It is quite common to see "chalky" teeth or teeth with a whitish patch in them. This phenomenon can be seen in milk teeth or permanent teeth, and may affect all or only some teeth.
The technical name given to these chalky teeth is hypomineralized teeth. The condition is called hypomineralization. There are a number of reasons why it may caused and some very compelling treatment options that are available for parents as well. Let us have a look at them in more detail.
What is hypomineralized enamel?
The outer-most covering of the teeth (milk and permanent alike) is called enamel. It is the hardest part of the tooth and it gets its strength from the high amount of calcium it contains. There are other minerals involved in its formation and this process of formation and hardening is called mineralization.
If there is a defect in the process of mineralization, the amount of calcium at these affected sites is quite low. It leaves that part softer, weaker, and discolored as compared to the other non-affected parts of the tooth.
There are two other layers in the teeth that get mineralized (dentin and cementum) and can be affected by hypomineralization. These other layers, though, are not visible to the naked eye and thus don’t really concern us for the purpose of this discussion.
What causes chalky teeth or enamel hypomineralization?
A number of different factors can cause a defect in the mineralization process. These are broadly divided into two categories:
- Genetic
- Environmental
Genetic factors, as the name suggests, are associated with a mutation in the gene responsible for sending signals about the mineralization process. Treacher Collins syndrome, Seckel syndrome, Usher syndrome, and Heimler syndrome are some of the common ones associated with enamel hypoplasia. Almost all the milk teeth and permanent teeth can be affected by such syndromes. The teeth are so soft that are get prematurely destroyed and have to be removed.
It is important to know here that different teeth mineralize at different stages. The affected tooth or teeth correspond with the time the disruption occurred. For example, chalky milk teeth generally signify some environmental disturbances during the pregnancy period because that is when the milk teeth develop. If the chalky teeth are permanent, then the disturbance to the mineralization process took place after birth.
What are the symptoms associated with chalky teeth?
The first and most obvious aspect is the aesthetic one. Chalky teeth, particularly the front ones, don’t look very good. They can compromise the smile and affect the self-confidence of a person, marking them out as different. This layer of hypomineralized enamel may appear as small brownish pits, a white opaque patch, or even a missing part of the tooth.
Equally importantly, hypomineralized enamel is a "weak spot" which is prone to developing tooth decay. People who have hypomineralized teeth are more likely to suffer from tooth loss and thus have to practice a higher degree of oral care. Some people also complain of sensitivity in the areas where their enamel is hypomineralized.
Treatment of chalky teeth/hypomineralized enamel
Small pits and fissures can be filled in using composite materials. This is the same kind of material that dentists use to fill up cavities. The shade of the composite material can be matched to the natural tooth very easily. This is an extremely simple and affordable option to explore.
For front teeth that have a larger chalky patch, a veneer may be needed. The veneer will cover the entire front of the tooth and allows the dentists to match the color, shape, or any other esthetic aspect to satisfy the patient. This option is a bit more invasive but still very easy and straightforward.
For patients who are suffering from a more severe form of enamel hypoplasia and have multiple affected teeth, the treatment options are a bit more severe. The teeth may require root canal treatment and then full coverage crowns to be made functional. Some teeth may even need to be extracted if they are destroyed beyond saving.
Use of fluoride on chalky teeth
Since one of the reasons causing chalky teeth is an excess of fluoride in the environment, parents are scared of using fluoride toothpaste or other fluoride treatment for their children. This may seem ironic, but fluoride is the best possible way of protecting affected teeth from decay. The excess amount of fluoride can only cause chalky teeth during the phase when the teeth are being mineralized and when given systemically.
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