Molar incisor hypomineralisation (MIH) is a developmental, qualitative enamel defect affecting all types of primary and permanent teeth with a worldwide prevalence of nearly 15% and no gender differences. Patients complain mainly of sensitivity and pain during eating or brushing teeth, and esthetics. Clinically, MIH manifests as hypomineralized enamel which is soft, porous, with color that may vary from white, yellow or brown. The porous, brittle enamel can easily chip under masticatory forces. Due to pain and sensitivity, children avoid tooth brushing, and with the porous, brittle enamel, this makes them more prone for dental caries. Caries on MIH teeth, if left untreated, will rapidly progress towards the pulp and can eventually lead to pulpal necrosis in which case root canal treatment or extraction would be required; both leading to loss of a vital tooth at a young age. Therefore, early examination, prevention and treatment are encouraged in light of the management difficulties of such children which include sensitivity, inability to obtain profound anesthesia, limited access and isolation, and behavior management in young patients and adolescents which may range from non-pharmacologic approaches to sedation, or need for general anesthesia.

Principles of management of MIH include preventive therapy, restorative therapy using adhesive materials or preformed crowns, pulp therapy (vital or non-vital procedures), and extraction of the first permanent molars if the timing is optimal. The purpose of this presentation will be to describe the diagnosis and clinical presentation and therefore, outline a sequential approach to management of MIH since partial eruption of molars till later stages of post-eruptive breakdown based on current literature and guidelines. Management of different cases will be presented.