Originally published in 2019.
Republished in 2022 following global agreement validation.
The 2022 version reflects methodological standardisation within the IAPD Consensus & Foundational Articles framework and formal evaluation of international agreement. No substantive changes were made to the clinical recommendations.
Molar Incisor Hypomineralization (MIH) is a developmental condition affecting the enamel of first permanent molars and frequently the permanent incisors. The condition is characterised by qualitative enamel defects that may present as demarcated opacities, enamel breakdown, hypersensitivity, and increased susceptibility to caries.
Children affected by MIH often experience discomfort, difficulty with oral hygiene, and aesthetic concerns. Early diagnosis and appropriate management are therefore essential to minimise complications and maintain oral health.
Core principles include:
Management of MIH requires careful clinical judgement and may involve a combination of preventive, restorative, and behavioural strategies to support the child’s oral health and quality of life.
Early diagnosis of MIH is essential to allow timely preventive and therapeutic interventions.
Preventive measures, including fluoride use and desensitising strategies, may help protect affected teeth and reduce hypersensitivity.
Treatment planning should consider the severity of enamel defects, the child’s age, and the functional and aesthetic impact of the condition.
(Evidence-based recommendations are not subject to global agreement scoring.)
(Evaluated for Global Agreement in 2022)
Management strategies should be individualised according to the severity of MIH and the specific needs of the child.
Restorative treatment options may include minimally invasive approaches, adhesive restorations, or full coverage restorations depending on the extent of enamel breakdown.
Children with MIH may require additional behaviour guidance and pain management strategies due to increased tooth sensitivity.
Regular monitoring and long-term follow-up are important to assess treatment outcomes and adjust care plans as needed.
To support clinical implementation and knowledge translation, IAPD has developed complementary educational materials.
🎙 IAPD Podcast Series
Selected episodes of the IAPD Podcast Series explore the prevalence, clinical challenges, and management strategies associated with molar incisor hypomineralization.
3️⃣ Understanding HSPM and MIH: Global Prevalence and Aetiology
Presenter: Dr Marlies Elfrink
4️⃣ The Child’s Voice & Aesthetic Management of MIH
Presenter: Dr Joana Monteiro
5️⃣ Hypersensitivity & Functional Management of MIH-Affected Teeth
Presenter: Dr Joana Monteiro
🎥 IAPD Webinar
Relevant webinars may address the diagnosis and clinical management of developmental enamel defects such as MIH.
The most difficult decisions in Molar Hypomineralization – Dr. Jorge Casian
International Association of Paediatric Dentistry (IAPD).
IAPD Foundational Articles and Recommendations on the Management of Molar Incisor Hypomineralization.
Originally published 2019. Global Agreement Validation 2022.
