Post-eruptive Enamel Breakdown Research Articles

Enhancing pediatric comfort: a comprehensive approach to managing molar-incisor hypomineralization with preemptive analgesia and behavioral strategies.

Preemptive analgesia is an important strategy used in pediatric dentistry to intercept pain signals in neural pathways early, thus mitigating the perception of pain and enhancing overall patient comfort. Pedodontists often encounter challenges in conducting the therapy and managing uncooperative patients, when addressing enamel defects of the Molar-incisor hypomineralization (MIH) type. The aim of this study is to demonstrate the impact of preemptive analgesia on optimizing behavioral management and restorative treatment strategies for immature permanent molars exhibiting severe MIH and Treatment need index 4 (TNI), through the effective control of pain. This study comprised 27 cases with MIH level 3 Posteruptive breakdown (PEB), indicating post-eruptive enamel breakdown, with initial hypersensitivity scores exceeding 4 on the Wong-Baker Scale, was conducted over 12 months, between January 2023-January 2024. Data on pediatric patients aged between 5 years and 4 months and 7 years and 1 month with varying degrees of sensitivity in their permanent first molars before the completion of the eruption process were collected. Pain intensity was systematically evaluated at six specific time points: before and after the administration of analgesic medication as well as during restorative treatment using the Wong-Baker scale and data from the Face, Legs, Activity, Cry, Consolability index (FLACC). Statistical analysis for Wong-Baker scores and FLACC index indicated statistical significance (p < 0.05) for Mann-Whitney and Wilcoxon tests, respectively t-test. The comparison of mean scores recorded before and after preemptive analgesia during rotary instrumentation moments for the Wong-Baker index (4 > 0.29) and for the FLACC index (8.47 > 1.71) indicates the positive influence of administering ibuprofen. In conclusion, preemptive analgesia, alongside standardized anesthesia, significantly improved intraoperative pain management and behavioral outcomes.

Molar incisor hypomineralisation in rural areas

Background: Molar incisor hypomineralisation (MIH) is a qualitative defect of enamel that is associated with the disruption of ameloblastic action during the transitional and maturational stages of amelogenesis. Demarcated opacities, atypical restorations, post-eruptive enamel breakdown, asymmetrical appearance of affected teeth and tooth sensitivity are some clinical features. Method: An electronic literature search in PubMed and Science direct was done in September, 2023 using the Population, Concept and Context framework. Search terms and keywords were combined by Boolean operators. Two independent investigators screened titles, abstracts and full text of publications. The inclusion criteria was original (primary) research articles with accessible full text on molar- incisor hypomineralisation of teeth among children in rural areas carried out in Africa continent, published in English and in electronic databases. Original research articles related to molar incisor hypomineralisation of teeth among children in urban, semi-urban or sub-urban areas and hospital based studies were excluded. Review articles, systematic reviews and dissertations related to molar incisor hypomineralisation were also excluded during screening. Results: One article with accessible full text was included as it was assessed to meet the aim of the review. The study was a cross-sectional study and it was carried out in Kenya. Conclusion: Molar incisor hypomineralisation can affect the quality of life of children with affected teeth associated with tooth sensitivity. The study identified was from one Africa country. More studies from diverse ethnic population in rural areas will add to the existing literature and fill the gaps in knowledge.

Hall Technique for the management of hypomineralized first permanent molars: A protocol of a randomized controlled trial with 3-year follow-up

The aim of this clinical protocol is to describe the methodology for the evaluation of the clinical performance of Hall Technique (HT) in comparison with glass ionomer cement (GIC) restorations in first permanent molars (FPM) severely affected by molar incisor hypomineralization (MIH). This protocol is related to a two-arm, parallel group, controlled and randomized superiority trial. It will be included 92 participants, 6 to 12 years-old, presenting at least one FPM with post-eruptive enamel breakdown and/or atypical caries and/or unsatisfactory atypical restoration involving cusp and extending to at least two tooth surfaces. Two trained and calibrated dentists will select the participants and assess the outcomes. Eight experienced clinicians who work as dentists at the public oral health system will be trained to perform the interventions. The participants will be randomized into the test (HT) or the control group (GIC). The outcomes will be assessed every 6 months up to 3 years. The primary outcome is the survival rate of the restorations. Secondary outcomes include satisfaction of the participants, parents, and dentists; impact on oral heath related quality of life; self-reported discomfort during treatment; signs/symptoms of temporomandibular joint dysfunction; and cost-effectiveness. Kaplan-Meier and Cox regression analysis will be used to analyze the primary outcome. Mann-Whitney or t-test will be used to compare the secondary outcomes between groups. We expect to provide scientific evidence about the treatment approach that maximizes success rates and minimizes retreatments in severe HMI.

Deciduous Teeth Hypomineralisation and Perinatal Risk Factors.

Hypomineralisation defects with demarcated opacities are also observed in the deciduous dentition and have been found to be a predictive factor for hypomineralisation defects in the permanent dentition. Deciduous molar hypomineralisation (DMH) represents a qualitative enamel defect primarily afflicting deciduous second molars, albeit its presence is not limited solely to deciduous second molars, as it can manifest in deciduous canines and first molars. Thus, the presence of demarcated hypomineralisation defects in deciduous teeth could be called as deciduous teeth hypomineralisation. Clinically, these defects are characterized by demarcated opacities, posteruptive enamel breakdown, atypical caries lesions, and atypical restorations. The accurate diagnosis of DMH continues to present a clinical challenge, and the reported prevalence of this defect exhibits notable variability across different countries. Its precise etiology remains elusive; however, there is a prevailing suspicion that events occurring during the prenatal, perinatal, or early postnatal periods, particularly those unfolding during the perinatal phase, are intricately linked to DMH development. Factors such as delivery complications, neonatal complications, prematurity, and low birth weight have been associated with DMH. Notably, there exists a possibility that, the more health-related events occur during this critical period, the greater the likelihood of a child presenting with this enamel defect. Nevertheless, the establishment of these associations warrants further investigation through prospective studies. Acquiring knowledge regarding the factors associated with this defect holds paramount importance for effective diagnosis, guidance for families with affected children, and the formulation of strategies to mitigate the incidence of these contributory factors.

Evaluation of antimicrobial photodynamic therapy and minimal intervention associated with deproteinisation in permanent teeth with molar incisor hypomineralisation: study protocol for a clinical, controlled, blinded trial

IntroductionMolar incisor hypomineralisation (MIH) is a qualitative defect of enamel development that occurs in the mineralisation phase. MIH affects one or more permanent molars and, occasionally, permanent incisors. The aim...

Asthma medication and risk of dental diseases in children - A prospective cohort study.

Dental caries and enamel defects are the main causes of poor dental health in children, with a substantial impact on their well-being. Use of inhaled asthma medication is a suspected risk factor, but there is a lack of prospective studies investigating this and other prenatal and early life risk factors. Copenhagen Prospective Studies on Asthma in Childhood 2010 mother-child cohort (COPSAC2010 ) consists of 700 women who were recruited at 24 weeks of pregnancy. 588 of their children participated in a dental examination at 6 years of age (84%) at the COPSAC2010 research unit. Caries was defined as decayed, missing, or filled surfaces. Enamel defect was defined as demarcated opacity, post-eruptive enamel breakdown, and/or atypical restoration on at least one molar. Caries and enamel defects were assessed in both deciduous and permanent dentitions. We found no associations between inhaled corticosteroids or β2 -agonists or asthma symptoms in early childhood and the risk of caries or enamel defects by 6 years of age. Furthermore, we found no strong pre-, peri-, or postnatal risk factors for dental diseases at 6 years, except from nominally significant associations between antibiotic use in pregnancy (OR = 1.25, [1.01-1.54]), maternal education level (OR = 1.57, [1.01-2.45]), having a dog at home (OR = 0.50, [0.27-0.93]), and risk of enamel defects. Use of inhaled corticosteroids, β2 -agonists, or asthma symptoms in the first 6 years of life were not associated with the development of caries or enamel defects. This finding is reassuring for parents and physicians prescribing asthma medication for young children.

Typical esthetic outcomes using 5 different modalities to treat MIH affected teeth: a case series

Introduction: therapeutic options for incisors affected by Molar Incisor Hypomineralization range from very conservative procedures to those considered to be more invasive. Clinicians must select the appropriate approach, considering the outcomes of the procedures. Methods: this case series presents clinical outcomes of five female patients with aesthetic complaints associated with the Molar Incisor Hipomineralization. Results: macroabrasion, microabrasion and dental vital bleaching were used as combination techniques in three cases. Resin infiltration was indicated for a specific case, considering the oncoming orthodontic treatment. Composite restoration was performed in one patient with posteruptive enamel breakdown. Conclusions: clinicians must select the appropriate approach according to an individualized evaluation of each case, considering factors such as the patient's expectations, dental age, psychosocial period, the severity of the condition, presence of sensitivity and the presumed aesthetic result of the selected treatment. The advantages and disadvantages of the techniques are presented.

Management of molar–incisor hypomineralization and hypodontia in monozygotic twins: a case report

Molar–incisor hypomineralization (MIH) is the hypomineralization of permanent first molars and is often associated with similarly affected incisors. This can lead to caries development and post-eruptive enamel breakdown. Early diagnosis and management are of prime importance to prevent premature loss of these molars at a young age, and to mitigate against negative changes on the patient's quality of life. This is particularly true when the patients also present with hypodontia. Wherever possible, conservative management in primary care should be undertaken. This case report explores the presentation and on-going treatment of MIH, and hypodontia, illustrated in monozygotic twin males. CPD/Clinical Relevance: It is important to consider factors involved in the early identification of MIH and hypodontia and to develop strategies to treat the patient.

Preemptive analgesia with ibuprofen increases anesthetic efficacy in children with severe molar: a triple-blind randomized clinical trial

Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia.Objective:This study evaluated the effectiveness of preemptive analgesia in children with severe MIH, post-eruptive enamel breakdown, and hypersensitivity.Methodology:Ibuprofen (10 mg/kg child weight) or placebo was administered, followed by infiltrative anesthesia and restoration with resin composite. Hypersensitivity was evaluated in five moments. The data were analyzed using the chi-square test, Fisher’s exact test, and t-test.Results:Preemptive analgesia provided benefits for the treatment of severe cases of MIH, with an increase in the effectiveness of infiltrative anesthesia and improved patient comfort during the restorative procedure.Conclusion:Preemptive analgesia has shown efficacy in reducing hypersensitivity during restorative dental procedures, evidencing the significance of this study for patients with MIH and hypersensitivity.

Hat die Molaren-Inzisiven-Hypomineralisation einen Einfluss auf die mundgesundheitsbezogene Lebensqualität betroffener Kinder?

Background: In dentistry, the assessment of oral health-related quality of life (OHRQoL) has gained considerable importance in clinical practice and research in recent years. In pediatric dentistry, the clinical picture of molar incisor hypomineralization (MIH) has also been the focus of attention for some time due to a steady increase in prevalence. The aim of this study was to determine the influence of MIH on OHRQoL using the Child Perceptions Questionnaire (CPQ) 8-10.Methods: Children aged 6-11 years diagnosed with MIH were asked to complete the German version of the CPQ8-10 to measure OHRQoL. MIH was classified according to the criteria of the EAPD (European Academy of Paediatric Dentistry) and the MIH-TNI (MIH-Treatment Need Index). Children were recruited from the Competence Center for Mineralization Disorders at the Medical University of Vienna.Results: 139 children aged 6-11 years (52.5 % female; 47.5 % male) were included in the study. The average CPQ score was 8.1 (± 7.3). Children with a mild form of MIH (opacities) showed a better OHRQoL (7.6 [± 7.1]) than children with a more severe form (posteruptive enamel breakdown [8.9 (± 7.3]). Conclusion: The results showed that MIH negatively impacts the OHRQoL of affected children.

Frequency of molar incisor hypomineralization and associated factors among children with special health care needs.

BACKGROUND: Molar incisor hypomineralization (MIH) is a frequently encountered oral condition that varies from mild opacities to posteruptive enamel breakdown. No previous published studies have investigated the frequency of MIH and associated risk factors among children with special health care needs (CSHCN) to our awareness.OBJECTIVES: Assess the frequency of MIH and associated risk factors among CSHCN.DESIGN: Cross-sectional.SETTING: Schools in provincial city of Saudi Arabia.PATIENTS AND METHODS: The study was conducted among 400 (180 boys and 220 girls) special needs children. Diagnosis of MIH was according to the European Academy of Paediatric Dentistry criteria.MAIN OUTCOME MEASURE: Result of logistic regression analysis that assessed the association between MIH prevalence and associated prenatal, perinatal, and postnatal factors.SAMPLE SIZE: 400 (180 boys and 220 girls) special needs children.RESULTS: Among 400 CSHCN, 98 (24.5%) presented with MIH. Children with multiple disabilities had a 3.89 times greater risk of MIH (95% CI: 1.91–6.19, P=.002). Children with positive prenatal factors had an adjusted odds ratio (aOR) of 2.31 times for MIH (95% CI: 1.22–4.73, P=.012). Children with a childhood infection history had an aOR of 2.43 times for MIH (95% CI: 1.31–5.85, P=.014). Children with a breastfeeding history >18 months had an aOR of 3.73 for MIH (95% CI: 1.62–8.60, P=.002). Permanent maxillary first molars were the most frequently affected teeth, and demarcated opacity was the most frequent MIH type.CONCLUSION: MIH should be recognized as one of the prevalent oral health problems among CSHCN to prevent tooth mortality.LIMITATIONS: A cross-sectional study cannot establish a causal relationship.CONFLICTS OF INTEREST: None.

Developmental hypomineralization of the enamel of the first permanent and the second deciduous molars - report of two cases

Introduction. Molar-incisor hypomineralization (MIH) is a developmental defect of dental enamel that affects one to all four first permanent molars (FPM) and frequently permanent incisors. Enamel aberrations are observed as demarcated opacities of different colors (from white to brown) and as posteruptive enamel breakdown. Clinically similar pathological signs can also be present in deciduous molars. Case outline. Histology of an FPM and a second deciduous molar was performed after extraction from two unrelated patients with MIH due to inflammatory complications. Tooth samples were analyzed using a stereomicroscope (SM), light microscope (LM), and scanning electron microscope (SEM). Enamel thickness of both affected teeth was normal. An obvious distinction in enamel microstructure was observed between the normally developed and the molar-incisor hypomineralized enamel with SM, LM, and SEM. Conclusion. In MIH patients, regular dental visits enable early diagnosis of the disease and appropriate treatment of the patient as soon as possible, with included preventive measures.

Structural integrity of MIH-affected teeth after treatment with fluoride varnish or resin infiltration: An 18-Month randomized clinical trial

ObjectiveTo evaluate the influence of fluoride varnish (FV) therapies or resin infiltration (RI) to maintain the structural integrity of Molar Incisor Hypomineralization (MIH) -affected teeth. MethodsFifty-one children aged 6–12 years with at least one incisor and one first permanent molar with yellow/brown MIH opacities were included. Patients were randomly allocated into three groups: FV – Fluoride Varnish (Duraphat); FV+etch – Fluoride Varnish (Duraphat) after enamel etching with 37% phosphoric acid; or RI – Resin Infiltration system (Icon). Opacities were monitored for 18 months. The primary outcome was the loss of integrity due to post-eruptive enamel breakdown (PEB). Covariables included sex, age, DMFT index, opacity colour, plaque index, number of MIH-affected teeth, and number of MIH-affected surfaces. Fisher’s Exact was used to test the association of treatments with PEB, the Kaplan-Meyer method analysed the survival rates and Cox-regression determined which covariables would predict failure (α=0.05). ResultsFrom a total of 235 teeth, the PEB rate for RI (6.1%) was significantly lower (p<0.05) than FV (17.9%; OR 3.0, 95%CI 1.07, 8.48) and FV+etch (17.3%; OR 3.1, 95%CI 1.13, 8.73). DMFT index >3, brown opacities, cusp involvement, and age between 6–8 years predicted PEB (p<0.05). ConclusionsResin infiltration positively influenced the structural integrity maintenance of MIH-affected teeth by decreasing the risk of enamel breakdown over18 months follow-up. Registry of Clinical Trials (RBR-8wwk3n). Clinical RelevanceResin infiltration proved to be a more efficacious intervention to maintain the structural integrity of MIH-affected teeth than fluoride varnish therapies.

Molar Incisor Hypomineralization: Prevalence and severity in six to nine-year-old Sarajevo children.

Research aimed to gather aepidemiological parameters of MIH from a sample of Sarajevo children born between the years 1999 and 2003. Prevalence of MIH, distribution according to severity (mild vs. moderate/severe cases) and distribution according to phenotypes (MIH vs MH) were investigated. Study design: This was a cross-sectional, observational, aepidemiological study that was conducted on a sample of 446 children aged 6 to 9 years. It was conducted as a part of regular dental screening of children attending a randomly selected primary school in the Bosnian capital city of Sarajevo. The overall prevalence of MIH was 11.5%. MIH prevalence varied between 19.9% of examinees born in year 2002 to 8.4% among those born in 2003. Number of teeth affected varied from 1 to 7. The average number of affected teeth was 3.82 ± 1.46. Demarcated opacities were recorded on 13.89%, post-eruptive enamel breakdown on 11.28% and atypical filling on 6.2% index teeth. Mild cases of MIH were rare in our sample, 18% of subject had only demarcated opacities present. A smaller percentage of examinees (35.3%) had hypomineralisation present only on first permanent molars (MH group). Out of 64.7% of subjects in MIH group, 37.25% had one incisor affected and 21.57% had two incisors affected. Over 80% of study subjects with MIH were categorised as moderate/severe case of MIH and they represent a major problem with regards to dental treatment. It is necessary to plan a multi-disciplinary approach for dental care of this population. It is necessary to educate primary care dentists to recognise this condition and provide recommended treatment to patients with mild clinical picture, while directing those with more severe problems to specialised doctors.

Prevalence of Hypersensitivity in Teeth Affected by Molar-Incisor Hypomineralization (MIH)

Aim: This study aimed to investigate the prevalence of hypersensitivity in molar-incisor hypomineralization (MIH)-affected molars through a census carried out in 8-year-old schoolchildren. Methods: Examinations were conducted by a calibrated examiner, using the Nyvad criteria for caries diagnosis and a new criterion for MIH assessment. For hypersensitivity assessment, all MIH-affected molars were included. Nonaffected molars from the same child were used as controls. Air blast reaction was measured using the Visual Analogue Scale (VAS) and the Schiff Cold Air Sensitivity Scale (SCASS) scale, while tactile hypersensitivity was scored using VAS only. Statistical analysis was performed using the Kruskal-Wallis test followed by Dunn’s multiple comparisons test for quantitative data. χ² was used for the comparison of categorical data. Results: In total, 631 children were assessed, of whom 102 had MIH-affected molars (16.1%). Of these, 51.7 and 8.7% presented enamel and dentin carious lesions, respectively. Regarding the number of teeth, 239 molars were MIH affected (59.8%), with 188 (78.7%) being classified as mild (opacities only), 20 (8.4%) as moderate (posteruptive enamel breakdown), and 31 (13%) as severe (posteruptive breakdown involving dentin/atypical restorations). Hypersensitivity was recorded in only one control molar, while the prevalence of hypersensitivity in MIH-affected molars was 34.7%, being of low intensity and more prevalent in moderate (55%) and severe cases (51.6 %) than in mild cases (29.8%, p = 0.008). An association between hypersensitivity and the presence of mild and moderate cases was observed. Although the same association was observed for severe cases, it was not considered a reliable information as 90% of the MIH-affected molars with posteruptive breakdown involving dentin were affected by carious lesions. It is known that dental caries is a confounding factor for the presence of hypersensitivity. Conclusions: Hypersensitivity was significantly higher in MIH-affected molars than in nonaffected molars, being associated with MIH teeth presenting opacities and posteruptive enamel breakdown.

Knowledge, attitude, and practice regarding molar-incisor hypomineralization among postgraduates and faculty members of K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India

Context: Molar-incisor hypomineralization (MIH) is a defect existing in the form of demarcated and opaque lesions and in severe cases with posteruptive enamel breakdown. There is a lack of knowledge, learning, and practice on MIH in pediatric dentistry. Aims: This study aimed to identify the knowledge, attitude, and practice on MIH among postgraduates and faculty members of K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India. Settings and Design: A questionnaire-based study was conducted among the dental staff and postgraduate students of K.M. Shah Dental College. Subjects and Methods: The questionnaire was hand-delivered to all 142 participants, and they were asked to fill it within 5 working days. The questionnaire included demographic information, prevalence, incidence, and severity of MIH in Vadodara City. Statistical Analysis Used: Data analysis was done using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). The data were found to be normal by the Kolmogorov–Smirnov test. Intergroup comparison was done using the Chi-square test for proportions and percentages (qualitative data). Results: 43.3% of the respondents could not implement the clinical criteria to diagnose MIH, 92.5% of the respondents recommended to include MIH-associated case studies in the curriculum, 95% of the respondents recommended to conduct awareness programs, and 40.5% of the respondents indicated a lack of knowledge as a barrier for performing MIH management. Conclusions: There is a need for dentists to attend continuing dental education programs and various awareness programs on MIH and to introduce in-depth information on MIH-etiology and its treatment into the dental curriculum.

Molar incisor hypomineralization: current research evidences

Molar-Incisor Hypomineralization (MIH) is a condition of systemic origin that involves one to four first permanent molar teeth and often associated with affected incisors. Although several associations to prenatal/perinatal childhood medical conditions have been reported, the etiology of MIH still remains unclear. The degree of enamel hypomineralization in the affected teeth can vary and the clinical problems associated with the teeth include increased susceptibility to caries, rapid wear, and post-eruptive enamel breakdown. Affected teeth are extremely challenging to treat as the enamel is porous, sensitive and treating clinicians might encounter great difficulty in achieving profound anaesthesia. The first part of thispresentation will give an update on prevalence, potential etiological factors, and management strategies of this condition. The second part of the presentation will cover a systematic review results on bonding strategies to hypomineralized enamel.

Prevalence of molar incisor hypomineralization (MIH) in Singaporean children

There is a lack of data on molar incisor hypomineralization (MIH) in Asia, but this is not an indication that MIH is rare in the Asian population. Early identification of MIH is important as affected teeth frequently display post-eruptive enamel loss which would result in rapid caries progression. This objective of this study was to assess the prevalence of MIH in Singaporean children. Patients were recruited from 30 schools across Singapore. All children were examined by a single dentist, and the judgement criteria used were based on the 2003 European Academy of Paediatric Dentistry criteria. A total of 1083 children; average age of 7.7 ± 0.3 years were examined. One hundred and thirty-five children (12.5%) had MIH. A significantly higher proportion of children of the Malay ethnicity had MIH, compared to Chinese children (P = 0.02). Post-eruptive enamel breakdown and the presence of atypical restorations were correlated with increasing number of MIH teeth/child (Rho= 0.599, P < 0.001) and the cumulative enamel opacity colour score (Rho = 0.601, P < 0.001). Our findings suggest the role of ethnicity in MIH occurrence and that MIH severity may be influenced by the number of MIH teeth/child and the cumulative enamel opacity colour score.

Molar incisor hypomineralisation: A review of its current concepts and management

Over the past two decades, there is an increasing number of congenital defects affecting enamel mineralisation referred to as molar incisor hypomineralisation (MIH). This defect usually involves one to four permanent first molars and permanent incisors. Clinically, the defect presents as opaque lesions varying in colour from white to yellow or brown, with a sharp demarcation between the affected and sound enamel to posteruptive enamel breakdown. The destruction of enamel is so rapid and clinically, it presents as if the enamel has not formed at all. It has been postulated that MIH is a consequence of a variety of environmental factors acting systemically, which disturb the ameloblasts during amelogenesis. However, the possibility of a genetic component in the development of MIH cannot be excluded. Management of MIH always pose a big problem to the clinicians, as well as for the child due to severe sensitivity caused by the defective enamel.

Increase in severity of molar-incisor hypomineralization and its relationship with the colour of enamel opacity: a prospective cohort study

Predicting risk of posteruptive enamel breakdown (PEB) of molar-incisor hypomineralization (MIH) opacity is a difficult but important clinical task. Therefore, there is a need to evaluate these aspects through longitudinal studies. The aim of this longitudinal study was to analyse the relationship between colours of MIH opacity of children aged 6-12 (baseline) and other clinical and demographic variables involved in the increase in severity of MIH. A blinded prospective 18-month follow-up was conducted with 147 individuals presenting mild MIH. Tooth-based incidence of increase in severity of MIH (PEB or atypical restorations) was used as dependent measurement. Enamel opacities were recorded according to colour shades of white, yellow and brown, allowing assessment of susceptibility to structural loss over time, according to colour of MIH opacity. Poisson regression models were used to adjust the results for demographic and clinical variables. Brown and yellow MIH opacities were at higher risk for PEB and atypical restorations than those of white ones, even after adjustment for clinical and demographic variables. Teeth presenting mild MIH severity associated with yellow and brown enamel opacities were at high risk for increase in severity of MIH than lighter ones. This result could help clinicians determine a risk-based treatment for children with MIH.