Diagnosis of chalk teeth: What parents need to know now

Discoloration and porous teeth – the diagnosis of chalk teeth is frightening news for parents and children. A congress of experts on the topic will take place in Berlin next week. But what does science already know about this? Answers to the most important questions:

The teeth have white, yellowish or brown spots. Only partial areas or the entire crown of the tooth can be discolored, says the President of the German Society for Pediatric Dentistry (DGKiZ), Katrin Bekes. Typically, one to four of the first permanent molars are affected, i.e. those that erupt around the age of six. In some cases, chalk teeth also occur on incisors. Experts speak of molar incisive hypomineralization or MIH. In some places, tooth enamel has fewer minerals than usual.

Depending on the severity, the less mineralized tooth enamel may be lost through chewing soon after the tooth erupts. Small discolorations tend not to be noticeable; larger ones can also be seen by a layperson, says Bekes. Within the discoloration, crumbling could occur. “But you don’t have to imagine it as a child biting into a carrot and half of their tooth falls out.”

Another symptom is the hypersensitivity of the affected teeth to heat or cold, chemical or mechanical stimuli. Especially when both enamel collapse and hypersensitivity occur, brushing and chewing can be painful.

This depends very much on the severity of the infestation. A small discoloration in the tooth enamel on a first permanent molar is usually hardly noticed, says Bekes. “It is often a chance finding.” In severe cases, for example if part of the tooth crown is missing, children may have difficulty chewing. At the same time, pain is possible. Early diagnosis and appropriate therapeutic measures are important “in order to enable children to eat food without restrictions,” said the DGKiZ President.

Affected children should go to the dentist regularly, said Bekes. Professional dental care and good oral hygiene are essential. To prevent tooth decay, brushing your teeth twice a day with a toothpaste containing fluoride is recommended. “Studies show that children with chalk teeth have a higher risk of developing tooth decay.”

In addition, you can also use a paste at home that supports mineralization with calcium and phosphate. “If only a mild form has been diagnosed in the form of a small white spot on the molar that has not broken in and the child is not in pain, then regular examinations and prophylactic measures remain,” says the expert.

As soon as the place collapses, you have to take a closer look. “The bigger the break-in, the more problems it can cause. You have to act quickly and fill the affected area with a filling,” says the DGKiZ president. Sometimes, ready-made children’s crowns could also be a therapeutic option for more severe forms. In very severe cases, tooth extraction with subsequent orthodontic treatment may also need to be considered. However, this is only necessary in exceptional cases. International data shows that many of the affected children have a mild form of MIH.

According to the overview study “Global burden of molar incisor hypomineralization” from 2018, in which Bekes was also involved, an estimated 13 to 14 percent of children worldwide are affected. To this end, 99 studies with more than 113,000 participants from 43 countries were evaluated.

The 5th German oral health study from 2016, on the other hand, showed a significantly higher number. At that time it was said that 28.7 percent of twelve-year-olds have at least one hypomineralized tooth with MIH. We don’t know why the numbers were so high, says the DGKiZ president. The new data from the 6th oral health study are eagerly awaited early next year.

The cause has not been conclusively clarified, says Bekes. There are almost certainly several factors. Since the mineralization of the teeth under consideration occurs around birth and in the early childhood phase, the research pays particular attention to this period. The focus is on problems in the last month of pregnancy, premature births, childhood illnesses such as bronchitis, pneumonia or middle ear infections or antibiotics. The affected teeth usually only appear around the age of six or later, and only then can the diagnosis be made – this makes research into the cause more difficult, says Bekes.

The term molar incisive hypermineralization (MIH) has officially been around for 23 years. The phenomenon was defined in 2001 and the main features were identified. In fact, there was a publication from the 1980s that described corresponding symptoms in children in Sweden, says Bekes. In recent years, the disease has become more and more aware.