With prevalence estimates suggesting that approximately one in seven children is affected worldwide, MIH represents a significant clinical challenge.^1,2 In Germany, the sixth German Oral Health Study, published in 2026, reported a prevalence of 15.3% among 12-year-olds.³ Hypomineralisation of the second primary molars or canines may also occur and has been associated with an increased risk of MIH in the permanent dentition. Children presenting with such defects are up to five times more likely to develop MIH.⁴

Among affected 12-year-olds, an average of 3.4 teeth are affected. Around 63% show aesthetically noticeable opacities and approximately 40% experience enamel breakdown. Around one in two affected patients already has an atypical restoration resulting from more extensive enamel breakdown.³

The aetiology of MIH is being intensively researched but remains unclear. Factors related to childbirth, early medication and plasticisers have been discussed. However, no correlation with these factors has been proven. The German Oral Health Study summarises the current evidence as follows: The search for the cause has so far been unsuccessful.³

Clinical challenges in MIH management

MIH presents several challenges during dental treatment. Affected teeth may be hypersensitive and can respond less predictably to local anaesthesia. Restorative treatment can also be challenging because restorations may bond less effectively to porous enamel, and restoration margins may show early signs of leakage. In addition, treating young patients with limited tolerance for lengthy procedures can be demanding. Repeated or painful treatments may contribute to dental anxiety.

The German Oral Health Study also examined the progression of MIH over time. Over a nine-year period, around 89% of opacities remained stable, and the proportion of atypical restorations increased by ten percentage points to 18%.³

Four phases for MIH management

Based on these clinical challenges, GC has developed an MIH treatment pathway consisting of four phases: identification, prevention, restoration and recall. The approach provides products and materials tailored to the severity of the condition and the age of the child.

Detection and prevention
Identifying patients at risk begins with an assessment of oral hygiene. The GC Tri Plaque ID Gel highlights cariogenic plaque and makes risk areas visible. This allows children and parents to identify areas where toothbrushing may need improvement, supporting better oral hygiene habits.

Prevention remains a key element of MIH management. At home, the focus is on an age-appropriate, fluoridated toothpaste containing at least 1,000 ppm fluoride and a diet low in sugar and acids. As MIH often begins with mild opacity, early and consistent preventive measures can help protect affected teeth.

GC Tooth Mousse and GC MI Paste Plus are used for strengthening and desensitisation. Both contain CPP-ACP, which has been shown to support the remineralisation of hypomineralised enamel by providing calcium and phosphate and to reduce sensitivity.^5,6 They are applied in the evening after brushing and are not rinsed out. GC Tooth Mousse does not contain fluoride and is suitable for all age groups. GC MI Paste Plus contains 900 ppm fluoride and is suitable for children aged 12 and older.

In the dental practice, MI Varnish complements home care. The fluoride varnish containing 22,600 ppm fluoride and CPP-ACP is designed to seal the dentinal tubules, desensitise teeth and leave a protective coating. It is applied quarterly after prophylaxis and can be incorporated into the recall schedule.

Early protection of the tooth surface may help delay or avoid invasive procedures. GC Fuji TRIAGE, a flowable glass ionomer, chemically bonds with the tooth surface even in a humid environment and can be used to seal areas that have not yet fully erupted. This may help postpone some early restorations and reduce the likelihood of treatment-related anxiety in children.

Care and aftercare
If preventive measures are insufficient, restorative treatment may become necessary. EQUIA Forte HT demonstrates the advantages of a glass hybrid material in this context: It chemically bonds to the tooth structure, tolerates moisture and can be applied quickly, which may be beneficial when treating teeth with mineral-poor enamel.

For teeth that are difficult to anaesthetise, the atraumatic restorative treatment method, in which the caries-affected tissues are removed manually using a minimally invasive approach, may help limit treatment-related sensitivity.⁷ For clearly defined lesions with limited loss of structure, composite restoration is another option. In cases of severe MIH where definitive restoration is not possible at a young age, glass ionomers or stainless-steel crowns may serve as interim solutions until permanent restoration becomes feasible.

Patients with MIH often require shorter recall intervals due to their increased caries susceptibility. During follow-up visits, affected teeth and restorations can be monitored, and oral hygiene and dietary habits can be assessed. Interim restorations should be replaced when definitive restoration becomes possible. Across all phases, the motivational programme for children aims to support positive treatment experiences and encourage regular attendance.

MIH treatment pathway from GC

With its MIH treatment pathway, GC provides a structured approach for managing affected first permanent molars, covering the stages from identification and prevention through to restoration and recall. The pathway combines products designed for use according to the individual needs of young patients. The following overview summarises the products used across the different phases of GC’s MIH treatment pathway and their respective applications:

 More information can be found here.