Mysterious illness: when children’s teeth suddenly crumble

Mysterious illness When children’s teeth suddenly crumble

Clearly visible here: whitish-yellow spots on the upper incisors. You are affected by an MIH.

(Photo: Maurizio Procaccini et al / Wikipedia / CC BY 2.0)

Caries is hardly widespread among children, but another dental disease puzzles: With MIH, teeth can simply break away. The disorder is created as early as baby – or even earlier. What’s behind it? An interview.

Almost a third of all twelve-year-olds in Germany are affected: Their teeth are free of caries and yet at least one tooth has white or yellowish-brown spots, is sometimes very sensitive to touch and crumbles away when the worst comes to the worst. The disease is called molar incisive hypomineralization, MIH for short. That sounds bulky, but describes well what it is about: the entire child’s dentition is never affected by the disease, but rather the first permanent molars that the dentist calls six-year molars, and the upper front teeth, the incisors. The reason for the complaint is that the enamel of these teeth lacks minerals – hence hypomineralization.

Danger recognized, danger averted? Not quite. Dentists can now easily diagnose this disease, which is quite new for them, and they know how to treat it. But why the MIH is so widespread, how it develops at all, which children get MIH and which do not – all these questions are still unanswered.

Prof. Dietmar Oesterreich, Vice President of the German Dental Association and a dentist based in Mecklenburg-Western Pomerania, explained what we know about the MIH: Prof. Oesterreich, what are the reasons for the MIH??

Dietmar Oesterreich: Many options are currently being discussed. Antibiotics are suspected, as are illnesses during pregnancy, infectious diseases in early childhood or environmental toxins such as dioxin. You are still looking.

At what age does the MIH develop?

Very early. The appearance occurs in the jaw long before the teeth have even broken. The molars and upper incisors are mineralized already in the early childhood phase, around the birth and the first years of life. This is the phase in which the MIH is created. The influencing factors can therefore be assumed during pregnancy and the early childhood phase.

And at what age does the disease become visible?

The phenomenon can be observed for the first time when the permanent molars and incisors pass through. That is between the ages of five and seven. As soon as the teeth can be seen, the MIH also shows up in the affected children. From the beginning.

That is, an eight-year-old child who has healthy teeth can no longer get MIH?

There are approaches to how parents could prevent the disease?

No, there is currently no wise thought. Since we do not know the causes of MIH, we cannot point out preventive measures.

What minerals are there that the affected teeth are missing?

The tooth enamel mainly consists of phosphates and calcium and it is these minerals in particular that are missing in the MIH during the enamel formation phase or are not sufficiently incorporated into the tooth enamel.

What are the consequences for the teeth??

That is different. In most cases, thank God, it’s all about the aesthetic appearance. So you can see brownish-yellow discoloration on the teeth that need no further treatment. That is the comfort. Only a very small percentage, around five percent of children, need to act. Then the tooth enamel is missing in places or even completely, it can even lead to tooth loss.

What does the dentist do at an MIH?

The therapy is basically no different from caries. If the enamel is missing in places, it is treated with fillings. However, the tooth is not prepared for the filling if possible, so it is not drilled. Because if possible, you refrain from sacrificing tooth substance and instead try to replace the missing tooth enamel – mainly with plastic fillings. If the entire tooth is affected, it must be restored with a crown or – in the worst case – extracted. The latter is very rarely the case.

Why does the MIH not affect any teeth apart from the molars and the upper incisors?

The causes – whatever they may be – apparently start precisely in the education phase of these two tooth groups. Later, the causes no longer have the same effects. Usually it is not just a cause, but there are several factors that come together in a disease. But if they work in their synergy, it is in the phase when exactly these teeth are formed.

How long have dentists known about this disease??

Since the beginning of the 1980s. Although there were individual indications of this before, it appeared in the scientific literature at the beginning of the eighties – although it has only been referred to as molar incisive hypomineralization since 2001.

Could it be that the disease has existed for a long time and that it just wasn’t recognized before?

Yes, it is actually possible. The children’s oral health has become excellent. If you look at the twelve-year-olds, for whom all permanent teeth are broken and easy to control, you can see that they have virtually no caries. It was different in the past. Therefore, it may well be that the MIH existed before the 1980s, but at that time it was hardly distinguishable from caries or was overlaid by it. I have been in the profession for 35 years and can remember early patients, where I wondered why their teeth were destroyed in a way that was not typical for caries. Caries occurs first in certain places in children and sometimes parts of the teeth were affected, which was unusual. In the meantime, the descriptions of an MIH have become much clearer, so that the diagnostic view is sharpened.

How intensively is the cause of MIH now being researched??

Not particularly intense yet. The fact that the teeth are so badly damaged by an MIH that they have to be removed affects only 0.1 percent of the cases. Compared to caries, a destructive MIH is still a minor phenomenon. But research approaches are sought.

In which direction they go?

There are certainly sensible ones that take into account the interaction between medicine and dentistry. You have to look much more closely at medicine: Which illnesses are in the foreground around the birth? Could certain medications be suspected? Are they used frequently? Have children who developed MIH been affected by such drugs? It is also discussed whether MIH is an indication of the presence of celiac disease. And you have to think even further: If environmental aspects can play a role, you also have to look at the regional situation. So where are there particular environmental burdens? All of these aspects have already been touched upon; we very much hope that scientists will pounce on it more and more. However, certain industrial companies must also have an interest in it. Because we know: Unfortunately, research funding does not fall from the sky.

Andrea Schorsch spoke with Prof. Dietmar Oesterreich

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