Chalking teeth in children: has a team of researchers solved the mystery of the disease?

Back pain, cardiovascular diseases, type 2 diabetes mellitus, obesity, depression, burnouts and cancer have been among the so-called "widespread diseases" for years. Even if this term is not a medical term, but a colloquial term, it is understood to mean so-called civilization diseases, which are of great socio-political importance due to their wide spread and economic effects and thus have consequences for numerous areas of life and the economy. For some time now, the common diseases have also included “chalking teeth”, which mainly occur in children. More than every third 12-year-old child is currently affected, and the trend is rising. The disease often only becomes apparent when the second teeth erupt, which is why research into the causes is currently being intensified. White, cloudy patches and brownish discoloration are the most prominent features of these teeth. But what are chalk teeth, what are the causes and what preventive measures are possible? What can you do if your teeth are already discolored?

What are chalk teeth?

More and more children have chalk teeth. According to the fifth German oral health study by the Institute of German Dentists from 2021, the frequency of so-called chalk teeth in children is increasing significantly, 28.7 percent of those under the age of twelve have at least one chalk tooth. As a result, ten to 15 percent of all children in Germany are affected. Chalk teeth are divided into different degrees of severity. In most cases, part of the tooth was clouded (23.3 percent), tooth extraction was only necessary in 0.1 percent of cases. Even if children are already affected worldwide, the disease has only been known for a few years.

Chalk teeth are teeth that have significantly softer enamel than healthy teeth. Tooth enamel is the hard-wearing layer over the tooth crown. Tooth enamel consists mainly of mineral salts and is very hard in healthy teeth. It can withstand heavy loads like chewing hard food and protects the softer interior of the tooth.

In the case of chalk teeth, the composition of the tooth enamel is disturbed, too few minerals are stored. This disorder is called hypomineralization. The enamel of chalk teeth is softer, the tooth surface is often rough and porous. Since the enamel does not protect the teeth adequately, they are much more susceptible to tooth decay. Chalk teeth are also more sensitive to pain. Enamel defects can affect one or more teeth. If the chalk teeth are severe, those affected often have lifelong dental treatments and follow-up treatments.

The enamel of the second teeth is most commonly affected, i.e. the permanent molars and incisors. Therefore, the disease is also called "molar incisive hypomineralization" (MIH). Molars and incisors are the molars and incisors. Molar teeth are more commonly affected by the disease than incisors. Although chalk teeth are much rarer in milk teeth, they can also be affected by the enamel disorder.

But how exactly do you recognize chalk teeth? Chalk teeth are not always clearly visible from the outside, so if you suspect it, a visit to the dentist is advisable. A first clue is the sensitivity to cold, heat and pressure of affected teeth, which can even occur when brushing your teeth. Furthermore, chalk teeth are often mottled, they have yellowish-brownish or whitish-cream colored spots and the tooth surface is often furrowed. The teeth can become porous and break easily. Mostly they are very sensitive. When visiting the dentist, there are sometimes reports of so-called "anaesthetic failure", which means that the anesthetic does not work on the affected teeth.

In 2019, around 230,000 six to nine-year-olds received dental treatment for chalk teeth. At least eight percent of all adolescents in this age group consequently have tooth enamel that is too soft. The exact number of children affected is probably even higher, since the disease often goes unnoticed due to a lack of sensitivity to pain. Chalk teeth sometimes pose a greater problem than caries. The finding is alarming, but the analysis of the distribution study revealed striking regional differences in the occurrence of chalk teeth that cannot be explained purely medically. A clear cause for the appearance of chalk teeth is also unclear, because the damage is often already present when the second teeth erupt.

Regional and social differences

An analysis by BARMER Krankenversicherung in 2019 dealt with the dental treatment of chalk teeth including regional distribution in 6-9 year old children. The basis was the health insurance data of the 6-9 year old children who were insured with Barmer in 2019. All cases with typical treatment patterns for chalk teeth were selected from the data in order to reveal distribution patterns in Germany. As a result, chalk teeth occur almost twice as often in children in some federal states as in other regions. In the western and north-eastern federal states, a disproportionately large number of children were treated with chalk teeth; the proportion of affected children in North Rhine-Westphalia was almost twice as high as in Hamburg. When comparing the individual rural districts and urban districts, the differences were even greater. As a result, the result was that chalk teeth appear to appear extremely differently depending on the region. However, the possible causes for the different distribution of chalk teeth cases in Germany cannot be clearly clarified. A different regional distribution of dentists in town and country or the density of dentists in a region were not criteria for an increased occurrence. A scientifically sound explanation for the spread of the disease and its spatial distribution within Germany does not yet exist to a sufficient extent, and the patterns of spread that have been discovered do not yet allow any conclusions to be drawn about the causes. Water, soil and pollutant analyzes play a role, as do genetic predispositions and other harmful influences on the human organism.

Furthermore, there are no differences in the distribution of the disease in the various social classes. According to the results of the Barmer analysis, children from all income brackets are equally affected.

Possible causes

Exact triggers for chalk teeth have not yet been scientifically clarified and proven. Chalk teeth have several causes at the same time, it is a multifactorial process, numerous possibilities are currently being discussed. The possible causes discussed range from genetic predispositions, a pronounced susceptibility to certain diseases that only break out with certain factors, environmental influences or surviving infections, to a suspected vitamin deficiency.

Since the enamel of the first permanent molars and incisors already develops during pregnancy in the womb from the eighth month of pregnancy, the basis for chalk teeth is already suspected during pregnancy. The enamel develops by the age of four, which is why early childhood must also be examined with regard to the development of porous teeth. Illnesses in the mother in the last trimester of pregnancy and complications during childbirth can also lay the foundations for chalk teeth. Other effects on the development of chalk teeth can also be infectious diseases in infancy or diseases of the upper respiratory tract. Dioxins (organic pollutants) and toxins (poisons) that surround people in everyday life and are absorbed by the body presumably have further influences on the formation of chalk teeth. Here, the plasticizer bisphenol A ("BPA") in particular was examined, which was used in the manufacture of plastic for products such as baby bottles and toys until 2018 and presumably plays an important role in the formation of chalk teeth. BPA is now banned and was added to the European Union’s list of Substances of Very High Concern in 2018. Microplastics in toys or cosmetic products are also said to play a role in the outbreak. The intake of antibiotics, but also diseases such as chickenpox can also have a not inconsiderable influence on the disturbed formation process of tooth enamel. The so-called predisposition also plays a role. However, the genetic predisposition only comes into play when several factors interact. A vitamin D deficiency should generally be avoided, because the human body needs vitamin D, and not just to build tooth enamel.

Scientists have been researching the mineralization disorder of tooth enamel since the late 1980s. So far, however, the causes of chalk teeth have not been clearly clarified. According to the President of the German Society for Preventive Dentistry, an increased frequency of chalk teeth has been observed since the mid-1990s.

Chalk teeth have to be treated again and again. This often leads to severe stress in the affected families. Patients should seek professional help as soon as possible.

Diagnosis of chalk teeth: what now?

Numerous children and parents take dental hygiene seriously from the moment they brush their teeth for the first time. They brush their teeth twice a day and go to the dentist regularly for check-ups, avoiding sugary drinks and sweets for the most part, and all visits to the dentist so far have been unremarkable. However, the first problems arise when the first permanent molars erupt. Eating and brushing your teeth are becoming more and more painful, and a doctor's check-up often results in the diagnosis of chalk teeth. Extensive care and appropriate therapy by the treating dentist bring relief in most cases. In any case, the basis is thorough dental hygiene with highly concentrated preparations containing fluoride. Dentists apply these to the teeth or prescribe them for use at home. Treatment for chalk teeth varies depending on how badly the teeth are affected.

In the case of a mild form of chalk teeth and minimal tooth damage, the chewing surfaces of the chalk teeth can be sealed with a layer of plastic, for example.

If the disease is already advanced and the structure of the tooth is already affected, fillings or crowns can restore the function of the tooth. Dentists use different materials depending on whether they are to remain in the tooth temporarily or permanently.

In the case of a severe form of chalk teeth, however, it may sometimes be necessary to remove the chalk tooth. Orthodontic treatment can close the resulting gap, and a bridge or denture is also possible with a fully grown jaw.

Regardless of the severity of the form, parents and affected children should always seek individual advice from an expert.

Chalk teeth only in children?

In general, the first signs of chalk teeth appear in childhood and are detected during routine dental checks or when the crumbly teeth are more sensitive to pain. In contrast, the occurrence of molar incisor hypomineralization (MIH) in adulthood is rather rare; those affected have suffered from porous chalk teeth since childhood. As already mentioned, chalk teeth cannot be completely healed because the enamel is too structurally damaged. Patients still have a good chance of largely healthy teeth and a relatively pain-free life. Regular and thorough dental hygiene in combination with fluoride products are the cornerstones for this.

With increasing age, the complaints about the chalk teeth usually decrease, since the teeth partly stabilize themselves again and become harder due to the mineral content of the saliva. The learned dental and oral hygiene also supports the process. As a rule, adults with chalk teeth no longer have any symptoms. Adult patients often have fillings and crowns in places that are not normally affected by tooth decay. A cosmetic treatment often helps to eliminate the discoloration.

Prevent chalk teeth

As soon as chalk teeth are identified, preventive measures must be stepped up to prevent the teeth from becoming porous and individual pieces breaking off.

Even if the causes have not yet been clarified, parents and children can still prevent an illness through regular dental check-ups, conscientious brushing of teeth and preparations* that harden tooth enamel. Although chalk teeth cannot be completely prevented or cured, with the right care, the affected teeth can be given a long life.

Brushing your teeth regularly and eating less sugary foods will help prevent tooth decay. Since chalk teeth have much weaker enamel, they are particularly badly damaged by plaque acids and are much more susceptible to tooth decay. In order to reduce plaque and thus plaque acids, people with chalk teeth should eat as few sugary foods as possible. Since chalk teeth cannot be prevented today, they should be particularly well cared for and observed in the event of a finding.

From the age of six, the first permanent teeth erupt in most children. The incisors and molars in particular should be observed closely here. However, chalk teeth are not always clearly identifiable at first glance, so a visit to the dentist to clarify them helps. A regular, six-monthly dental check-up is recommended in any case. In the case of the diagnosis of "chalking teeth", the dentist must be consulted more often, a visit at least every three months is recommended. Good oral and dental hygiene at home is also important. Parents should clean up smaller children because not all areas are easy for children to reach.

Teeth with poor tooth structure and rough and ridged tooth surfaces provide a good breeding ground for tooth decay. On the other hand, fluoride in particular helps, here an application can already be started before the first permanent teeth appear. Table salt containing fluoride should also be used as a supplement to toothpaste containing fluoride when cooking. The correct dosage should be taken into account, especially for smaller children. From the moment the tooth erupts, a junior or adult toothpaste with a higher fluoride concentration can be used. In addition, a fluoride-containing mouthwash solution should be used twice a day or a highly concentrated fluoride jelly once a week for oral hygiene.

Even if the current research has not yet clearly clarified the reasons for the development of chalk teeth, there are still possibilities to live pain-free with healthy and beautiful teeth after a diagnosis.

By the way: A pleasing result of the fifth German oral health study by the Institute of German Dentists is that the general dental and oral health of the German population has improved again in almost all areas and across all social classes. The years of dental prevention, prophylaxis, education and improved oral hygiene are already bearing fruit. But even in an international comparison, dental care in Germany performs excellently. In this country, children have the healthiest teeth, but even German seniors rarely suffer from complete toothlessness. The number of serious periodontal diseases has almost halved. However, due to demographic change and the associated aging of the population, a general increase in the need for dental treatment is to be expected. Most health insurance companies offer private supplementary dental insurance, which is recommended regardless of age.