Researchers have identified a potential cause of molar hypomineralization (MH), or “chalky teeth,” an underrecognized condition that affects one in five children worldwide. The findings could be the basis for preventive medical treatments to prevent dental caries and extractions, they say.
A team headed by Michael J. Hubbard, BDS, Ph.D., biochemist at the University of Melbourne, Australia discovered that enamel’s inability to properly harden is caused by the exposure to serum albumin during the development of teeth. The blood protein “poisons” the growth of mineral crystals rather than causing injury to the cells that produce enamel they said.
The findings of the researchers who included researchers from Chile have great potential for improved treatment of MH. They also open up new avenues for research into the broader nature of the disease and its causes.
“We believe this breakthrough could eventually lead to a medical treatment of MH which will lead to worldwide health benefits, including significant reductions in childhood tooth decay,” they write in an article published online December 21 in Frontiers in Physiology.
More Than Cosmetic
Teeth that are chalky, as evidenced by spots of discolored enamel, are not merely an aesthetic issue. This condition can cause severe tooth discomfort, tooth decay abscesses, tooth decay, and even extractions. Although its causes have eluded dental research for more than a century, Hubbard’s research group stated that fossilized blood proteins, such as albumin in the teeth appear to be a possible cause.
Biochemical evidence indicates that serum albumin that surrounds developing teeth is normally excluded from enamel, Hubbard said in an interview. “Although albumin binds strongly with hydroxyapatite-based minerals and hinders their growth, we conclude that the epithelial barrier (the enamel-forming cells, Ameloblasts, which are responsible for exclude albumin) must be broken down in response to medical triggers.”
This permits localized infiltrations of albumin which blocks further hardening and hardening of soft mature, older enamel. When the tooth finally emerges it will leave behind spots or patches that are made of chalky enamel. “In other words we can conclude that chalky enamel spots occur with the localized breach of an epithelial barrier caused by yet to be determined systemic injuries,” he said.
Joseph Brofsky, DMD, section director of pediatric dentistry at North Shore LIJ Cohen Children’s Medical Center of New York, in Queens agreed that the most definitive cause of MH has been elusive for more than a century. However, he expressed doubt about the fossilized blood protein hypothesis.
“That’s a long shot. It’s a possibility, and I’m not ruling it out however we’re not sure,” Brofsky, who was not involved in the research, said.
In Brofsky’s experience, MH is a little less common in the United States, affecting about 1 of 10 children in the United States approximately half the global rate. “But it’s a problem, and we wish it would be gone, but until we have a clear doubt what is causing this condition, it’s going to be hard to stop it.”
Hypomineralization of 6-year-old molars is the most common reason for MH. These are the first adult molars that emerge. However the process begins as early as the time of birth. “For 6-year molars, normal hardening of dental enamel takes place in the postnatal period from the beginning through the infancy stage,” Hubbard said.
The molars of the 2-year and 12-year age ranges are affected less frequently as their 6-year counterparts, “so this extends the risk of medical problems to early school days and back to the perinatal period for the 12-year and 2-year molars in both cases,” he said.
He added that it is crucial to determine which childhood diseases will most likely set the stage for MH. “Forty-plus years of epidemiology have failed to pinpoint a causal link or cause. However, given the prevalence of MH — 20percent in otherwise healthy kids -naturally, we believe that some common illnesses are the culprits,” he said. “But which diseases, what medicines, and which combinations?”
Hubbard’s advice for pediatricians: “If you are checking a child’s throat, why not also look at their back teeth , particularly when they are getting their first teeth at the age of 2, 6 and 12 years old?”
The study was funded by the Melbourne Research Unit for Facial Disorders Department of Pharmacology & Therapeutics, Department of Paediatrics, and Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne. The authors and Brofsky have not disclosed any relevant financial relationshps.
Front Physiol. Published online on December 21 2021. Full text
Diana Swift, a medical journalist, is based in Toronto.
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