“We have children for whom the thermal stimulus of a cold instrument or the warming light of an operating lamp alone hurts,” says the Professor of Pediatric Dentistry at the Medical University of Vienna. Many of them don’t even want to be looked at in the mouth in the first place.
In some children the teeth literally crumble in the mouth. The causes of the disease MIH are still not known. Parents can do very little if the little patients’ teeth turn yellow or brownish. The children who come to Katrin Bekes in the special outpatient clinic almost always have severe toothache and anxiety.
Molar Incisive Hypomineralization (MIH), better known as chalk teeth, spreads faster than caries and has become a widespread disease in the last decades. The causes of this mineralization disorder, which makes the teeth soft and vulnerable, are not yet sufficiently understood. Renowned dental experts explain the current state of knowledge.
Discoloration and hypersensitivity
Causes of hypomineralization still unexplained
The children Katrin Bekes treats suffer from MIH – short for molar incisor hypomineralization. In these children the mineralization of the enamel of the first permanent molars and partially of the incisors is disturbed. In weaker cases the teeth are only discolored, in severe cases the enamel is strongly weakened and collapses. That is why they are generally called chalky teeth. The affected children react extremely sensitively to touch and temperature on their teeth.
In 1987, Swedish scientists described the disease for the first time. Since then it seems to be spreading. “About 14 percent are affected worldwide,” says Bekes, who is also president of the German Society for Pediatric Dentistry. However, the figures fluctuated greatly from study to study. In Germany as many as 28 percent of 12-year-olds suffer from MIH, as the 5th German Oral Health Study found out in the first nationwide study. However, the majority of them only develop discoloration.
Children are particularly frequently affected
“The view has sharpened”, says Dietmar Oesterreich, Vice President of the German Dental Association in Berlin. Today, more MIH cases are being detected that were previously thought to be caries. “This is why scientists are arguing whether there is a relative or absolute increase in MIH.”
The pediatric dentistry expert Norbert Krämer from the University Hospital in Gießen considers these figures to be too high, but also sees an increase in the number of cases. “The severity of the cases is also increasing,” he says. Like Bekes, he is one of the MIH experts, has published various studies on the disease and gives continuing education courses for dentists.
Many children today have caries-free teeth – also because parents pay attention to thorough brushing and a healthy diet. The importance of healthy teeth is emphasized by numerous events and campaigns nationwide every year on September 25th. This year the focus is on nutrition. Among other things, the focus is on the question of what damages teeth and what strengthens them.
Triggers include antibiotics, infectious diseases, nutrition during pregnancy, environmental influences such as dioxins or the chemical bisphenol A (BPA). “There is still a lot of research needed,” says Krämer. It is now known that other permanent teeth can also be affected. And the second milk molars can also show mineralization disorders – called milk molar hypomineralization. These children are eleven times more likely to suffer from MIH, says Krämer.
The weakened tooth enamel cannot be seen on X-rays. Therefore, the damage would only become visible years later, when the teeth break through. This is what makes research into the cause so difficult, emphasizes Bekes. “There are plausible attempts at explanation, but we are still fishing in the dark.
However, diet has just as little influence on the development of MIH as brushing teeth. The Viennese expert Bekes often meets desperate parents who reproach themselves. “The parents must know that they have done nothing wrong,” she says. The damage occurs when the enamel forms, i.e. the teeth are still in the jaw. With the first remaining cheek teeth that is in the main phase between the first and the third year of life, explains Bekes.
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