MIH Classic Pattern — ORE Part 1 MCQ

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ModeratePaediatric DentistryMIH Classic PatternORE Part 1

A 6-year-old child presents with brown discolouration of the buccal surfaces of all four first permanent molars and upper central incisors. The defects are demarcated and the affected enamel is soft. The primary teeth are unaffected. What is the most likely diagnosis?

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

The answer is D: Molar-incisor hypomineralisation (MIH). The clinical presentation is pathognomonic for MIH: demarcated brown opacities affecting all four first permanent molars and incisors (classic 'four molars plus incisors' pattern), soft enamel indicating hypomineralisation, and unaffected primary teeth. Brown discolouration indicates severe hypomineralisation. MIH results from a systemic disturbance during permanent FPM and incisor enamel formation (birth to age 3–5 years), sparing primary dentition. Fluorosis would affect teeth exposed to fluoride during the same developmental window and could not selectively spare primary teeth if exposure occurred prenatally or in infancy. Amelogenesis imperfecta is a genetic defect affecting multiple tooth types symmetrically. Enamel hypoplasia produces pitting or thickness loss, not demarcated soft opacities. Turner tooth affects single teeth following primary tooth trauma. Early diagnosis is essential to prevent post-eruptive breakdown and manage hypersensitivity.

Reference: SDCEP (Scottish Dental Clinical Effectiveness Programme): Prevention and Management of Dental Caries in Children – Section on Caries and MIH, current guidance; also Newcastle Hospitals NHS Foundation Trust and other UK NHS trust MIH patient information consistent with current practice. https://www.childcaries.sdcep.org.uk/guidance/assessment/clinical-assessment/assessing-carious-lesions/caries-and-mih/