Molar-Incisor Hypomineralization: What Parents Should Know

It can be incredibly exciting when your child gets their first adult tooth. However, some parents will ask me, "Why does my kid have a funny spot on their tooth?" Sometimes, the front adult teeth or the back adult molars can look like they have different colored spots on them. These spots can be bright white, dark yellow, or even brown. The spots can sometimes be noticed as soon as the teeth poke through the gums. Parents ask me if those spots are from cavities or because of some other reason.

What is Molar-Incisor Hypomineralization (MIH)?

These spots on your child's teeth could be from the tooth developing weaker than a normal tooth. These teeth may have tiny white spots on the tooth surface or huge brown spots that develop into holes. Teeth affected with MIH can be discolored, can break, and get cavities more easily compared to a healthy tooth. This pattern is also called molar-incisor hypomineralization, or MIH. These teeth may not be painful. If the teeth are painful, hot or cold foods and drinks, air, or even a toothbrush can make the teeth hurt. At least one to four of the back permanent molars and sometimes the front adult teeth might be affected. Rarely, children can have hypomineralization in their baby molars, too.

The current guess is that MIH affects about 1 in 9 children in the US. The most recent research suggests that there are multiple possible causes such as genetics, medical conditions, or environmental exposures. Although cavities don't directly cause MIH, MIH can make teeth much more prone to cavities. There are different ways to categorize MIH from being mild, moderate, to severe.

What are the treatment options?

Based on how broken or how painful the teeth are, there can be different options for treatment. With mild MIH, options like protective sealants, silver diamine fluoride, or other fluorides and remineralization medicine can be applied to the teeth. In more severe cases, the teeth may need to be fixed with tooth-colored fillings, silver fillings, or stainless steel crowns. If the teeth are not fixable or the tooth probably won't last very long for other reasons, pulling the tooth (extraction) might be the best option. Based on the timing of when a back permanent molar is removed, the second permanent molar can sometimes replace the spot of the missing first permanent molar without any braces or orthodontic treatment. This can be a lower cost and better overall outcome than trying to fix a very broken molar.

What should you do if your child has MIH?

The most important recommendations are to have your child see a dentist regularly and to take care of your child’s teeth with a healthy diet as well as good toothbrushing. Brushing twice daily with fluoride toothpaste and staying away from sugar snacks, drinks, and foods can help protect weaker teeth. If you have concerns about MIH, ask your dentist. After your dentist looks at your child's teeth and takes x-rays, your dentist can determine if the pattern is truly MIH or it is due to cavities.