Molar incisor hypomineralisation — ORE Part 1 MCQ

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HardPaediatric DentistryMolar incisor hypomineralisationORE Part 1

An 8-year-old has demarcated cream-brown opacities on first permanent molars and upper incisors. The molars are hypersensitive and one has posteruptive enamel breakdown. The primary dentition was largely unaffected and oral hygiene is reasonable. What is the most likely diagnosis?

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Correct answer: E — Molar incisor hypomineralisation

The diagnosis is Molar Incisor Hypomineralisation (MIH). The cardinal diagnostic features are present: demarcated cream-brown opacities on first permanent molars and incisors, hypersensitivity, posteruptive enamel breakdown, and critically, the primary dentition is largely unaffected. MIH is a qualitative developmental enamel defect of systemic origin affecting one to four permanent first molars with or without incisors. The unaffected primary dentition excludes amelogenesis imperfecta (a hereditary disorder affecting all permanent and primary teeth). Dental fluorosis causes diffuse, bilateral symmetrical changes, not discrete demarcated lesions. Early childhood caries presents with cavitation and is associated with poor oral hygiene. Tetracycline staining produces diffuse yellow-grey discolouration. This 8-year-old presenting with posteruptive breakdown requires referral for specialist management, commonly including sealing, desensitization, and consideration of molar extractions depending on severity.

Reference: European Academy of Paediatric Dentistry (2021). Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8926988/