Israeli Expert Highlights MIH as Hidden Cause of Severe Tooth Pain in Children

Molar Incisor Hypomineralization (MIH) is a common yet often overlooked developmental dental condition affecting children’s permanent first molars and incisors. Prof. Malka Ashkenazi, a leading pediatric dentist in Israel, explains that MIH causes the enamel to form weak and soft, making teeth prone to breakage and extreme sensitivity shortly after eruption, often leading to severe pain during routine dental exams.

In Israel, about 18% of children are affected by MIH, which can manifest as white or yellow-brown spots on teeth, with darker discoloration indicating more fragile enamel. Early signs include intense sensitivity to hot and cold, such as pain when eating ice cream. Many parents are unaware that permanent molars can erupt as early as age five or six, delaying diagnosis and treatment.

Treating MIH is challenging because the affected teeth are difficult to numb, causing real pain rather than behavioral issues. Prof. Ashkenazi emphasizes tailored anesthesia techniques to prevent dental anxiety. Without proper management, children may require sedation or general anesthesia for extractions, increasing emotional and financial burdens.

The causes of MIH are multifactorial, involving genetic predisposition and environmental factors like childhood illnesses and antibiotic use. Early detection is critical, especially if second primary molars show damage, signaling risk for permanent teeth.

Treatment varies by severity and tooth type. For front teeth, microabrasion and composite fillings improve aesthetics. For molars, fragile enamel often leads to repeated filling failures, making stainless steel crowns a preferred long-term solution. In severe cases, planned extraction of a damaged first molar around ages 8-9 can allow natural shifting of second molars and wisdom teeth, often avoiding future orthodontic complications.

Follow-up frequency depends on treatment type and severity, ranging from quarterly visits for fillings to biannual check-ups for crowned teeth. Decisions about extractions involve close collaboration between pediatric dentists and orthodontists to ensure optimal outcomes.

Prof. Ashkenazi, recognized among Israel’s top medical specialists, stresses the importance of awareness and early intervention to reduce pain and improve dental health in children with MIH.