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The causes of hypomineralization still unclear

Hypomineralization of molar incisors (MIH), better known as chalk teeth, spreads faster than tooth decay and has become a widespread disease in recent decades. The causes of this mineralization disorder, which make teeth soft and vulnerable, are not yet sufficiently understood. Renowned dental experts explain the current state of knowledge.

There is a mineralization disorder behind the so called chalk teeth. The causes are so far unknown. (Photo: Patrick Pleul / dpa-Zentralbild / dpa)

In some children, the teeth literally crumble in the mouth. The causes of MIH are still unknown. There isn’t much parents can do when their young patients’ teeth turn yellow or brown. Children who come to Katrin Bekes’ special clinic almost always have severe toothaches and anxiety.

Children are particularly often affected

“We have children for whom the thermal stimulus of a cold instrument or the heating light of the operating light alone is painful,” explains the professor of pediatric dentistry at the University of Medicine in Vienna. Many don’t even want to be looked at in the mouth.

Discoloration and hypersensitivity

Children treated with Katrin Bekes suffer from MIH – short for Molar Incisor Hypomineralization. In these children, the mineralization of the enamel of the first permanent molars and partly of the incisors is disturbed. In the weakest cases the teeth are only discolored, in severe cases the enamel is severely weakened and collapses. This is why we generally speak of chalk teeth. Affected children are extremely sensitive to the touch and temperature of their teeth.

Chalk teeth known only since 1987

Swedish scientists first described the disease in 1987. Since then, it seems to have spread. “Around 14% are affected globally,” says Bekes, also president of the German Society for Pediatric Dentistry. The numbers have fluctuated a lot from study to study. In Germany, even 28% of 12-year-olds suffer from MIH, as the 5th German Oral Health Study found in the First National Study. Most of them only fade.

MIH cases are recognized more often

Pediatric dentistry expert Norbert Krämer from Giessen University Hospital considers these figures too high, but also sees an increase in illnesses. “The severity of cases is also increasing,” he says. Like Bekes, he is one of the experts at MIH, has published various studies on the disease, and gives advanced training courses for dentists.

“The point of view has become more refined,” says Dietmar Oesterreich, vice-president of the German Dental Association in Berlin. Today, more cases of MIH would be recognized that would previously have been considered dental caries. “This is why scientists wonder if this is a relative or absolute increase in MIH.”

Many children these days have cavity-free teeth – also because parents care about brushing and eating healthy. Every year on September 25, numerous events and campaigns across Germany highlight the importance of healthy teeth. This year, the focus is on nutrition. Among other things, it is about knowing what harms the teeth and what makes them stronger.

Develops between the first and third year of life

However, diet has just as little influence on the development of MIH as brushing your teeth. Viennese expert Bekes often meets desperate parents who blame each other. “Parents need to know that they haven’t done anything wrong,” she said. Damage occurs when tooth enamel forms, i.e. the teeth are still in the jawbone. With the first permanent molars, this is the main phase between the first and third year of life, Bekes explains.

The weakened tooth enamel cannot be seen on x-rays. Therefore, the damage would not be visible until years later when the teeth erupt. This is what makes finding the cause so difficult, Bekes points out. “There have been plausible attempts to explain it, but we are still fishing in murky waters.”

The causes still unclear

Possible triggers include antibiotics, infectious diseases, diet during pregnancy, environmental influences such as dioxins or bisphenol A (BPA). “There is still a lot of research to do,” says Krämer. It is now known that other permanent teeth can also be affected. And deciduous second molars can also have mineralization disorders – called deciduous molar hypomineralization. These children are eleven times more likely to also suffer from MIH, says Krämer.

But precisely because the causes of MIH are not yet known, prevention is not possible. There is still something parents can do, according to Krämer: keep a close watch on their children’s teeth and take them to the dentist regularly from a young age so that they get used to it and are not afraid later. (vb; source: Irena Güttel, dpa)

Author and source information

Fade now

This text conforms to the requirements of specialized medical literature, medical directives and current studies and has been verified by health professionals.

Author:

Graduate Editor (FH) Volker Blasek

Sources:

North Rhine Dental Association: Incisor molar hypomineralization (MIH): what is it? (Access: October 2, 2020), zahnaerztekammernordrhein.de Institute of German Dentists: Fifth German Oral Health Study (from 2016), idz.institute

Important note:
This article is provided for informational purposes only and should not be used for self-diagnosis or self-treatment. It cannot replace a visit to the doctor.