MIH Initial Management — ORE Part 1 MCQ

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ModeratePaediatric DentistryMIH Initial ManagementORE Part 1

A 7-year-old child presents with a partially erupted lower first permanent molar affected by severe molar-incisor hypomineralisation (MIH). There is post-eruptive enamel breakdown and marked hypersensitivity, but no swelling or signs of infection. What is the most appropriate initial management?

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Correct answer: A — Apply fluoride varnish and place a protective glass-ionomer restoration

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

A is correct. This painful, partially erupted MIH molar has post-eruptive breakdown and needs prompt stabilisation. Fluoride varnish and a protective glass-ionomer restoration reduce sensitivity, protect vulnerable enamel/dentine and limit further breakdown while eruption and longer-term prognosis are assessed. SDCEP identifies MIH molars as prone to breakdown, hypersensitivity and rapidly progressing caries, and its MIH advice includes GIC restorations. B is premature: planned extraction may be appropriate for a poor-prognosis first permanent molar, but requires fuller assessment and is not the default immediate response. C may be considered later, but bonding to MIH enamel is challenging and it is not necessarily the best initial option in a partially erupted tooth. D is inappropriate at age 7. E leaves a symptomatic tooth unprotected.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Prevention and Management of Dental Caries in Children: Guidance Update Methodology, Appendix 4.13 Molar Incisor Hypomineralisation, 2025. https://www.childcaries.sdcep.org.uk/media/tcdbh4uc/sdcep-prevention-and-management-of-dental-caries-in-children-guidance-update-methodology-2025.pdf