0:13 [Music] I would like to say that it's a great pleasure for me to be here in Vietnam it's my and I really appreciate the invitation and I would like to to come to Vietnam so I've Tred quite a long distance you heard it I'm from Europe from Austria originally I'm from Germany
0:58 from Europe and just to give you a little bit of an impression the long way I traveled so this okay okay hello [Music] [Music] [Music]
1:46 theying the conc January all over the worldend this concer this year so you see them on the side and I've also brought you some other pictures of Austria of on the left lower side you see one of our Nies of the old buildings that we and to Europe are the famous cakes of a called the s cake it's a chocolate cake and when come to so I'm working at the Medical University
2:33 VI it's the biggest university in Austria and unfortunately we only have three state universities in Austria and private but Austria is a very small country only 8 million inhabitants so it's the same I think as um and I'm working there and it's the first Department of in the whole country and it was just 10 years ago when I got the great chance Austria to Austria and to start building
3:22 up this department so right now I think we are out of the baby shoes we exist since April 2015 and now we havea over 4,000 children per year so that's quite a lot the H that we are is 0 to 15 so [Music] [Music]
4:09 asically ill and patient and as know I'm a little bit specialized in m so it was a goal of mine when I started there to also open a compet center for mineralization disorders on Mi and we started with this compens Center about 9 years ago and it's a possibility for other dentists to showes there to transfer them to us so that we can discuss the treatment approaches and on the other side there are also parents coming on their own for to know the center and then say okay we would like
4:56 to present our child you think our child so as told you I'm um working in Austria but I'm originally from Germany and this is also the reason why I'm right now the president of the German Society ofri I'm doing this for years it's a lot of work but it makes a lot of fun because I have fantastic Coles and I'm also the vice president of the aan society and it's a little bit my wish and my goal to bring both countries together and to work together so this is about me and um today we are talking about mih not only
5:43 I will talk also Professor I think there will be some repetition but um I would like to show you a little bit the European on Mi and how it all develop so you can the outline more or less within the next 9 minutes we will talk a little bit about after short introduction talk a little bit about prevalence figes in Europe diagnostic what is the possibility to diagnose mih very easily and what are differential diagn how can I classify between mih or
6:31 Oris and then we will go and dive deeper into systemy and we develop soce town of Germany and I will explain why we call it the concept and not the B concept but concept um and um maybe we have some time who already talk about propis and hyp sensitivity then there will be a break and in the second part I will talk about all of the treatment approaches and how we um decide how to treat mih patients
7:19 regarding the m and mostly and also thees regarding aesthetic treatment so before we short video again and then we go into [Music] [Music]
8:04 [Music] okay now everybody M away and we can start um already promised you I would like to make a little bit the shift and to show you how we in Europe and probably you will see it's not different from the rest of the world but how we are approaching mih and um it it comes with a lot of challenges you all know
8:51 this um but it's not only although we are we have the it dat today it's not all about the it's a lot also about the M because we have to think about um Poss eruptive breakdown it's not only discoloration of these they may may break down very rapidly and then we have a huge problem with chewing with brushing the teeth because often it's connected to hyp sensitivity well and we will talk about possibilities of treatment as well it might also be connected to carriers and that's a huge
9:39 problem as well if you not only have Mi but also carriers in these children and we also have to talk about Restorations lots of restorations why they not work in way as we know from so we will talk about this and of course we will talk about Aesthetics about possibilities of treatment in but let me already say this at this stage this comes second the first step is always
10:24 toat and to give the child quity of life back having toat and and so let's go back a little bit and have a look since when do we know this condition because carriers been know for hundreds of years but what about Mi so of course our main goal is still to treat also in Europe also in Austria although we have in the highest quality of life we have lot of GC a lot of early
11:10 child but we also have to deal with mih and officially this term was coined in the year 2001 so we are talking about the disease about the condition being only usually in dentistry for 23 years it's a young and I can tell you that in Germany where I worked at that time it was 200 was shortly before my graduation I graduated in2 um nobody outside the really about Mi so when we were talking about this every general dentist
12:00 is a problem of pediatric but we will never see it in general practice because hopefully it will be in prevalent dat like we see [Music] amenis or D but it changed the the the it moved a little bit and in 2018 we had a press conference from the German Society of pediatric dentistry representing recent prevalence data Nationwide prevalence data on mih and you will see these data in few slides
12:47 but what you can see from the translation is that the title of the press mode was there is a new public illness because we see certain age groups M more often than we see par so let's start maybe with three different cases just to show you again the variability of this here you can see n old patient in the second face of the he did not have any problems they just mov to Vienna and they showed up
13:32 for a regular check up the patient did not have any complaints but what we saw and what you are seeing right now is that on the two two and 36 meaning upper left and lower left first permanent M you see opacities on the ble side it's only a small opacity it's white um as I already said the patient didn't really notice it's so far back in the mouth he didn't have any problems nevertheless of course we saw it we diagnosed it and that would be a very M form of mih but to be honest probably it
14:20 will never be a problem for the patient on the other side we have to count it into disase it's the picture BEC a little B more clearer you to this PTI because here also the parents notic that three of the four first permanent MERS do not look like as they should because they were erupting and they recognized the yellow color the brownish color taking over the whole crown also you see although the patient is very young first phase of the mix dentition
15:06 lateral sizes haven't changed yet you already see first postop breakdown in the mol and this patient also had a little bit of pain and did not really want to bring cold GRS to be honest this was not the main complaint of the the parents complained because of the Inus and this is why they showed up they said we recognize that there are discoloration in the Ani we do not like it so make something do something um you see the um discoloration in the centralises and you see them on the
15:53 right side of the lower sizes so this was the main complaint but we will talk about this later this treatment of because very young patient um and we first focus on the m so I would like to end with the third case as I promised I think here it's even more clearer a verye form of age every four first permanent M are affected you already see huge breakdown and if you have a look to the to on the upper right first permanent
16:38 you see accumulation which is always a sign of hyp sensitivity because the rest of the primary ke are brushed very well but the patient did not want to brush the first permanent M because interestingly there were no opacities in the interior and this is why I have picked and chosen the case number two and three just to demonstrate that the amount and also the severity that we see in the molar are not um great way connected to
17:24 the anties it's a huge variability it does not you have a huge sity in the first permanent M that automatically you have a lot of anterior tee being affected and that you have S forms in the because luckily this patient did not have any hyper neuralization in the so I already told you that the term was coined 2001 but it was not Sunny there overnight so what happened before if you go into the literature you will find a publication
18:09 from the 80s from Professor C from Sweden and he uh wrote a paper about um about results and data that he found in the Public Services uh in some years ago and he's talking about idopathic Hy so um he presents in this paper some cases as well saying we found hyper mineralization in bers and in iners in a bigger prevalent number than we have ever seen and he also added some
18:57 pictures and here is what you see what we would call mih today demarc capacity on the first permanent M beginning breakdown and you see a very s form in the interior so it took some time till the definition was formed um over 10 years and in the year 2000 so one year before the official definition there was a meeting of the European Academy of pediatric dentistry in B in Norway they had their annual meeting and during this meeting there was the surprising
19:44 situation that from different working groups from different European countries there were presentations about hyper mineralized te mainly the M and sizes and they talked about mineralization they also chose the term of non flated hyp mineralization because if you see whsh coloration uh maybe you always think about so it's not dat typization and uh the colleagues from the Netherlands for nevertheless are very
20:30 famous for their cheese they called it the cheese mod um and after that they all said together and said probably we are all desing the same condition and we should give it a term an official definition and this was done of the working one later so the term m in h mineralization was offici given a definition and describe first of all it's about classically at least one first permanent M has to be effective and the Anor can be affected additionally but do
21:18 not necessarily have to be affected and can also be only up point is that it is a qualitative it's no quantitive because otherwise it would be called hypoplasia but during formation of the tooth the tooth is form find from the form from the shape of the but within the en we have a problem in certain areas which we see as discoloration areas the enamel is hyper minized it's
22:03 Horus and we see it in a color change so after that quite some Publications came up discussing is it the new and there were some colleages from London who had look into the SKS of old people and they also found it in some [Music] old you see here the black and white picture the m and also the second primary M so probably um it was always there but we are now discussing in what prev only in cases in the P so what has happened since the
22:51 official introduction we we would see that we have now very nice Publications we going up to the 800 nevertheless if you type in into car or you will find thousands and thousands of Publications so we have have time the never say that in the first years there were a lot of stud being published about re everybody wanted to know does this condition also exists in my country uh in most cases it's not
23:38 Nationwide data we only have data so there are only a few dat we have mainly data from every country and during the last there was a little bit of shi that we now get more clinical studies giving us how to treat these patients nevertheless I have to say that a lot of these studies we're only set up because we already knew what is working and what is not working and a lot wased in private practic in practices so practitioners gave us the way how how we should go and
24:26 so yes [Music] and it's also top from time to time in the newspap in Europe I don't know about Vietnam but in in Germany and when we had like the day of oral heal or whatever so this is picked up also in the newspapers and they talk about they crumbling and so um parents are today much more aware of this top than they have been like 15 years ago because if you go into Google and we all go Google
25:12 to check certain things um if you have Ty this in a lot of years ago so in Germany we call if you type this um in 20089 Sor you just got the information that it is form disorder of the TRU maybe and thees arear un so if parents wanted to look it up on the internet they did not really find anything so here you can see has
25:58 happened over the years now we have a lot of information about it also in the English literature and um the same if you do not type in the official word but also um you can see that you but it's not always the right information that you get on the internet and just to show you go to Wikipedia you have very nice with a lot of CH so no problem on the English but we have huge problem on the on the German side because if you have a look the right
26:47 picture this is no Mi theity and if you go into the description of the picture it says H pleasure so totally wrong on a page focusing on Mi but this is what the parents and we also have one more problem because it's taken up in the newspapers from time to time I get a lot of name and I have translate for you me urgently my son 16 months as Mi and now we all know this cannot be because I already told you it's about
27:34 first um he was in heed um he does not open the mouth he does not want to brush um I tried everything what can I do so everybody of has already a picture in his mind what this pict pict so right now what I mean is we seeing in theer more and more parents who have heard about the structural disorder which is much nicer to discuss
28:21 than having finding arguments on the on the own side that maybe I have done something wrong and and I also like show you a very show it it's from a colleague of mine saying I I read one of your articles and I think our do has and they also sent some pictures doish and here are the pictures of the dog and of a little bit of I'm not this is not my my specialty to diagnose mih in in
29:08 dogs but maybe the dog has a problem so juste I think what we have seen over the years come more and more together and right now we are very confident in giving the diagnosis and also the prev like to start with a unfortunately we do not have nationwide we only have some Regional data from the very western part of 11% and also the middle of Austria
30:00 and um what we found in studies that only only and we will get beginning of next year get our Nationwide data and we are very looking but I would like to come back to the Press note um from Germany data that we presented quite some time ago and these were data from the German oral health study it's a study that is being done every s to8 years not only the work
30:48 also and we took the chance on a regular basis studies a chance not only to examine them for car but also for Mi so we got our [Music] first meaning every child that exam show atast an opacity permanent Modas and we saw mih more in these patients than we saw on the other side we have to state that luckily most of these discolorations
31:35 were M forms because you see 81% only had discoloration and no break which is nice because in a 12y old the first per is already six years in the cavity um these uh figures are quite and we have [Music] PR lower figes 10 and 15% and we will get our new dat beginning of next year I already know them but I'm not allowed to tell but I can only tell
32:20 you another Direction um like we know from worldwide data 30% on the other hand this means every seven to e child so we are not talking about rare disease but parents are not interested in prevalence teach parents want to know why why does my child have and my age what I and unfortunately I can [Music] this notar but I would like to show you
33:07 problem what the challenges are figuring out the reasons so there's a time difference when the [Music] of sizes Anders have the same colors
33:56 meaning they at the same time so the main time frame is and of but it starts with the of already short before um so we have to have a look and I can tell you right now we are not anymore focusing so much on [Music] which are [Music] descri would be everything so uh it's a very let's say
34:41 cloudy statement fusing more and the and regarding cian section or hypoxia for example know there is not enough oygen this might but we are focusing most on the all about connect [Music]
35:27 mainly childhood bues that are also connected to so um in some cases of course you would antibiotics and now there's still the big discussion and question is it about the antibiotics or is it about the child you will never know because mostly the [Music] there's only more or less one study about it and they did um a stage study so first of all they took patients and
36:16 diagnosed them with Mi or no mih and both groups of parents questionnaire about antibi use in the first of life and they saw a positive correlation in children with antibiotic and it was more or study with in the laboratory so what they did is that they took out the them in different conentration of and what they saw was that it didn't
37:01 affect the but it affected the and this a little bit more or less why we are now assuming that antibiotics might have influence um nevertheless we have to keep in mind that antibiotics were only for 10 years we it for a lot of years now and [Music] [Music] we still have to think about this is because the that I right
37:49 now like0 years ago in [Music] France time so Pregnant w got noral food and the other group got food plus the and also aftering the children of these the same food and then they had on day 30 aftering um that there was some that
38:37 hadol not every but some and one day after 100 days they disappeared but it's nevertheless it was a big discussion can this a be responsible for Mi and this discussion was very in Germany and we the German Federal Institute of risk assessment St because it was around conference they we still have UNC
39:23 because if we have look into these studies [Music] experiment female reacted less than the m in the P [Music] exp also there are differences between human so thisor is a little bit taken off the table in Europe now and in
40:11 recently but what has upin more studies this to summarize if you just ask your patient or the parents about all that are mentioned here on the maybe say no to everything maybe they say only one keep in mind only so we also did nice study a this
40:57 and here we only got delivery and the nevertheless [Music] I so theology let de at least one per could [Music]
41:44 be might see an opacity will always be also mineralizes it's not anation but what we see the less number is that we see all m
42:33 can see the first M are fine but the second show the same signs of Hy mization and in that case have not to but to theas because theas are mineralized the same first left PR and on the lower right second PR you also see a slight discoloration
43:18 on the this we have these figures ofation um we we see much [Music] more have now SE ter for it's not it's called minary h have so much data the disease later and now
44:04 we it's around 8% but I think the picture will get more clearer in the future and in some cases it's not the second primary but the first primary if you see it in the second primary you also have to have [Music] also at the same time there might be an opacity on that team as well it might be might but might on the itn't
44:50 problem also saw one little baby who had hyper mization opacity we don't know why but I only want to show right now [Music] what we have to know is that the hyp mineralization does not
45:38 stop anywhere within the en it's always down the weater CH are not l so D together and
46:28 there are spes between spes are so we also did a nice study [Music] about my we took some samples and we only includ analis and I don't want to I want to show you something happened that we didn't
47:15 expect because we saw some um protein that was only identified of course there was a group that was um that both had but we had um some proteins that were only identified and we were interested in what kind of are explain to you what see there we saw these were mainly protein this makes sense we know has a chronic inflammation and this what
48:00 we also demon this so let's go what are the criteria that we can apply di Mi you see from the timeline that [Music] in3 how mih should look
48:51 like a very [Music] put it on the paper you will see the pain and you will see the white paper you see [Music] is that this discoloration but always the Second
49:42 Step this break down can occur can OCC later the will only be in the areas that not the other part of the only theol and probably it's not the whole discoloration that break down so these are the main crer
50:38 already and might [Music] some you will find restoration us usually and what diagnosis easier is if the respiration is not covering the
51:28 and theerum is you can see the erupted yet first per M have been taken out very so these are the main criteria what other conditions what other diseases we have to think about so first of all a lot of small children young children have when they start
52:13 walk what the to very there might only exporation as well [Music] but this of course to the m and we didn't see anything in the m
53:05 connected toyia as you can see on the C but if you [Music] have this child also had affected M so the Le and they connected [Music] but um te after trauma can now are already with it we see that this is as this so think about the trauma if you
53:53 don't see anything second differential diagnos in most Cas verys in [Music] Europe might see and then have notice it's always that were developing that time [Music]
54:43 were so we saw every and in every quite symmetrical um the [Music] is in the nor would be on the cical edge because it's always see this mineralized areas and it could only M but it's not necessar
55:39 connected we after not Tre chronic inflammation those the who will never find turn in the first should think about other structural disorders you can see a
56:24 patient with genis [Music] also thises not look like [Music] and po are the two
57:11 Mia have Ander on you have restation or for exted tee so now we have made the DI we go step fur the before you know what already show picture we have huge variation in mineralization small discoloration break and I think we all agree that the left F needs
58:02 another so what is even more challenging is different in one patient so you see on the on the right side we probably never affecting the child on the left side see more form already some po eruptive breakdowns and more or less you see a similar picture in the so if we have a look now into the internet the literature how can we classify Mi so there are a lot of
58:49 also has given us one only subid mil and mocus on the presence of they say if there is no break and we have a break down form and if there is no [Music] nevertheless this is not how easy it is I
59:36 can only focus on the amount of break sometimes also lot we did this quite some time ago over over a years ago and at that time point maybe all of system um if you have already seen Mi patient you know that H patient and it can be so different so
1:00:22 you might have a patient with a breakdown it's not necessarily connected to a breakdown and you could also have a patient with no break cannot [Music] anity are young children of these children didn't have
1:01:23 any so this was more or less the Baseline why we develop this so and it's [Music] called and this where we to just put the next index on the market
1:02:08 and it yeah it would be the same but if you have done the gradation from the also to give you an idea how [Music] to no nothing like this told you we took [Music]
1:02:56 yes or no decision of course you have theity that because other you don't have M but then just yes or no I have break [Music] down break down and no hyper sensitivity so this is the grade one and the most form would be to have break down and and you can see that this child has sensitivity you can already see from
1:03:41 the the child pain as I already said you might have but not [Applause] pain but on the other [Music] side break from theic
1:04:32 patient so this why because for a years nobody [Music] [Music] why we assume right now is because the prisons are not lying so dense together
1:05:26 [Music] so what you should also do if you have a type two or type four other with how huge is the breakdown [Music] the whole CR not regarding with respect to the opacity but with respect to the whole [Music]
1:06:12 CR time patient also in epidemiological studies so in epidemiological studies only are of for your for um maybe we can do a quick game I introd
1:07:01 how would you what about it's a yellow my um you think we bre any so it could only be one because now we have to decie
1:07:55 is it the one or so now we go to the next picture we down so compared to the whole clown is [Music] it or um for
1:08:40 less or without hyp sensitivity is it Rush properly or not rush properly so be 2 or we go to the right side yes we see a breakdown yes we see a breakdown is it more or [Music] less and um do you see some rest of the pl was not brush properly so it was so
1:09:26 it be a or withens yes and um so you see you can do it very nicely and now [Music] we see anac here yes and we go to the left bre think the
1:10:11 patient yes is one or three one yes so now we go to the lower what is this because now you are all experts one [Music] break
1:10:57 down or and see very easy so but this was only one concept and I promise to you at that time point we only had some nice guidance from but they only summarize
1:11:54 possib of course we didn't invent wheel in new way so it's always it's always so what kind of Mi is
1:12:42 [Music] what of [Music] [Music] on the expectations not only of the child but also of the parents understand what I would like because not you are very limited in what you
1:13:28 let um on the left of the see temporary or last and have we just disc so in your practice you need like this you have
1:14:13 resp col meaning for one um with brushing and in office the patient would get fluish depending on also necessary more compated go to the column of the TNI to because it break and as
1:15:00 you have already seen break can be so different and now you can assume that there is no one F concept for so first of all and this looks a little bit difficult you can and then what about SE can I seal a with of course only very small chipping fracture on the back side or on the L side the
1:15:51 rest if you have larger break down [Music] so the child will not be comp [Music] emercy the child already see and that's the same and for the and see the
1:17:03 [Music] um and what is the differ the difference is we know so much so this is very important um and we also have some new approaches for is now included also you seeing the preab
1:17:48 [Music] [Music] so if you would like to see this a little bit more [Music] in what you do after the break is the foll I will not go each because do sense to times so what I do is I the other
1:18:41 way and then we will go for restoration and and first of all I will do this and then we have and I also show [Music] [Music] you probably 99% would have no it's not
1:19:33 to classify them so this makes it much moreas um but this is what we would the bre and now we have a few minutes time it would be great if you I hope this is the right so are there any questions
