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Chalky Teeth

“My child has white marks on her teeth which I have been researching and discovered the condition hypomineralisation.

I have never heard of this before and not sure what it means and what I should do. Can you tell me more about it?”

– Question from Natasha of Albany Creek in Brisbane

Dr David Kerr replies:

Hypomineralisation (aka Molar Hypomineralisation) might commonly be called chalky teeth. It was a topic recently discussed in ABC’s radio national health report where they were worried that the early loss of children’s adult molars due to this condition would lead to years of expensive orthodontics and dentistry.

What are chalky teeth?

The condition Hypomineralisation is where the tooth enamel, commonly on the molars, contains less mineral and is thereby softer and like chalk.

The incidence of this in children is quite high – between 15 – 20% or 1 in 6 children. These figures have been established from over 40 different studies. Within these cases there is a large spectrum of variation – it can vary from very mild to very major.

It has become apparent in the last couple of years in dental circles that it is not necessarily linked to decay. So whilst we work to reduce the incidence of decay in children this is not related to or affecting the amount of teeth lost to hypomineralisation.

The cause is not fully understood. While we think genetics may play a part, there may be other factors such as environmental or otherwise.

What happens to children’s teeth who have this condition?

Hypomineralisation in a molar tooth.
Source: Dr Axelrad

Chalky teeth have the tendency to break down whether they are affected by decay or not. They are more susceptible to cavities and break down faster with decay because the teeth are so weak. But we are also realising that these teeth are breaking down anyway even when there is no plaque or bacteria to cause decay.

The tooth most commonly affected first is the adult molar that arrives at the age 6 or 7.

Why are chalky teeth a big concern for dentists and parents?

Essentially, they are very difficult to treat.

They are very hard to fill because the materials that are used for fillings are designed to adhere to enamel that is healthy and has minerals in it. Without the proper amount of mineral, then the fillings just don’t stick and the tooth just continues to break.

Depending on the situation we have been able to put a crowns on these teeth. However if we see them late then often the teeth are so damaged there is no choice but to extract them.

Another big problem, apart from limited treatment options, is the pain and sensitivity that children might experience. We certainly do our best to ensure our younger patients don’t associate the dentist with pain, but this condition will make their teeth hyper-sensitive. This means it is very difficult to numb the teeth in order to treat them, so often this procedure has to be done under general anesthetic.

What can parents do for chalky teeth?

The best thing to do is identify if this condition is present early – so get their kids in for a checkup at age 3 or 4. If we can identify this condition early then we can monitor it for severity and manage it accordingly, before pain and tooth loss.

Another key age for us to check this condition is around 6 years old when the child’s molars come in. We have had many cases where we will see 9 or 10 year old children with this as an advanced condition – they are in pain, they have to hospitalised and their teeth will have to be extracted. We’d like to catch it before it comes to that.

If we can identlfy this condition early then we can possibly use crowns or stainless steel pediatric crowns to protect the affected teeth from decay and breaking down until all the child’s teeth have fully erupted.

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