Seattle's Child

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Pediatric Dentists Seeing More Chalky Teeth

Baking a cake takes precision. You need the right mix of flour, eggs, sugar and baking powder, all mixed up and cooked at an exact temperature. Otherwise, you’ll open the oven and instead of finding a puffed-up confection, you’ll get a sagging mess.

It turns out the same is true for teeth.

For a pearly white to turn out right, “It has to bake at the right temperature and with the right ingredients,” said Dr. Eve Rutherford, a family dentist in Snohomish.

But sometimes when teeth are “baking,” life happens. A baby might be born months prematurely, or a toddler could suffer high fevers or have infections that require antibiotics. An illness can throw off a child’s metabolism, tweaking the “ingredients” that go into the teeth. Sometimes – and not always – these bumps in a child’s early development can affect how teeth are formed.

Dentists say they’re seeing a growing number of babies and children who have teeth that are sometimes described as looking chalky – those that are weak, discolored, more vulnerable to cavities and that can be sensitive to extreme temperatures. The medical term for the condition is enamel hypoplasia or hypomineralization, which means that the tooth enamel – the hard outer shell that protects a tooth – lacks the minerals needed to strengthen it and shield it from decay.

“It’s like having microscopic pores in the surface (of the tooth),” said Dr. Joel Berg, director of the Department of Dentistry at Seattle Children’s and chair of the University of Washington’s Department of Pediatric Dentistry.

There isn’t a rigorous scientific survey showing an increase in U.S. cases, but rather, “It’s a collection of anecdotes,” Berg said. “People who’ve practiced for decades are reporting increased amounts.”

The condition can affect baby or permanent teeth, and both require special attention.

Children most at risk for chalky baby teeth are those who are born preterm by approximately three months and who have a low birth weight. The tooth enamel is forming while a fetus is in the womb, and an early delivery can disrupt the process.

All children should see the dentist by their first birthday, experts say, but parents of preterm babies should consider coming in sooner and notifying their dentist that they were an early arrival.

These children are also at heightened risk for “baby bottle tooth decay” that can be caused when a baby sucks on a bottle of milk or juice over long stretches of the day or night, rather than during brief periods. The sugars in the beverages feed bacteria that produce acids that attack the tooth enamel. If the enamel is already weakened, there’s a greater chance for cavities to form. (While children with chalky teeth are more at risk of cavities, a bottle of juice at bedtime is a no-no for any baby.)

“When it comes to cavity risk, the frequency of (sugar) exposure gives you a higher risk,” Berg said, whether it’s a child with hypomineralization or normal tooth enamel. If they’re sucking a bottle or cup all day, “that constant exposure puts them at extremely high risk.”

While baby teeth do eventually fall out naturally, their molars aren’t lost until age 10 or 12.

“They really need that baby molar for a long time,” said Rutherford, who is also on the board of trustees for the Washington Dental Service Foundation, which champions oral health.

Plus, babies can suffer from the chronic pain of a toothache and not realize it’s not a normal phase of development, or have any way to effectively communicate their discomfort. Berg said infant patients come to the emergency room on a daily basis with infections, cavities and swelling in their mouths. They may appear fine at a one-year checkup and then take a sudden turn.

The causes of hypomineralization in permanent teeth are less well understood. Researchers have found that children with poor health during the first three years of life are most at risk for this condition because it’s during this time that the enamel covering the first permanent molars, incisors and canines is forming. One likely cause of hypomineralization is the use of the antibiotic amoxicillin, visit as well as continuous high fevers and diseases that disrupt metabolism.

It’s important to identify hypomineralization quickly in order to limit the damage. In more mild cases, dentists can bleach the teeth or use a pumice scrub to reduce the discoloration. Children can receive a fluoride varnish to the teeth several times a year to strengthen the enamel and make the teeth less temperature sensitive.

In more serious cases, Berg likes to cap a tooth with something called a glass ionomer, which is a restorative material that can essentially be glued to the tooth to cover and protect it.

If a molar has really broken down, it can be covered in a stainless steel crown that’s replaced with a ceramic one once the teeth and mouth are fully developed. Damaged front teeth can be covered by a porcelain veneer when a child reaches adulthood. The important thing, dentists said, is to protect the structure of the tooth so it’s not lost completely to hypomineralization and cavities.

“With early recognition we can handle it well,” Berg said.

Good oral hygiene is key to protecting children’s teeth, whether they have normal or weakened enamel.

“It’s incumbent of parents to brush their children’s teeth daily until they’re about 6 or 7 years of age,” Rutherford said.

And, he added, “Kids need to have a good low-sugar, and low-frequency-of-sugar, diet. Most decay is preventable.”

About the Author

Lisa Stiffler