Molar hypomineralization also known as chalky teeth is not uncommon in America. There is strong concern of the lack of public awareness that this prevalent condition may be due to limited understanding, research, and pathology. Visual cues include demarcated enamel opacities such as white, cream, brown, or yellow that normally are bordered with the enamel. More frequently seen in 6 year old or 1st molars but the primary and secondary dentition can still be affected. Furthermore you can either find 1 molar or all 4 molars of the 1st molar types be involved in children.
Seeing the pattern stated previously is how you distinguish molar hypomineralization from more generalized developmental dental defects such as fluorisis, enamel hypoplasia, amelogensis imperfecta. The other more common defect is early caries in enamel such as white spot lesions. The defects listed have more systemic and wide spread symptoms. Sometimes clinically degraded opacities such as posteruptive breakdown can be confused with true hypopolasia and to misdiagnose rampant caries in hypomineralized molars as cavities. Molar teeth are more caries-prone than any other teeth. The average caries location is at the molars with a ten fold higher risk of decay. Molar hypomineralization most frequently affects children. In some cases dental pain is common even when the opacities areas appear stable and intact. There is suspicion the cause of the hypomineralization is tied with systemic illnesses which destabilize the tooth during development. Unfortunately dentists may require treatment that can be costly or time consuming as the molars may warrant restorative treatments ranging from root canals to crowns or fillings. Molar hypominearlization is not a new phenomenon. It has been around for decades and has been studied in multiple research facilities. States such as Texas, North Carolina, Iowa, California, and New York have researchers studying this for a while back. Mexico has even reported this occurrence. Molar hypomineralization is not receiving proper attention as even in dental schools, professional organizations, and companies rarely discuss it. The condition is most often misdiagnosed as caries.
Brian Y. Kuo DDS FAGD
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