Molar incisor hypomineralization (MIH) refers to specific developmental qualitative
defect of the enamel that typically affect 1 to all 4 of the permanent molars and can
also involve the permanent incisors.
MIH is clinically characterized by morphological enamel defects that can be seen on the
occlusal surface of permanent molars and the incisal one-third (or more) of the incisors
result from hypomineralization. These defects more or less well-defined opacities that
vary in size and can be discoloured from white to yellow brownish. The hypomineralized
enamel is friable and has inferior mechanical properties as well as reduced modulus of
elasticity when compared to sound enamel.
As a consequence, hypomineralized enamel leads to post-eruptive breakdown and
hypersensitivity, and it is prone to development of carious lesions and pain. Due to
pain, fragile enamel and increased treatment need at an early point of time in life, MIH
treatment represents a clinical challenge. The well-defined opacities are focal
subsurface decalcifications in enamel are commonly associated with extended plaque
retention. Periodontal disease in children is mainly limited to gingival inflammation and
is observed as gingival oedema, colour and contour changes, bleeding on probe or
spontaneous bleeding.
Recent study showed that plaque accumulation and gingival inflammation were higher in
patients with MIH compared with healthy children, and that oral hygiene and gingival
health worsened as the severity of MIH increased.
Vitamin D, plays a pivotal role in many biological functions such as in innate immunity
effect, the regulation of calcium (Ca+) and phosphate metabolism and their deposition in
mineralized tissues. Since the presence of Vitamin D3 receptors on ameloblast and
odontoblast cells, its function in tooth development and remineralization, changes in the
biochemical composition of saliva and immunological modulation of dental infection has
been suggested.
Vitamin D has been demonstrated to have significant potential in improving the
remineralization of early lesions on enamel surfaces enhancing surface microhardness and
minerals content. Remineralization is defined as the process whereby calcium and
phosphate ions are supplied from a source external to the tooth to promote ion
deposiption into crystal voids in demineralized enamel, to produce net mineral gain.
Recent ex-vivo study revealed that the topical application of fluoride and vitamin D
promoted the formation of persistent mineral crystals on enamel surfaces of deciduous
teeth. Consequently, this study recommends further evaluation to be potentially used as
an alternative strategy.
The treatment of teeth affected by MIH should be a minimally invasive procedure that aims
to protect, strengthen and preserve dental structure. Numerous therapeutic alternatives
have been proposed over time for the treatment of MIH-affected teeth, but the clinical
management of these conditions is very demanding and less conservative.