“Chalky Teeth” Enamel Hypomineralisation
Chalky teeth (Enamel Hypomineralisation) is a relatively common condition that varies in clinical severity and can result in early loss of the first permanent molars. Teeth most commonly affected are the first permanent molars (six-year-old molars) and the permanent incisors. This condition is therefore referred to as “Molar Incisor Hypomineralisation”.
Although the cause is unclear Enamel Hypomineralisation has been seen in children born preterm and in those with poor general health in the first 3 years. In addition to a number of systemic conditions, low birth weight, toxins from breast feeding and common childhood illnesses such as upper respiratory tract infections, recurrent ear infections, asthma, tonsillitis in the first 3 years have all been linked to Enamel Hypomineralisation.
Degrees of Enamel Hypomineralisation range from mild colour changes in the enamel to enamel that is very sensitive and readily breaks away and is prone to large cavities as the tooth emerges in the mouth.
Early diagnosis and management are important to ensure the best long-term outcome. If children appear to have this condition on their baby molars (usually detected between 2-5 years of age) there is an increased likelihood of Enamel Hypomineralisation also affecting the first permanent molars and permanent incisor teeth as they teeth develop around the same time.
Treatment depends on the severity and the teeth that are affected.
Permanent molars severely affected by Enamel Hypomineralisation commonly require full coverage with Stainless Steel Crowns. This provides a long-term interim restoration and prevents further sensitivity and breakdown. Conventional composite resin restorations (white fillings) are not recommended as they break away easily.
Around the age of 9-91/2 the decision is then made as to whether we retain the affected teeth and replace the metal crowns with ceramic crowns (as an adult) or extract the affected teeth to allow the molars behind (second and third molars) to grow into their space. The decision to extract the first permanent molar is made following a radiographic and orthodontic assessment. In teeth that are severely broken down with the nerve affected extraction earlier than 9 years of age is considered as the only other alternative would be root canal therapy which is often not an ideal option in young children.