A common clinical challenge: molar incisor hypomineralisation (MIH)
A concerned parent brings a child to the practice complaining of painful teeth that appear to have “come through decayed”. Examination reveals demarcated opacities on the first permanent molars and incisors. This is a familiar presentation for many clinicians managing molar incisor hypomineralisation (MIH). Affecting around 10-20% of the UK population, MIH is a common finding in everyday practice[i]. Its impact on quality of life can be significant, and early recognition allows timely intervention.
What to spot
The exact cause of MIH remains unclear, although early life factors may play a role[ii]. Events during pregnancy, birth, or early childhood such as measles have been linked to its development[iii],[iv].
Clinically, it presents as demarcated enamel opacities ranging from white, cream, yellow, or brown. The enamel is often fragile, leading to hypersensitivity and rapid breakdown shortly after eruption. The term ‘cheese molars’, coined by Dr Jan Jälevik, aptly describes their appearance[v]!
Not to be confused with amelogenesis imperfecta, fluorosis, enamel hypoplasia or white spot lesions, MIH typically shows an asymmetrical distribution of lesions. If you’re unsure, it’s often safest to manage the tooth as MIH, since these teeth are particularly vulnerable to caries[vi].
More than a dental defect
MIH is more than an enamel defect. It can significantly affect a child’s daily life. Persistent sensitivity and pain make brushing and eating difficult, often leading to dental fear and avoidance of care[vii]. Repeated appointments may mean missed school, while visible defects on incisors can impact confidence and leave children vulnerable to teasing or bullying.
Ready, steady, protect
Management of MIH begins with careful assessment and early diagnosis. A preventive-first approach focuses on optimising oral hygiene, providing dietary advice, and using fissure sealants and regular fluoride varnish to reduce caries risk and manage sensitivity[viii].
When breakdown or caries occurs, interim restorations can stabilise the teeth until definitive treatment is possible. Then clinicians may place composite resin restorations or stainless-steel crowns. In extreme cases of extensive caries or limited cooperation, extraction with orthodontic planning may be considered. Ongoing monitoring is essential to achieving successful long-term outcomes.
Advanced biotechnology
Higher-fluoride toothpastes (2800 ppm and 5000 ppm formulations) require a prescription and, whilst considered clinically safe, may raise concerns among some parents regarding accidental ingestion[ix]. In contrast, BioMin® F toothpaste’s patented bioactive glass contains just 540 ppm fluoride, which is released during gradual dissolution in saliva, with accelerated release under acidic conditions.
This is particularly relevant for patients experiencing frequent acid challenges, such as grazing, where repeated drops in oral pH occur[x]. Following carbohydrate intake, salivary pH can fall below the critical threshold of ~5.5, initiating hydroxyapatite dissolution[xi]. In the presence of fluoride, this promotes the formation of more acid-resistant fluorapatite, lowering the critical pH to ~4.5 and providing more resilient protection[xii].
Prolonged protection between brushing
Using bioactive glass technology, BioMin® F dissolves gradually in saliva and water, and more rapidly in acidic conditions, subsequently releasing fluoride, calcium and phosphate ions, supporting fluorapatite formation on the tooth surface[xiii]. Unlike conventional sodium fluoride, which dissolves in saliva and is quickly washed away, this matrix bonds to the tooth and releases ions over approximately 10-12 hours[xiv]. This sustained action supports sensitivity management, with studies demonstrating dentinal tubule occlusion even after acid challenge.[xviii]
For patients who struggle with sensitivity or maintaining consistent routines, BioMin® F toothpaste provides extended protection between brushing.
For optimal benefit, clinicians advise patients not to rinse after brushing. However, many young patients find minty toothpastes too “spicy”. BioMin® F therefore features a mild flavour and is available in a child-friendly strawberry version.
Prevention, comfort and care
Together with early diagnosis and preventive care, BioMin® F offers clinicians a valuable adjunct for supporting long-term oral health in patients with MIH.
