European Archives of Paediatric Dentistry

, Volume 18, Issue 4, pp 225–242 | Cite as

Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice

  • A. GhanimEmail author
  • M. J. Silva
  • M. E. C. Elfrink
  • N. A. Lygidakis
  • R. J. Mariño
  • K. L. Weerheijm
  • D. J. Manton
Original Scientific Article



Despite clear assessment criteria, studies of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) are marked by inconsistency in outcome measurements. This has detracted from meaningful comparisons between studies and limited interpretation.


To provide a comprehensive manual as a companion to assist researchers in planning epidemiological studies of MIH and HSPM, with particular reference to outcome measurement.


This manual begins with a succinct review of the clinical problems and evidence for management of the conditions. The subsequent sections guide researchers through diagnosis of MIH and HSPM and implementation of both the long and short forms of a recently proposed grading system. MIH and HSPM can often be confused with fluorosis, enamel hypoplasia, amelogenesis imperfecta, and white spot lesions but can be distinguished by a number of unique clinical features. Based on the grading system, a standardised protocol is proposed for clinical examinations. Intra and inter-examiner reliability is of key importance when outcome measurement is subjective and should be reported in all epidemiological studies of MIH. The manual concludes with an exercise forum aimed to train examiners in the use of the grading system, with answers provided.


The use of a standardised protocol, diagnostic and grading criteria will greatly enhance the quality of epidemiological studies of MIH.


MIH HSPM Charting sheet Scoring method Calibration Enamel hypomineralisation EAPD Epidemiologic studies 



Some of the clinical photos used in this article are from the databases of Drs. Elfrink M, Ghanim A and Silva M. The authors would like to thank Drs. Bagheri R, Bhatnagar U, Gaton P, Leen A, Lim J, Owen M, Palma C and Raj J for their contribution to the article photos, their support is acknowledged with gratitude.

Compliance with ethical standards

Conflict of interest

Dr. Aghareed Ghanim declares that she has no conflict of interest. Dr. Mihiri Silva declares that she has no conflict of interest. Dr. Marlies Elfrink declares that she has no conflict of interest. Dr. Nick Lygidakis declares that he has no conflict of interest. Prof. Rodrigo Mariño declares that he has no conflict of interest. Dr. Karin Weerheijm declares that she has no conflict of interest. Prof. David Manton declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Approval was gained to use images from legal guardians of children involved.


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Copyright information

© European Academy of Paediatric Dentistry 2017

Authors and Affiliations

  • A. Ghanim
    • 1
    Email author
  • M. J. Silva
    • 2
  • M. E. C. Elfrink
    • 3
  • N. A. Lygidakis
    • 4
  • R. J. Mariño
    • 1
  • K. L. Weerheijm
    • 3
  • D. J. Manton
    • 1
  1. 1.Oral Health CRCMelbourne Dental School, The University of MelbourneMelbourneAustralia
  2. 2.Department of Paediatrics, Murdoch Children’s Research InstituteRoyal Children’s Hospital, The University of MelbourneMelbourneAustralia
  3. 3.Paediatric Research Project (PREP)AmsterdamThe Netherlands
  4. 4.NHS Dental Centre for ChildrenAthensGreece

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