What To Know About Molar Incisor Hypomineralisation

While you might not have heard about it so often, molar incisor hypomineralisation (MIH) is a fairly common dental condition that results in defective enamel. Normally, the enamel is responsible for protecting the tooth, but in the case of MIH, the teeth are left more vulnerable to a plethora of problems, which not only cause physical discomfort but also come with aesthetic issues for the affected individual. 

With a condition like MIH, one needs to be extra careful about taking care of their teeth. Fortunately, there are treatments that can help in the management of molar incisor hypomineralisation, however, it’s a good idea to understand what it really is, what it may look like, and what you can do.  

What Is Molar Incisor Hypomineralisation?

Molar incisor hypomineralisation is a condition which negatively affects the mineralisation of the tooth, leaving it prone to damage. While the name of the condition might suggest that it only affects incisors, this isn’t the case.

The term was initially used to refer to first permanent molars as well as incisors, but it has since been noted that it can “affect any primary or permanent tooth,” as reported in a study published in the British Dental Journal.  

If you have this condition, it doesn’t necessarily mean that all your teeth will be affected. According to research published in the International Journal of Paediatric Dentistry, enamel hypomineralisation can be more commonly seen in the 1st and 2nd permanent molars.


The researchers also noted that when the MIH was severe in the 1st permanent molars, mild defects were more frequent in the second permanent molars.

Regardless, the condition can make the enamel “softer” than it normally is, per the NHS. Additionally, the enamel is so porous that it might not even be able to withstand the forces of mastication, getting “easily damaged” by it, as explained by a study published in Contemporary Clinical Dentistry.

The same study also noted that MIH may make it easier for cavities to develop and make the teeth more sensitive; other issues associated with this condition can include:

  • Poor aesthetics
  • Anxiety
  • Loss of tooth

It can also be difficult for children with this condition to get treatment because anaesthesia on such teeth is more difficult; the use of inhalation sedation has been suggested for MIH patients, however, only your dentist can best advise you on this.

How Common Is Molar Incisor Hypomineralisation?

In the UK, 1 in 8 children are affected by molar incisor hypomineralisation, per King’s College Hospital NHS Foundation Trust. However, as far as the worldwide prevalence rate of MIH is concerned, 11.24% to 14.2% has been reported by a study published in Acta Odontológica Latinoamericana.

What Does Molar Incisor Hypomineralisation Look Like?

People with molar incisor hypomineralisation are said to have “chalky teeth” (they were also referred to as “cheesy molars” early on). Because of the issue with the enamel, not only can it make the teeth more prone to wearing away – with even pieces of it breaking away – they can also get discoloured. Such teeth can have clearly defined areas of “white/yellow/brown opacities,” according to a study in the Journal of Pharmacy and Bioallied Sciences.

molar incisor hypomineralisation
Image credit: Rodd HD, Graham A, Tajmehr N, Timms L, Hasmun N. Molar Incisor Hypomineralisation: Current Knowledge and Practice. Int Dent J. 2021;71(4):285-291. doi:10.1111/idj.12624/CC BY-NC-ND 4.0

The opacity of the tooth can indicate how “problematic” the tooth can be. According to a paper in the European Archives of Paediatric Dentistry, the darker it is, the more soft and porous the enamel is, and the risk of substance loss is greater along with dentin exposure.

What Causes Molar Incisor Hypomineralisation?

The cause of molar incisor hypomineralisation (MIH) is not yet known. But among the different causes of this problem, as reported by the study in the British Dental Journal, the following are included:

  • Low birth weight
  • Respiratory tract infections
  • Oxygen starvation
  • Frequent diseases in childhood
  • Prolonged breastfeeding
  • Antibiotics
  • Dioxins (environmental pollutants)
  • Perinatal complications (period of time at or around the time of birth)
  • Calcium and phosphate metabolic disorders
  • (Possibly) genetics

According to the NHS, the issue may occur due to “disturbance” in the development of the tooth either when the birth occurs or during the early years of life.

How Is Molar Incisor Hypomineralisation Diagnosed?

For a proper diagnosis of molar incisor hypomineralisation, it is important that you get in touch with a medical professional. In addition to performing an X-ray, your dentist will also check for the signs of this condition, such as the discolouration and the condition of your teeth, along with asking for a history to check for any of the potential causative factors.

What Is The Treatment For Molar Incisor Hypomineralisation?

The treatment for molar incisor hypomineralisation can depend on the teeth that have been affected, what their condition is and how old the child is. In case the teeth at the front are affected, the treatments may include:

In the case of back teeth, the treatment may include:

Other than that, to make sure that the teeth stay protected, your dentist may also advise more frequent dental check-ups, controlling the intake of sugar, and using fluoride toothpaste. A tooth mousse may also be recommended for sensitivity. In any case, you must consult your own doctor and follow their advice.


Molar incisor hypomineralisation can be a very problematic condition. Not only can it be a cause of severe discomfort, but the discolouration of the teeth can also affect the self-esteem of the children affected by this condition.

While it can damage the teeth drastically, it’s important that you don’t delay treatment and make sure to attend all the check-up appointments to try and keep the teeth in the best possible shape.

Reviewed and approved by Dr Izbel Aksit


At what age does molar incisor hypomineralisation occur?

Usually, the presence of this condition is noticed around the age of 6 to 7 – the time when permanent teeth start to come out. However, it can also occur earlier, from the ages of 2-3 and onwards, according to the NHS, as molar incisor hypomineralisation can sometimes affect baby molar teeth at the back.

What is the difference between molar incisor hypomineralisation and hypoplasia?

As noted in a 2019 study in the British Dental Journal, molar incisor hypomineralisation is a “qualitative” issue, while hypoplasia is a “quantitative” one. In MIH, the reduced minerals lower the quality of the enamel, while in enamel hypoplasia, the enamel can be missing, have pits, grooves or you can have smaller teeth. 

Does molar incisor hypomineralisation predispose to caries?

Molar incisor hypomineralisation can make your teeth more vulnerable to cavities. It’s because of the poor quality of the enamel.

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