Differential diagnosis It is essential to exclude other causes of enamel opacities, differentiating MIH from them, to ensure an appropriate treatment plan is made. These conditions include: * Dental caries, which is the most common cause of destruction of dental hard tissues. This is more unlikely in a patient with a previously intact primary dentition. White spot lesions are also uncommon on incisors, hence ruling out dental caries. * Fluorosis, which can result from an intake of a high fluoride concentration while the tooth is still undergoing mineralisation. Fluorosis presents as irregular, diffuse enamel opacities which affect more than 1 tooth, in contrast to the well-demarcated borders of hypomineralised enamel seen in MIH. * Amelogenesis imperfecta, a genetic condition, and thus there may be a history of similar defects in other family members. This condition affects both the primary and permanent dentition, and all surfaces tend to be equally affected, differentiating it from MIH. * Trauma to primary incisors resulting in discolouration of permanent incisors. * Administration of tetracycline during pregnancy and to children under 6 resulting in tooth staining (grey or yellow). * Enamel hypoplasia, caused by defective enamel matrix formation, is a quantitative defect which presents as a localised reduction in enamel thickness. This differs from<unk> , which is a qualitative defect affecting the translucency of enamel. Classification MIH examination should be carried out on clean, wet teeth. The ideal age for examination is when the child is 8 years old - the age where all permanent first<unk> s and most of the incisors are erupted. The permanent first<unk>  will also still be in a comparatively sound condition without excessive post-eruption breakdown. Judgements of each individual teeth should be recorded, aiding the correct diagnosis of the condition. There is currently a lack of standardisation in the scoring system and severity indices used to record the diagnosis of MIH. Various systems commonly employed in studies include: * Modified Defect of Dental Enamel (DDE) Index: This set of criteria allows for enamel defects to be detected, enabling a distinction between demarcated and diffused opacities. * European Academy of Paediatric Dentistry (EAPD) judgement criteria: This set of criteria was developed in 2003 to standardise classifications for use in epidemiological studies. However, while it allows the categorisation of the enamel condition, it does not address the severity of the enamel condition. *<unk><unk>  Severity Index (MHSI): This set of criteria has been developed to address deficiencies in indices concerning the severity of<unk> . It is based on both the clinical characteristics of hypomineralised defects and the EAPD judgement criteria. It was found to be effective in guiding the clinical management of children by predicting treatment undertaken for affected permanent first<unk> s. *Ghanim et al index: The index combines principles of the EAPD judgement criteria and DDE index in order to grade the clinical status, amount of tooth surface area affected, and other enamel defects comparable to MIH. The index has been validated and a training manual was developed to assist researchers in implementing the index in a standardised manner.
Molar incisor hypomineralisation
Maxillary lateral incisor agenesis
Chattering teeth
Shovel-shaped incisors
Cartilage–hair hypoplasia
Impacted wisdom teeth
Maxillary hypoplasia
Enamel hypoplasia