The frequency of first permanent<unk>  treatment for children with MIH is nearly 10 times greater compared to children without MIH. The available treatment modalities for MIH is extensive but the decision on which treatment should be used is complex and multi-factorial. Factors may include: condition severity, the patient’s dental age, the child/parent’s social background and expectations. There are treatment modalities available to manage children affected by MIH; however, the evidence supporting these modalities are still weak. Anterior teeth Etch-bleach-seal technique Involves repeated cycles of etching with 37% phosphoric acid followed by applying 5% sodium hypochlorite until improvement of discolouration is achieved. Clear resin composite or resin infiltrate can be used to seal the lesion after the technique. Microabrasion This image shows a dental veneer, usually used to improve aesthetics of teeth. The aesthetics of a child’s anterior teeth is a concern for both children and their parents alike. Yellow or brownish-yellow defects are of full thickness, and therefore may respond to bleaching with carbamide peroxide. However, careful consideration should be made of the risks including hypersensitivity, mucosal irritation and enamel surface alterations. Creamy-yellow or whitish-creamy defects are less porous and variable in depth, and may respond to microabrasion with 18% hydrochloric acid or 37.5% phosphoric acid and abrasive paste. Again, this should be undertaken cautiously as microabrasion may result in loss of enamel. Veneers Direct or indirect composite veneers can be effective in improving aesthetics with minimal tooth tissue removal. Ceramic veneers as a treatment option should be delayed due to the risks of resulting in a short clinical crown height, immature tooth pulp irritation and also the instability of the gingival margins during the eruption of teeth. Posterior teeth Fissure sealants The placement of fissure sealants on permanent<unk> s without post-eruptive breakdown should be undertaken. Use of a 5th generation bonding adhesive prior to fissure sealant application may improve retention rates of fissure sealants. For partially erupted<unk> s with inadequate moisture control, glass ionomer cements (GIC) can be considered as an interim treatment option. As the retention rate of GIC is often poor, replacement with a resin-based fissure sealant is recommended following tooth eruption. Resin-based fissure sealants can be beneficial to patients affected with mild MIH where the first permanent<unk> s have fully erupted, although the degree of<unk>  affects the bond strength of said sealants. The bond strength of resin based fissure sealants to affected MIH can be enhanced by pre-treating with 5% sodium hypochlorite for one minute after etching, and applying a bonding agent. However, more evidence is needed from clinical based studies. Direct restorations Cavity design There is still much debate of whether margin extension should include removal of all defective enamel or only the porous enamel. The former provides sound enamel for bonding but leads to excessive tooth tissue loss. The latter is less invasive, but the margins may have a high risk of breakdown due to defective bonding. Yet, it is agreed that adhesive restorations should be used as opposed to those reliant upon mechanical retention (such as amalgam). Composite resin restorations Composite resin material has been shown to have longer-term stability in MIH teeth, with a median survival rate of 5.2 years and a success rate of 74%-100% during a 4-year follow-up period. Self-etching adhesive was found to have better bond strength to enamel affected by MIH compared to total etch single-bottle adhesive. The use of composite should be considered both for permanent<unk> s affected by MIH, as well as incisors. Furthermore, composite veneers may achieve a better aesthetic result where deep lesions are seen in incisors. Glass ionomer cement (GIC) restorations GIC materials have adhesive capabilities with both enamel and dentine, long-term fluoride release and hydrophilicity when there is inadequate moisture control intra-orally, during early post-eruptive stages. However, GIC’s poorer mechanical properties suggest avoidance in stress-bearing areas. In later post-eruptive stages GIC may be valuable as sub-layer beneath composite restorations. Indirect restorations Preformed metal crowns Pre-formed metal crowns (PMC), also known as stainless steel crowns, can be used to reduce the risk of marginal breakdown, coronal leakage and has a good longevity. The use of preformed metal crowns on MIH-affected<unk> s can prevent further tooth loss, control hypersensitivity and aim to establish correct interproximal and occlusal contact. They are relatively inexpensive and require little preparation. To prevent further tooth preparation and tissue loss, use of the Hall Technique should also be considered. There advantage is use during any stage of post-eruptive breakdown, but evidence of their efficacy is limited. Although the PMC has evidence to show that it is well accepted, a few of the children and their carers expressed their concerns about the metallic appearances of the restoration. Cast restorations Cast restorations may include full coverage crowns for MIH-affected permanent teeth. Generally cast restorations requiring tooth preparation are not recommended in young children due to large pulp size, short crown height and potential difficulties in obtaining a good impression for subgingival crown margins. Extractions Tooth extraction is one of the treatment options for MIH, especially for symptomatic cases. A list of considerations can affect the final decision on whether extraction of the affected teeth should be carried out or should it be retained such as: severity of MIH; patient’s aesthetic expectations; whether the patient is suitable to undergo orthodontic treatment; orthodontic concerns (e.g. crowding, facial profile, missing or supernumerary teeth, presence of third<unk> s). Timely extractions are often the preferred treatment plan for first permanent<unk> s that are severely affected and symptomatic. The facilitation of eruption of the second permanent<unk> s to the space of the first permanent<unk>  removes the burden of continuous restorative treatment. A favourable occlusion may be acquired following a well-planned treatment and this eliminates the need for fixed orthodontic appliances therapy. However, a comprehensive discussion of the possible need of orthodontic sequelae and treatment is important. Favorable eruption position of the second permanent<unk>  may result if the first permanent<unk>  is extracted when the child is at the age of between 8–10 years old. This is when the crown formation of the second permanent<unk>  is complete and the mineralization of the bifurcation is commenced. Extraction of first permanent<unk> s before 8 years old increases the chances of the unerupted second permanent premolar drifting distally. Extraction after the age of 10 years reduces the likelihood of the mesial movement of the second permanent<unk>  in to the first permanent<unk>  space and may result in tilting of the second permanent<unk> .
Molar incisor hypomineralisation
Maxillary lateral incisor agenesis
Chattering teeth
Shovel-shaped incisors
Cartilage–hair hypoplasia
Impacted wisdom teeth
Maxillary hypoplasia
Enamel hypoplasia