Molar-Incisor Hypomineralisation – Treatment Aspects and Outcomes

Abstract

Molar-Incisor Hypomineralisation (MIH) presents substantial challenges for dental pro-fessionals, children, and healthcare systems. This thesis aimed to investigate treatment aspects and outcomes of first permanent molars (FPMs) affected by MIH from four perspec-tives: the tooth, the clinic, the patient, and society. Four studies were conducted within the GuREx-MIH project. Paper I explored clinical decision-making among Swedish dentists. Considerable varia-tion in treatment preferences was observed, with specialists more inclined to extract mod-erately and severely affected FPMs, while general dentists more often chose restorative options. Prognostic considerations and reliance on specialist advice shaped decisions in unclear cases. Paper II examined patient-reported outcomes following restorative treatment or extraction of affected FPMs. Children in both groups showed improved oral health-related quality of life (OHRQoL) and reduced dental fear and anxiety (DFA) by age eleven. Neither treatment produced higher outcomes, suggesting that symptom relief rather than treatment type drives improved well-being. Paper III evaluated eruption patterns after early FPM extraction using a split-mouth trail. Maxillary second molars erupted more favourably on the extraction side, while mandibular teeth showed no significant differences. No overeruption of antagonists was observed. Paper IV assessed cost-effectiveness of restorative versus extraction therapy at age eleven. Extractions were more expensive when general anaesthesia was required but cost-efficient without it. Both treatments yielded similar OHRQoL improvements, though more children in the extraction group achieved a minimally important difference. Conclusion: The studies provide a multifaceted understanding of MIH management in 11-year-olds. Treatment decisions depend on clinician experience; both treatments similarly benefit children; early extraction mainly affects maxillary eruption patterns; and costs are strongly influenced by the need for general anaesthesia. Findings highlight the importance of child-centred care, careful extraction timing, and efficient resource use, as well as the need for longer follow-up and updated evaluations of clinical practice.