Hypomineralisation

Aninke Lippert
6 days ago
5 min read

Updated: 1 hour ago

What is it?

Hypominerlisation is a defect that affects the quality of the outside surface of a tooth (enamel). Studies show that usually not just the outer layer is affected, hence why these teeth are 4-10 times more likely to break and get decay.

Hypomineralisation can affect both deciduous (baby) and permanent (adult) teeth. Most commonly not just one type of tooth is affected: usually molars and incisors can be seen having some form of quality defect.

The degree in which a tooth is affected can range and vary between mild (a small white spot) to moderate (yellow-brown with a chalky surface), to severe (yellow, brown, chalky surface with post eruptive breakdown).

It’s the quality of the teeth that is affected BUT as soon as the teeth erupt and get used in the mouth, you can quickly notice they break and can become decayed. This seems like a limited quantity of tooth structure but it started with the right shape, but poor quality and later broke down.

These hypomineralised spots or teeth are often referred to as being “chalky”. Nothing we do can change them from being chalky and vulnerable so it is important to get them diagnosed and a dental clinician on your side to help you manage these teeth and prevent further break down as much as possible.

Why does it occur?

It is Important that parents don’t blame themselves as many of the reasons for occurrence are out of their control or could not be avoided.

The defective quality in teeth happens while the tooth is developing.

Your baby’s teeth start forming very early on in pregnancy and aren’t fully formed when they are born. It is hard to pinpoint an exact reason for this defect as it can happen along a long timeline.

Some of the most common possible reasons include:

infections, illnesses or dietary deficiencies such as low calcium either during pregnancy and/or as a baby.
premature birth or birth complications (lack of oxygen or traumatic birth)
diseases as a child that may have included an ear infection, high fever or viral infection.
chronic ongoing illnesses at a young age. Commonly requiring antibiotic use.
injury to the teeth or jaw
genetic/ hereditary (passed down from the parent)

What can you do to prevent chalky molars?

Although chalky molars can’t be prevented, regular check-ups will give your dentist the chance to identify the condition early and put measures in place to minimise its impact. That’s why consistent dental visits are so important for children, especially around ages two and six, when new molars typically develop.

It’s completely understandable that many parents haven’t taken their two‑year‑old to the dentist yet, but checks are essential for catching any issues early. If you have any concerns at all, it is best to make an appointment straight away.

How common is hypomineralisation ?

In our practices in the Clarence Valley, the prevalence has been between 14-16% of our children have molar-incisor hypomineralisation. Depends on how you look at it…comes down to the same thing: it is much more common than you realise!

How can you help?

Brushing your child’s teeth 2x per day: morning and night with a fluoridated toothpaste to help remineralise and mechanically remove harmful bacteria and residual food.
Cleaning between your child’s teeth with floss and or interdental picks (pixter) to ensure the contact point between teeth are being thoroughly cleansed and food debris is removed.
Eating a healthy well rounded diet limiting sugars and processed foods. Ideally stick to 5 meals a day and avoid your child grazing all through the day.
Apply remineralising agents CPP-ACP (calcium phosphopeptide – amorphous calcium phosphate) such as Tooth Mousse
Attend regular dental appointments with your child from an early age to diagnose, monitor, manage or treat the the affected teeth if required.

Tips for effective brushing - Use adult-strength fluoridated toothpaste, and have your child spit, not swallow - Pay close attention to cleaning the hypomineralised teeth - If the teeth are sensitive, wet the toothbrush with warm water - For children who need a little motivation, try a brushing chart and small rewards for good building good habits - You can stain your child's plaque with disclosing tablets (available at your dentist or pharmacy) or simply with regular food colouring to help see where brushing can be improved.

How can a dental clinician help?

Firstly, a dental practitioner is trained to diagnose and grade a hypomineralised tooth as mild/moderate/severe as well as document the location. They can monitor these lesions on teeth closely and help pick up early signs of deterioration or secondary decay.

Where on which teeth these hypomineralised lesions occur, matters. Treating permanent and deciduous teeth as well as front vs back teeth differ. Moderate and severely hypomineralised teeth can be quite cold and sweet sensitive and make your child avoid eating certain foods or even touching them with a toothbrush.

Mild: the treatment is very “preventative”

These small, usually white/beige spots are easily missed as a small white dot that is incidentally picked up at the dental appointment.
Monitoring and regular dental visits are at the core of the treatment for these mild spots.
Treatment may include applying fluoride varnish to help remineralise the area, as well as recommending remineralising agents to use at home. Usually these topical agents just keep the teeth stabile but unfortunately can’t prevent further break-down as these can be brittle.

Moderate: treatment may include “prevention and some early interventions”

Same preventative treatments as mentioned in the mild category
Preventative Treatment for back teeth may include a fissure sealant to prevent caries and cavitation as well as decrease symptoms of sensitivity. The clinician may describe this treatment as placing a “raincoat or protective layer” over the tooth.
Sometimes moderately affected teeth may require a more long-term/permanent treatment. Especially in primary molars, the clinician may recommend a full protective coverage like a Stainless-steel Crowns. These are the ‘golden’ standard of treatment and also have the added benefit of not only preventing further break-down of the tooth but also sealing the whole crown, preventing decay and keeping the teeth stable (especially molars) till they are naturally ready to wobble out and be replaced by adult teeth.

Severe

Treatment is focused on relieving symptoms and actively covering the whole tooth crown as a long-term solution.

If aesthetics is a concern, most commonly if a patient or parent have become aware of a “white, yellow or brown, chalky spot” on a front tooth, usually adult front teeth: the dental clinician will take into consideration the quality and quantity of the tooth that is affected, how much it affects the child’s self-esteem, how likely it is to break down again, is it deterring them from smiling and eating….There is no cookie-cutter solution. Each tooth in each child is individually assessed and managed.

For us it is paramount to keep their dental visits fun and nurturing their trust in us. We are very careful to not alleviate unnecessary sensitivity or to break their trust in us. We want you to know we care deeply about your children and their experience, and it is our utmost priority to keep them from having bad experiences and needing extensive work in future. Remember, we are on your team. We’re not just on the side-line. We come on the field with you to care for your child and to do the best for them…while harbouring trust for when we do need to do something more in future.

Before and after treatment for chalky teeth

Please remember that chalky teeth are not your “fault” and parental guilt is horrendous on the best of days: so, we are the last ones to make you or your child feel embarrassed or scared about their teeth and their treatment! We take your trust in us to help you look after your kids very seriously.