisation: trial of a new
severity index. Int J Paediatr Dent. 2014;21(2):131-51.