Molar-Incisor Hypomineralisation — ORE Part 1 MCQ

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ModeratePaediatric DentistryMolar-Incisor HypomineralisationORE Part 1

A child presents with yellow-brown hypoplastic defects on the first permanent molars and upper central incisors. The defects are demarcated and asymmetric in distribution. What is the most likely diagnosis?

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Correct answer: E — Molar-incisor hypomineralisation (MIH)

Explanation lettering: B = shown as A · E = shown as B · A = shown as E

The diagnosis is Molar-Incisor Hypomineralisation (MIH). The stem provides three pathognomonic features: (1) demarcated defects with clear borders, (2) selective involvement of first permanent molars and upper central incisors, and (3) asymmetric distribution. MIH is a qualitative developmental enamel defect (hypomineralization, not hypoplasia) of systemic origin characterised by demarcated opacities that present in white, yellow, or brown discoloration. The asymmetric pattern is a hallmark distinguishing MIH from other conditions. Fluorosis (B) produces symmetric, diffuse opacities across multiple teeth. Amelogenesis imperfecta (C) affects all teeth symmetrically and bilaterally. Vitamin D deficiency (D) causes hypoplasia (not hypomineralization) with a generalized pattern. Turner tooth (E) is a localized single-tooth defect due to local trauma. The combination of demarcated, asymmetric yellow-brown defects on first permanent molars and incisors is diagnostic of MIH.

Reference: Weerheijm KL, et al. (2001). Molar-incisor hypomineralisation. Caries Research. Confirmed by European Academy of Paediatric Dentistry (EAPD) diagnostic criteria; endorsed in systematic reviews and international literature on paediatric dental developmental defects. https://pubmed.ncbi.nlm.nih.gov/33764036/