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Molar incisor hypomineralization (MIH): Everything you need to know about so called chalky teeth
Molar incisor hypomineralization (MIH): Everything you need to know about so called chalky teeth
D21 Dental Excellence Team
10. June 2025
Medically reviewed by the Doctors of the D21 Dental Excellence Team, more than 70 years of Dental Experience.
Content
Content
Molar incisor hypomineralization, or MIH for short, is a dental disease that has increasingly become a focus of dental research in recent years. It affects children and adolescents, but can also be diagnosed in adults if the problem was not recognized or adequately treated in childhood. In common parlance, the affected teeth are often referred to as “chalk teeth”, a term that vividly describes the characteristic features of this enamel defect.
Molar incisor hypomineralization, or MIH for short, is a dental disease that has increasingly become a focus of dental research in recent years. It affects children and adolescents, but can also be diagnosed in adults if the problem was not recognized or adequately treated in childhood. In common parlance, the affected teeth are often referred to as “chalk teeth”, a term that vividly describes the characteristic features of this enamel defect.
What is MIH? Definition and appearance
What is MIH? Definition and appearance
MIH is a developmental disorder of the tooth enamel that occurs during tooth development. In contrast to caries, which is caused by bacterial acid attacks, MIH is a qualitative disorder of the mineralization of the tooth enamel. This means that the enamel is not sufficiently enriched with minerals such as calcium and phosphate. The result is enamel that is porous and has a chalky texture.
MIH is a developmental disorder of the tooth enamel that occurs during tooth development. In contrast to caries, which is caused by bacterial acid attacks, MIH is a qualitative disorder of the mineralization of the tooth enamel. This means that the enamel is not sufficiently enriched with minerals such as calcium and phosphate. The result is enamel that is porous and has a chalky texture.
MIH can occur in both milk teeth and permanent teeth. It typically affects the first permanent molars and often also the front incisors. This is where the name molar-incisor hypomineralization comes from. The affected teeth can have white to yellowish-brown spots that stand out clearly from the healthy enamel.
MIH can occur in both milk teeth and permanent teeth. It typically affects the first permanent molars and often also the front incisors. This is where the name molar-incisor hypomineralization comes from. The affected teeth can have white to yellowish-brown spots that stand out clearly from the healthy enamel.
However, enamel defects in MIH are not merely cosmetic. The affected enamel is often softer and more brittle than normal. As a result, the teeth are more susceptible to wear and fractures. In severe cases, the teeth can even break off. The porosity of the enamel also makes the teeth more sensitive to pain, especially to thermal stimuli such as cold or heat, and increases the risk of tooth decay, as bacteria can penetrate the defective structure more easily. An immediate reaction to these symptoms should therefore be to consult a dentist and confirm the suspicion with a diagnosis. Here you will find an overview of our practices throughout Germany.
However, enamel defects in MIH are not merely cosmetic. The affected enamel is often softer and more brittle than normal. As a result, the teeth are more susceptible to wear and fractures. In severe cases, the teeth can even break off. The porosity of the enamel also makes the teeth more sensitive to pain, especially to thermal stimuli such as cold or heat, and increases the risk of tooth decay, as bacteria can penetrate the defective structure more easily. An immediate reaction to these symptoms should therefore be to consult a dentist and confirm the suspicion with a diagnosis. Here you will find an overview of our practices throughout Germany.
Causes of MIH: a complex issue
Causes of MIH: a complex issue
The exact causes of MIH are still not fully understood. It is assumed that it is a multifactorial process in which various influences play a role during tooth development. The factors discussed in research include:
The exact causes of MIH are still not fully understood. It is assumed that it is a multifactorial process in which various influences play a role during tooth development. The factors discussed in research include:
Systemic diseases and infections: Febrile infections, respiratory diseases or the use of certain medications, especially antibiotics, during pregnancy or in the first years of the child's life are cited as possible triggers.
Systemic diseases and infections: Febrile infections, respiratory diseases or the use of certain medications, especially antibiotics, during pregnancy or in the first years of the child's life are cited as possible triggers.
Environmental factors: Environmental toxins or certain chemical substances, such as plasticizers, can disrupt the formation of tooth enamel. However, current research suggests that this theory is rather unlikely (BfR).
Environmental factors: Environmental toxins or certain chemical substances, such as plasticizers, can disrupt the formation of tooth enamel. However, current research suggests that this theory is rather unlikely (BfR).
Vitamin D deficiency: There are indications that a lack of vitamin D during tooth development could increase the risk of MIH, as vitamin D plays an important role in the mineralization of bones and teeth.
Vitamin D deficiency: There are indications that a lack of vitamin D during tooth development could increase the risk of MIH, as vitamin D plays an important role in the mineralization of bones and teeth.
It should also be noted that MIH is not a consequence of poor oral hygiene, but a developmental disorder. The disease was first described by Swedish scientists in the late 1980s. Since then, however, the prevalence has increased, with around one in seven children worldwide now showing signs of chalk teeth.
It should also be noted that MIH is not a consequence of poor oral hygiene, but a developmental disorder. The disease was first described by Swedish scientists in the late 1980s. Since then, however, the prevalence has increased, with around one in seven children worldwide now showing signs of chalk teeth.
Consequences of MIH: long-term effects
Consequences of MIH: long-term effects
If left untreated, this dental disease can have far-reaching consequences for the oral health and quality of life of those affected, which result directly from the symptoms:
If left untreated, this dental disease can have far-reaching consequences for the oral health and quality of life of those affected, which result directly from the symptoms:
Increased risk of tooth decay: The porous and defective enamel is more susceptible to decay, which can lead to premature tooth loss.
Increased risk of tooth decay: The porous and defective enamel is more susceptible to decay, which can lead to premature tooth loss.
Sensitivity to pain: The extreme sensitivity of the teeth can make it difficult to eat and lead to a reduced quality of life.
Sensitivity to pain: The extreme sensitivity of the teeth can make it difficult to eat and lead to a reduced quality of life.
Tooth fractures: The fragility of the enamel increases the risk of tooth fractures, where parts of the tooth break off, which can require costly restorations.
Tooth fractures: The fragility of the enamel increases the risk of tooth fractures, where parts of the tooth break off, which can require costly restorations.
Aesthetic impairments: The discoloration and defects on the incisors can be aesthetically displeasing and have a negative impact on the self-esteem of those affected, especially during childhood and adolescence.
Aesthetic impairments: The discoloration and defects on the incisors can be aesthetically displeasing and have a negative impact on the self-esteem of those affected, especially during childhood and adolescence.
Psychosocial effects: Pain and cosmetic concerns can even lead to social withdrawal and psychological stress in severe cases.
Psychosocial effects: Pain and cosmetic concerns can even lead to social withdrawal and psychological stress in severe cases.
Treatment and prevention: what can be done?
Treatment and prevention: what can be done?
As the exact causes of MIH are not yet fully understood, targeted prevention is difficult. Nevertheless, there are general recommendations that can help to promote healthy tooth development. These include a balanced diet rich in vitamins and minerals, an adequate supply of vitamin D and minimizing the risk of infections and febrile illnesses during pregnancy and in the first years of life. In addition, regular dental check-ups, ideally as early as infancy, also help to detect and treat any abnormalities at an early stage. These include in particular individual prophylaxis services (IP services), during which oral hygiene status checks, tooth brushing training and fluoridation would be done. Such measures can be crucial in protecting weakened tooth enamel and preventing tooth decay. For children aged six to 17 with statutory health insurance, the costs are even fully covered by health insurance companies.
As the exact causes of MIH are not yet fully understood, targeted prevention is difficult. Nevertheless, there are general recommendations that can help to promote healthy tooth development. These include a balanced diet rich in vitamins and minerals, an adequate supply of vitamin D and minimizing the risk of infections and febrile illnesses during pregnancy and in the first years of life. In addition, regular dental check-ups, ideally as early as infancy, also help to detect and treat any abnormalities at an early stage. These include in particular individual prophylaxis services (IP services), during which oral hygiene status checks, tooth brushing training and fluoridation would be done. Such measures can be crucial in protecting weakened tooth enamel and preventing tooth decay. For children aged six to 17 with statutory health insurance, the costs are even fully covered by health insurance companies.
If the disease is diagnosed, individualized treatment approaches are used. The treatment of MIH depends on the severity of the disease and the extent of the enamel defects. The aim is to protect the affected teeth, reduce sensitivity to pain and prolong the life of the teeth. Treatment may include the following measures:
If the disease is diagnosed, individualized treatment approaches are used. The treatment of MIH depends on the severity of the disease and the extent of the enamel defects. The aim is to protect the affected teeth, reduce sensitivity to pain and prolong the life of the teeth. Treatment may include the following measures:
Fluoridation: Regular intensive fluoridation of the tooth enamel helps to harden the surface and make the teeth more resistant to acid attacks. During this treatment, the dentist applies special fluoride-containing varnishes or gels to the affected teeth.
Fluoridation: Regular intensive fluoridation of the tooth enamel helps to harden the surface and make the teeth more resistant to acid attacks. During this treatment, the dentist applies special fluoride-containing varnishes or gels to the affected teeth.
Fissure sealing: For mildly to moderately affected teeth, fissure sealing of the chewing surfaces of the molars can be useful. This involves filling the depressions and fissures on the chewing surfaces with a special plastic material to prevent bacteria from penetrating and to protect the teeth from decay.
Fissure sealing: For mildly to moderately affected teeth, fissure sealing of the chewing surfaces of the molars can be useful. This involves filling the depressions and fissures on the chewing surfaces with a special plastic material to prevent bacteria from penetrating and to protect the teeth from decay.
Minimally invasive restorations: For small defects, composite fillings or glass ionomer cements can be used to replace the defective enamel and strengthen the tooth structure. These filling materials adhere well to the tooth structure and prevent the development of caries.
Minimally invasive restorations: For small defects, composite fillings or glass ionomer cements can be used to replace the defective enamel and strengthen the tooth structure. These filling materials adhere well to the tooth structure and prevent the development of caries.
Partial crowns and crowns: Partial crowns or full crowns may be necessary for more pronounced defects, especially if large sections of enamel are missing or the teeth are severely fractured. These restorations cover the entire tooth and offer comprehensive protection.
Partial crowns and crowns: Partial crowns or full crowns may be necessary for more pronounced defects, especially if large sections of enamel are missing or the teeth are severely fractured. These restorations cover the entire tooth and offer comprehensive protection.
Paint treatment: Due to the increased sensitivity to pain, desensitizing varnishes or gels can be used. In some cases, local anesthesia may also be necessary before dental treatment.
Paint treatment: Due to the increased sensitivity to pain, desensitizing varnishes or gels can be used. In some cases, local anesthesia may also be necessary before dental treatment.
Regular dental check-ups: Frequent check-ups are essential to monitor the condition of the teeth and to be able to react to changes at an early stage.
Regular dental check-ups: Frequent check-ups are essential to monitor the condition of the teeth and to be able to react to changes at an early stage.
All of the measures described above are carried out at our locations by qualified dentists. You are welcome to contact us if you have any questions about the treatments.
All of the measures described above are carried out at our locations by qualified dentists. You are welcome to contact us if you have any questions about the treatments.
How parents should react to the first symptoms in their children
How parents should react to the first symptoms in their children
If you notice the first signs of MIH in your child, it is crucial to react calmly and prudently. Early diagnosis and treatment are of utmost importance to minimize long-term effects on your child's dental health.
If you notice the first signs of MIH in your child, it is crucial to react calmly and prudently. Early diagnosis and treatment are of utmost importance to minimize long-term effects on your child's dental health.
First, careful observation of symptoms is essential. Look for the characteristic features already described: white to yellowish-brown spots on the molars or incisors. Another important indication may be increased sensitivity to pain, especially when eating cold or hot food.
First, careful observation of symptoms is essential. Look for the characteristic features already described: white to yellowish-brown spots on the molars or incisors. Another important indication may be increased sensitivity to pain, especially when eating cold or hot food.
As soon as you notice such signs, a prompt visit to the dentist is essential. Only an expert dental examination can confirm MIH and determine the severity of the disease. Do not delay - even if the symptoms still appear mild, because the earlier treatment begins, the better the prognosis for preserving the affected teeth.
As soon as you notice such signs, a prompt visit to the dentist is essential. Only an expert dental examination can confirm MIH and determine the severity of the disease. Do not delay - even if the symptoms still appear mild, because the earlier treatment begins, the better the prognosis for preserving the affected teeth.
It is also important to maintain open communication with your child. Talk sensitively about any discomfort, such as sensitivity to pain when eating or brushing teeth. Convey to your child that although careful oral hygiene is important, MIH is a developmental disorder and not a consequence of poor care. Nevertheless, to minimize the increased risk of tooth decay, meticulous oral hygiene is crucial for affected teeth. Make sure your child brushes their teeth regularly and thoroughly, using a fluoride toothpaste if necessary. Your dentist can also recommend special, more concentrated fluoride preparations to strengthen the tooth enamel.
It is also important to maintain open communication with your child. Talk sensitively about any discomfort, such as sensitivity to pain when eating or brushing teeth. Convey to your child that although careful oral hygiene is important, MIH is a developmental disorder and not a consequence of poor care. Nevertheless, to minimize the increased risk of tooth decay, meticulous oral hygiene is crucial for affected teeth. Make sure your child brushes their teeth regularly and thoroughly, using a fluoride toothpaste if necessary. Your dentist can also recommend special, more concentrated fluoride preparations to strengthen the tooth enamel.
Conclusion
Conclusion
Molar incisor hypomineralization (MIH), also known as “chalk teeth”, is a common enamel development disorder in children and adolescents. Unlike tooth decay, it is not a consequence of poor hygiene, but a mineralization disorder that makes the enamel porous, brittle and sensitive to pain. It typically affects the first permanent molars and incisors, which show white to yellowish-brown spots.
Molar incisor hypomineralization (MIH), also known as “chalk teeth”, is a common enamel development disorder in children and adolescents. Unlike tooth decay, it is not a consequence of poor hygiene, but a mineralization disorder that makes the enamel porous, brittle and sensitive to pain. It typically affects the first permanent molars and incisors, which show white to yellowish-brown spots.
The causes are not yet fully understood, but early childhood diseases and vitamin D deficiency are among the causes discussed. If left untreated, MIH can lead to an increased risk of tooth decay, tooth fractures and severe pain.
The causes are not yet fully understood, but early childhood diseases and vitamin D deficiency are among the causes discussed. If left untreated, MIH can lead to an increased risk of tooth decay, tooth fractures and severe pain.
Early diagnosis and treatment by a dentist are crucial. Treatment includes fluoridation, fissure sealing, fillings and, in severe cases, crowns. If parents notice the first symptoms in their child, they should talk openly about them, consult a dentist immediately and ensure good oral hygiene.
Early diagnosis and treatment by a dentist are crucial. Treatment includes fluoridation, fissure sealing, fillings and, in severe cases, crowns. If parents notice the first symptoms in their child, they should talk openly about them, consult a dentist immediately and ensure good oral hygiene.
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