Why are bad teeth considered hereditary

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Chalk teeth are teeth of children and adolescents with a tooth enamel defect. This leads to the fact that these teeth are discolored in sharply defined areas and are less hard and brittle like chalk. This so-called Molar Incisor Hypomineralization (MIH) makes the teeth overly sensitive. Chewing and brushing your teeth are more difficult, which in turn promotes tooth decay. Here you can find out how you can recognize chalk teeth, how they are formed and what the dentist can do!

Brief overview: chalk teeth

  • What are chalk teeth?Teeth with developmental enamel defects. The first permanent molars and incisors are particularly affected.
  • Causes: unknown; suspected triggers include maternal illnesses during pregnancy, birth complications, illnesses in the first four years of life, etc.).
  • Symptoms: Depending on the degree of severity, discoloration of the teeth up to enamel collapse; also hypersensitive and very prone to caries teeth.
  • Treatment: Depending on the severity of the chalk teeth, it ranges from seals to fillings and crowns to pulling the affected tooth.
  • What can you do yourself? Desensitizing pastes against pain-sensitive teeth, consistent dental care with fluoride, brushing the back teeth, tooth-friendly diet, caries prophylaxis every three to six months at the dentist.

"Widespread Disease" Chalk Teeth: What is it?

Tooth enamel protects the dentin and is usually the hardest substance in the human body. In chalk teeth, however, the affected enamel is softened. Because it contains too little of the enamel-hardening mineral hydroxyapatite as well as too much water and protein. This under- or hypomineralized tooth enamel discolors and, in the worst case, collapses. In addition, bacteria in the mouth can more easily get inside the tooth through the under-mineralized enamel. They trigger inflammation there, which probably makes the children's broken teeth overly sensitive to external stimuli.

These chalk teeth were first noticed in recent years in children of preschool and elementary school age. The milk teeth usually begin to fall out at the age of six and are replaced by permanent teeth. In more and more children, the first permanent molar (called six-year molar) and the first permanent incisors (incisors) are already brittle and discolored when they slide out of the jaw through the gums. That is why the disease has been known as Molar Incisor Hypomineralization (MIH) designated.

In the meantime, however, it has been shown that the disease is not limited to the first molars and incisors - all permanent teeth can be affected. Even milk teeth can step through the gums as chalk teeth. This will then Deciduous Molar Hypomineralization (MMH) called.

How common are chalk teeth?

Chalk teeth are described by experts as a new widespread disease. They occur worldwide, in Europe as often as in Germany. The information on frequency fluctuates. On average, almost every tenth child (10 to 15 percent) in Germany suffers from this tooth enamel defect. In the fifth German health study, almost every fourth 12-year-old (28.7 percent) found at least one permanent molar that was affected by MIH. This means that chalk teeth are more common than tooth decay in this age group.

However, only a few of the 12-year-olds affected had severe MIH with extensive enamel invasions. In most of the children the disease was only mild.

New illness?

Swedish scientists first described chalk teeth as an independent disease in 1987. However, it is still unclear whether MIH is really a new disease that is now occurring more and more frequently. The experts suspect that caries diseases and their treatment may have masked the symptoms of the chalk teeth so far. Since tooth decay has been decreasing for years, the chalk teeth are now more noticeable.

Chalk teeth: causes

The causes of chalk teeth are still unclear. The experts only agree that the function of the enamel-forming cells, the ameloblasts, must be disrupted in those affected. This means that the enamel formation (amelogenesis) does not proceed properly.

This is how enamel normally forms

The teeth are placed in the jaws of the unborn child during pregnancy. For the tooth enamel, the ameloblasts produce certain proteins that form a basic structure for the tooth enamel. These proteins store salts and mineralize to form hydroxyapatite - a mineral made up of calcium and phosphate. It takes up to the age of four for the enamel of all permanent teeth in the jaw to form completely. Then the ameloblasts stop functioning and are lost. You will then no longer be able to repair the tooth enamel.

Different triggers for chalk teeth suspected

It is still unclear why the ameloblasts do not work properly in some children and thus lead to chalk teeth. Several factors are likely to play a role. So far, there have only been guesses as to what that might be. Scientists are discussing the following factors as possible triggers for chalk teeth:

  • Diseases of the mother during pregnancy
  • Complications during childbirth (lack of oxygen, premature birth, low birth weight, or caesarean section)
  • Diseases of the child in the first four years of life such as bronchitis, asthma, recurrent high fever or measles and chickenpox
  • Vitamin D deficiency
  • frequent use of drugs such as antibiotics or aerosols
  • Disturbances in the calcium-phosphate balance, e.g. due to chronic kidney diseases
  • Environmental toxins such as dioxins or plastic softeners such as bisphenol A * or polychlorinated biphenyl
  • genetic factors

* According to the current state of knowledge, the Federal Institute for Risk Assessment (BfR) considers a connection between bisphenol A and chalk teeth to be unlikely.

Chalk teeth: symptoms

If your child's baby teeth or first permanent teeth show any of the following symptoms, these could be signs of a defective tooth enamel:

  • white-creamy to yellow-brown looking sharply demarcated areas
  • missing cusps or chipped enamel on newly erupting teeth
  • Pain when brushing your teeth (touch!) Or when eating cold or hot food

You should have such symptoms clarified by the dentist at an early stage.

Chalk teeth: examinations and diagnosis

The dentist must first find out if your child actually has chalk teeth. There are other reasons why the tooth enamel may be insufficiently mineralized. This includes:

  • some forms of the genetic disease "Amelogenesis imperfecta" (here all milk teeth and permanent teeth are affected by the tooth enamel defect)
  • long-term overdose of fluoride overdosed
  • Treatment with the antibiotic tetracycline

The dentist must also separate chalk teeth from teeth that have been attacked by a fall on the tooth or by caries bacteria. The exact diagnosis is crucial for the correct treatment!

Chalk teeth: division into degrees of severity

If your child actually has chalk teeth, the dentist will check how severe they are. Often there are mild forms in which the teeth are only discolored. But there are also cases in which entire parts of the tooth enamel are missing or chipped off.

The classification of a group of experts from Würzburg, the “MIH Treatment Need Index”, helps dentists to divide chalk teeth into four degrees of severity (indices). The decisive factor here is whether there is oversensitivity (hypersensitivity) and / or loss of tooth enamel (substance defect):

  • Index 1: MIH without hypersensitivity, no substance defect
  • Index 2: MIH without hypersensitivity, with substance defect
  • Index 3: MIH with hypersensitivity, without substance defect
  • Index 4: MIH with hypersensitivity, with substance defect.

Severe cases of chalk teeth are considered a pain emergency. The dentist should treat your child immediately - do not put up with long waiting times!

Read more about the examinations

Find out here which examinations can be useful for this disease:

Chalk teeth: treatment at the dentist

Chalk teeth are more susceptible to caries bacteria than normal teeth because:

  • the surface of the chalk teeth is rough and difficult to clean.
  • the teeth are more sensitive to touch, which makes it difficult to brush your teeth.

Therefore, the main goal of treatment is to protect teeth from tooth decay. In addition, permanent teeth should be preserved for as long as possible and become less sensitive to touch and temperature stimuli.

So far there are no uniform therapy standards for chalk teeth. However, the Würzburg MIH concept offers a guideline. The dentist orients his treatment according to how pronounced the chalk teeth are:

Intensive prophylaxis

In any case, the dentist will protect the affected teeth from tooth decay with the help of intensive prophylaxis. To do this, he applies a highly concentrated fluoride varnish to the affected teeth every three to six months up to four times a year.

Seals and covers ("Sealing")

The dentist treats mild forms of chalk teeth and hypersensitive teeth with seals and covers made of plastic or so-called glass ionomer cement.


If the enamel has already broken in or chipped off, the teeth are restored with the help of fillings made of composite, a composite plastic.


In the event of major damage to the tooth, crowns made of stainless steel or composite are used. They protect the tooth from further damage over the long term and make the teeth less sensitive to pain.

Surgical measures

In severe cases it may be necessary to pull a chalk tooth. This option is usually an option if the enamel keeps breaking off or the tooth is extremely sensitive to pain. Even if there is little space available from an orthodontic point of view, tooth extraction can be useful. In the case of molars, the gap is then closed using orthodontic methods.

The usual local anesthetic injection is very bad for chalk teeth. The dentist should therefore prescribe pain relievers for your child (preferably paracetamol or ibuprofen) before a planned treatment. He can also tell you when and in what dosage your child should take the drug.

Read more about the therapies

Read more about therapies that can help here:

Chalk teeth: you can do that yourself

As long as the triggers for the chalk teeth are not found, it is impossible to prevent the disease in a meaningful way. If the chalk teeth are already there, there are a number of things that can be done to alleviate the symptoms and reduce the increased risk of tooth decay.

Dental care with fluoride

Chalk teeth are not a sign of neglected oral hygiene - in contrast to dental caries, in which a high-sugar diet and poor dental care can rot the teeth. Nevertheless, consistent dental care with fluoride is very important for chalk teeth - it reduces the risk of tooth decay and makes the teeth less sensitive to pain. Specifically, dentists usually recommend the following for chalk teeth:

  • Brush teeth with fluoride toothpaste in the morning after breakfast and in the evening before bed (at least 1,000 ppm fluoride)
  • Apply a fluoride gel (12,500 ppm fluoride) to the teeth once a week
  • Prepare meals with fluoridated table salt

Right nutrition

In addition, a balanced diet can help prevent tooth decay. Sweets are best (if at all) consumed as dessert and not between meals. Sweetened drinks should be avoided entirely - better thirst quenchers are water and unsweetened tea.

Cross brushing of the new molars

The first permanent molars (called “school teeth” or “six year molars”) are initially hidden behind the milk teeth. It is not enough to brush these teeth normally. Instead, it should be brushed across, i.e. moving the toothbrush back and forth at right angles to the row of teeth.

You have to brush across your child's first permanent molars. Your child cannot do this alone! You should also brush your child's teeth carefully until they are around nine years old.

Desensitizing pastes

Hypersensitive teeth that react painfully to cold, heat or contact can be treated with desensitizing pastes. These contain arginine or a combination of casein phosphopeptide and amorphous calcium phosphate (CPP-ACP). Talk to your dentist about it!

Regular visits to the dentist

Because of the high risk of tooth decay, children with chalk teeth should go to the dentist for a check-up every three to six months.

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