A child attends the practice with persistent sensitivity in their newly erupted molars. On examination, demarcated opacities are evident – a familiar presentation for many clinicians managing molar incisor hypomineralisation (MIH). First described by Weerheijm in 2001, it is now a widely recognised developmental condition of systemic origin.[i] Although prevalence varies across countries and studies, it is estimated to affect around 10-20% of the UK population.[ii],[iii] For many dentists, the impact of MIH on a child’s quality of life is evident in everyday practice. Recognising the signs early allows prompt intervention and supports long-term management.[iv]
Spotting MIH
There are multiple factors that can cause MIH, most of which are still not fully understood. Current evidence suggests that prenatal, perinatal and early childhood factors may contribute, with gestational or systemic illnesses, such as respiratory tract infections or measles being implicated.[v],[vi]
Clinically, MIH presents as demarcated opacities ranging in severity from white and cream to yellow or brown. Historically, these lesions have been described by various terms, including the colloquial ‘cheese molars’, coined by Dutch paediatric dentist Dr Jan Jälevik.[vii] First permanent molars and permanent incisors are most commonly affected, although similar hypomineralised lesions have also been reported in second primary molars, sometimes referred to as hypomineralised second primary molars (HSPM).[viii] Differential diagnoses include amelogenesis imperfecta, fluorosis, enamel hypoplasia and white spot lesions. Where diagnostic uncertainty exists, caution should be exercised before excluding MIH, as affected teeth are at increased risk of caries. Demarcated opacities and an asymmetrical distribution help distinguish MIH from diffuse opacities as seen in fluorosis.[ix]
More than a dental defect
Typically diagnosed in early childhood, at the eruption of first permanent molar and incisors, the consequences of MIH are multifaceted, encompassing functional, aesthetic and psychosocial impacts.[x] Compromised oral hygiene due to hypersensitivity can lead to post-eruptive enamel breakdown and subsequent atypical caries. Difficulty eating, dental anxiety and treatment avoidance due to the pain associated with hypersensitive or carious teeth can make management challenging. Chronic pulpal inflammation may compromise the effectiveness of local anaesthesia, further complicating treatment and adding to the child’s distress.[xi] Repeated dental appointments may result in missed school, potentially affecting academic progress. Aesthetic concerns from visible enamel defects, particularly on incisors, can contribute to self-consciousness, negatively impacting the child’s wellbeing.[xii]
The ABC of MIH management: ready, steady, protect.
A thorough assessment enables early diagnosis and underpins a comprehensive preventive approach. In practice, this includes enhanced oral hygiene instruction, patient and parent education, and dietary advice. Resin-bonded fissure sealants are recommended for molars with intact enamel, whilst glass ionomer cements provide a temporary option for partially erupted or structurally compromised molars. For desensitisation and symptom control, regular fluoride varnish applications are indicated, which may have the added benefit of reducing caries risk.viii
When preventive measures are no longer sufficient to arrest the progression of caries, restorative intervention may be required. Glass ionomer cements provide an interim solution until the patient can tolerate more definitive treatments such as composite resin restoration or stainless-steel crowns. In extreme cases of extensive caries or limited cooperation, extraction with orthodontic planning may be considered. Ongoing monitoring is essential for successful long-term outcomes.
Bioglass: advanced technology
Higher-fluoride toothpastes (2800 ppm and 5000 ppm formulations) require a prescription and, whilst considered clinically safe, may raise concerns among some parents regarding accidental ingestion.[xiii] In contrast, BioMin F toothpaste’s patented bioactive glass contains just 540 ppm fluoride, which is released during gradual dissolution in saliva, with accelerated release under acidic conditions.
This is particularly relevant for patients experiencing frequent acid challenges, such as grazing, where repeated drops in oral pH occur.[xiv] Following carbohydrate intake, salivary pH can fall below the critical threshold of ~5.5, initiating hydroxyapatite dissolution.[xv] In the presence of fluoride, this promotes the formation of more acid-resistant fluorapatite, lowering the critical pH to ~4.5 and providing more resilient protection.[xvi]
For topical fluoride to be effective, patients are advised not to rinse after brushing to maximise retention. However, strongly flavoured toothpastes can discourage this behaviour. BioMin F’s milder flavour profile, including a strawberry option for children (BioMin F for Kids), may improve compliance with no-rinse guidance and support greater retention of the bioactive glass particles.
Mechanism of action
Bioactive glass particles adhere to tooth surfaces via polyacrylic acid, with carboxylate groups chelating calcium ions. The glass gradually dissolves in saliva and water, and more rapidly in acidic conditions, subsequently releasing fluoride, calcium and phosphate ions, supporting fluorapatite formation on the tooth surface.[xvii] In contrast to conventional sodium fluoride formulations, which are cleared relatively quickly from the oral environment, the bioactive glass matrix bonds to the tooth and releases ions over approximately 10-12 hours, prolonging availability.[xviii] Patients who struggle with sensitivity or consistent routines may benefit from this extended protection between brushing. In vitro and in vivo studies demonstrate dentinal tubule occlusion, even after acid challenge.[xix]
Prevention, comfort and care
The literature supports early recognition and diagnosis of MIH with a minimally invasive, preventive approach to long-term management. With timely intervention and thoughtful care, clinicians can ensure that children with MIH can look forward to healthier smiles and improved wellbeing.
The science is clear. The solution is simple.
www.biomin.co.uk
2026 Supply Update
BioMin Toothpastes are currently unavailable across many of our usual stockists. This pause ensures we continue to meet the highest standards of quality and regulatory compliance for all our products.
We understand that this may be inconvenient, and we sincerely appreciate your patience and support during this period. We are working hard behind the scenes to resolve the situation and will share updates on our website as soon as we have a clearer timeline.
Thank you for continuing to trust BioMin® for your oral health needs.
Author: Alec Hilton | CEO | BioMin Technologies
[i] Weerheijm KL. Molar incisor hypomineralisation (MIH). European Journal of Paediatric Dentistry. 2003 Sep 1;4:115-20.
[ii] Schwendicke F, Elhennawy K, Reda S, Bekes K, Manton DJ, Krois J. Global burden of molar incisor hypomineralization. Journal of dentistry. 2018 Jan 1;68:10-8. https://doi.org/10.1016/j.jdent.2017.12.002
[iii] Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. International journal of paediatric dentistry. 2018 Mar;28(2):170-9. https://doi.org/10.1111/ipd.12323
[iv] Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FS. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. European Archives of Paediatric Dentistry. 2022 Feb;23(1):3-21.
[v] Garot, E., Rouas, P., Somani, C. et al. Correction to: An update of the aetiological factors involved in molar incisor hypomineralisation (MIH): a systematic review and meta-analysis. Eur Arch Paediatr Dent 26, 1247–1249 (2025). https://doi.org/10.1007/s40368-025-01117-3
[vi] Silva MJ, Scurrah KJ, Craig JM, Manton DJ, Kilpatrick N. Etiology of molar incisor hypomineralization–A systematic review. Community dentistry and oral epidemiology. 2016 Aug;44(4):342-53. https://doi.org/10.1111/cdoe.12229
[vii] Jälevik, B. Prevalence and Diagnosis of Molar-Incisor-Hypomineralisation (MIH): A systematic review.Eur Arch Paediatr Dent 11, 59–64 (2010). https://doi.org/10.1007/BF03262714
[viii] Elfrink, M. E., Schuller, A. A., Weerheijm, K. L., & Veerkamp, J. S. (2008). Hypomineralized second primary molars: prevalence data in Dutch 5-year-olds. Caries research, 42(4), 282–285. https://doi.org/10.1159/000135674
[ix] Almuallem, Z., Busuttil-Naudi, A. Molar incisor hypomineralisation (MIH) – an overview. Br Dent J 225, 601–609 (2018). https://doi.org/10.1038/sj.bdj.2018.814
[x] Jälevik, B., Sabel, N. & Robertson, A. Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents?—a systematic review. Eur Arch Paediatr Dent 23, 65–78 (2022). https://doi.org/10.1007/s40368-021-00631-4
[xi] Rodd, H. D., & Boissonade, F. M. (2003). Immunocytochemical investigation of neurovascular relationships in human tooth pulp. Journal of anatomy, 202(2), 195–203. https://doi.org/10.1046/j.1469-7580.2003.00153.x
[xii] Joshi T, Rahman A, Rienhoff S, Rienhoff J, Stamm T, Bekes K. Impact of molar incisor hypomineralization on oral health–related quality of life in 8–10-year-old children. Clinical oral investigations. 2022 Feb;26(2):1753-9. https://doi.org/10.1007/s00784-024-05490-z
[xiii] Public Health England. Delivering Better Oral Health: An evidence-based toolkit for prevention. 4th Ed. London: Public Health England; 2021
[xiv] Featherstone JD. Dental caries: a dynamic disease process. Australian dental journal. 2008 Sep;53(3):286-91. doi: 10.1111/j.1834-7819.2008.00064.x
[xv] Featherstone JD. Dental caries: a dynamic disease process. Australian dental journal. 2008 Sep;53(3):286-91. doi: 10.1111/j.1834-7819.2008.00064.x
[xvi] Ten Cate JM. Remineralization of caries lesions extending into dentin. J Dent Res. 2001;80(5):1407–1411.
[xvii] Fejerskov O, Kidd EAM, eds. Dental Caries: The Disease and Its Clinical Management. 2nd ed. Oxford: Blackwell Munksgaard; 2008.
[xviii] Earl, J. S., Leary, R. K., Muller, K. H., Langford, R. M., & Greenspan, D. C. (2011). Physical and chemical characterization of dentin surface following treatment with NovaMin technology. The Journal of clinical dentistry, 22(3), 62–67.
[xix] Earl, J. S., Leary, R. K., Muller, K. H., Langford, R. M., & Greenspan, D. C. (2011). Physical and chemical characterization of dentin surface following treatment with NovaMin technology. The Journal of clinical dentistry, 22(3), 62–67.
