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There is currently insufficient evidence in the literature to establish aetiological factor/s relevant for MIH. Improvements in study design, as well as standardization of diagnostic and examination protocols, would improve the level and strength of evidence.

Growing interest in the treatment and prevention of Molar/Incisor Hypomineralization (MIH) warrants investigation into the protein composition of hypomineralized enamel. Hypothesizing abnormality akin to amelogenesis imperfecta, we profiled proteins in hypomineralized enamel from human permanent first molars using a biochemical approach. Hypomineralized enamel was found to have from 3- to 15-fold higher protein content than normal, but a near-normal level of residual amelogenins. This distinguished MIH from hypomaturation defects with high residual amelogenins (amelogenesis imperfecta, fluorosis) and so typified it as a hypocalcification defect. Second, hypomineralized enamel was found to have accumulated various proteins from oral fluid and blood, with differential incorporation depending on integrity of the enamel surface. Pathogenically, these results point to a pre-eruptive disturbance of mineralization involving albumin and, in cases with post-eruptive breakdown, subsequent protein adsorption on the exposed hydroxyapatite matrix. These insights into the pathogenesis and properties of hypomineralized enamel hold significance for prevention and treatment of MIH.

Background: Worldwide, molar incisor hypomineralization (MIH) affects a substantial number of children and impacts greatly on treatment need and dental anxiety, yet there is little information regarding its prevalence, aetiology, presentation and management. The aims of this survey were to assess awareness and perceptions of the Australian paediatric dental community concerning MIH, and to describe current treatment strategies. Methods: A questionnaire, based upon a previous European study, was sent to all Australian members of the Australian and New Zealand Society of Paediatric Dentistry. The questionnaire sought information on clinical experience of MIH, knowledge of prevalence, aetiology and contemporary management strategies for MIH. Results: One hundred and thirty useable responses were received (58.8 per cent response rate) of which 36 were paediatric dentists, 6 paediatric dentistry postgraduate students, 59 general dentists, 14 dental therapists and 14 specialists in other fields. Most (98.5 per cent) respondents were familiar with MIH and encountered it in their practice. The majority (73.1 per cent) estimated that MIH occurred in between 5 to 25 per cent of their clinical practice and almost all (96.9 per cent) considered it to be a clinical problem. Only 16.9 per cent of respondents were aware of existing prevalence data and 96.9 per cent valued investigating the prevalence of MIH. No consensus existed regarding the aetiology of MIH or its restorative management. Paediatric dentists used preformed crowns significantly more than non-specialists, however glass ionomer cements were popular with all groups. Conclusions: MIH is a well recognized and widely encountered clinical condition. MIH presents several clinical problems and is worthy of further investigation. Currently, no consistent clinical management strategies are utilized.

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