Enamel Hypoplasia (Chalky Teeth) Causes and Treatment - savina dental clinics malta and gozo

Enamel hypoplasia is a name used to refer to underdeveloped or incomplete tooth enamel. But before we proceed further, what is the enamel? Simply put, it’s the protective layer that covers the outside of the teeth. It’s the white part of the teeth that is made up of a mineral-based compound deposited by the body to form teeth.

At times, during enamel formation, different things can lead to defects in the process, causing some parts of the enamel to have below-average strength. This is seen as lines running through the surface of one or more teeth. It can also manifest as a discolouration. In some rare cases, the affected tooth may be dark brown.

Causes of Enamel Hypoplasia

Generally, there are two types of enamel hypoplasia (1). These types are derived from the cause, and include;

  • Hereditary enamel hypoplasia
  • Environmental enamel hypoplasia

As you would expect, hereditary enamel hypoplasia is caused by genetic defects that negatively impact enamel formation. Usually, the defects affect small areas on the teeth. But in some rare and serious cases, the defects may affect multiple teeth.

Some hereditary syndromes that cause enamel hypoplasia include:

  • Seckel syndrome
  • Otodental syndrome
  • Treacher Collins syndrome
  • Heimler syndrome
  • Ellis-van Creveld syndrome

Environmental hypoplasia is brought about by environmental factors which carry symptoms that are the hereditary kind. Several factors come into play. These include malnutrition, premature birth, viral and bacterial infections and trauma to the developing teeth.

The main symptoms of chalky teeth

Some signs that you have enamel hypoplasia are apparent. However, others can be difficult to notice until they have blown out into severe dental problems. Having thin enamel can cause;

  • White spots
  • Tiny groves, pits, fissures and depressions
  • Yellow-brown stains – this denotes the dentin layer is exposed
  • Sensitivity to cold or heat
  • Retention of bacteria
  • Vulnerability to cavities and tooth decay

Treatment of Enamel Hypoplasia

Early diagnosis is imperative. For this reason, it’s essential for kids to have a dentist appointment when the first teeth start to show.

Treatment of enamel hypoplasia depends on the severity of the conditions. The goals of the different treatment options are usually aimed at;

  • Preserving the tooth structure
  • Maintaining a great bite
  • Keeping the teeth in their best form
  • Keeping tooth decay at bay

Some small defects that don’t cause sensitivity or decay may not need immediate treatment. However, they still need monitoring. Your dentist will most likely use topical fluoride to protect the teeth. But in the case of cavities, sensitivity or affected tooth structure, treatment should be immediate. The available options include;

  • Resin-based composite filling – these are designed to match the colour of your teeth. As such, they are perfect for back and front teeth and last longer.
  • Resin-bonded sealant – these help to improve tooth sensitivity
  • Dental amalgam fillings – these are a combination of durable metals. Given their silver colour, they are not ideal for front teeth
  • Gold fillings – gold fillings are similar to dental amalgam fillings. Though durable, they don’t look natural. They are also quite expensive
  • Crowns – crowns are used to cover the teeth completely
  • Enamel microabrasion – this is minimally invasive. It helps in improving the appearance of teeth
  • Dental whitening by a professional

In some cases, the permanent tooth is severely malformed that the best course of action is extraction.

What are the potential complications?

Without timely treatment, some complications may arise, including:

  • Browning of the teeth
  • Severe cavities and caries
  • Teeth need extraction
  • Loss of confidence in your smile

Factors that contribute to the above complications include:

  • Eating a lot of sugar
  • Crowded teeth
  • Poor oral hygiene


Having a thin enamel means that you will need to monitor your teeth carefully and attend to the symptoms as soon as they manifest. This will help to prevent serious problems.

Enamel hypoplasia is managed through dental check-ups and good oral hygiene.

FAQs About Enamel Hypoplasia

chalky teeth fAQ - savina dental clinics malta and gozo

Are chalky teeth hereditary?

While the condition itself isn’t hereditary, its causative factors and syndromes are. These syndromes include Treacher-Collins, Heimler, and Otodental syndromes.

How to whiten chalky teeth

Extra caution should be exercised when whitening chalky teeth. And since many homemade and over the counter products and methods can worsen the condition, the best way to whiten chalky teeth is through professional methods. Contact us for whitening remedies.

How to fix chalky teeth in adults

The remedy for chalky teeth depends on the extent of damage to the teeth. The treatments include resin-based composite fillings, enamel microabrasion, and dental amalgam fillings. If the condition is too advanced, then tooth extraction is recommended.

What causes chalky teeth in babies?

Poor oral hygiene is not a cause in babies. Chalky teeth can be caused by prenatal problems including;

  • Mother’s weight gain
  • Drug use
  • Premature birth
  • A lack of vitamin D

Other common causes include;

  • Infection
  • Trauma to teeth
  • Calcium deficiency
  • Liver disease
  • Vitamin D, C, and A deficiency
  • Cerebral palsy

Is enamel hypoplasia common?

Mild enamel hypoplasia is common. However, it is easy to correct in the early stages. Severe enamel hypoplasia is rare, especially in adults.

How to differentiate enamel hypoplasia and fluorosis

The two conditions often manifest with similar symptoms and may have similar repercussions. However, they are different in a couple of ways (2).

First, fluorosis mainly affects the incisors and permanent teeth. On the other hand, enamel hypoplasia affects all teeth, including deciduous teeth. Also, while fluorosis affects many teeth, enamel hypoplasia can affect a single tooth.

Second, fluorosis often manifests as paperwhite stains although they can also be brown. Enamel hypoplasia, on the other hand, often manifests as dark-yellow or creamy-yellow stains.

What medications cause enamel hypoplasia?

Research conducted found a connection between enamel hypoplasia and paracetamol intake in babies.

What is linear enamel hypoplasia?

This is the lack of proper development of teeth enamel during formation, which leaves horizontal bands of weakened enamel spots on the surface of the teeth (3).

Enamel hypoplasia can be unsightly. Luckily, when caught in its early stages, it can be cured through simple treatment methods. To prevent this condition, mothers need to adhere to strict maternal care.

Have You Tried Our Free e-Consultation Service?

If you are worried about a dental related issue, interested in travelling to Malta for a dental holiday or have questions about any of the treatments we offer, please contact us using our new free e-Consultation service. One of our highly-qualified team will respond to your query as soon as possible. Our e-Consultation service is live 9am – 6pm Monday to Friday.

If you would like to schedule an in-person consultation at Savina Dental, please book your appointment using this form.

Savina Clinic – Dental & Implantology Centres are friendly, state-of-the-art practices in Malta and Gozo dedicated to comprehensive quality dental care. Savina Dental is an innovative dental practice in Malta and prides itself on the high-quality customer service, low waiting room times, attention to detail and the advanced dental technology at their disposal.

Joseph Xuereb
Principal Dental Surgeon & Owner of Savina Dental Clinics, Dr Joseph Xuereb BChD (Hons), MFGDP(UK), MGDS RCS(Eng), FFGDP RCS(UK), FICD is a general dental practitioner with a special interest in Implant and Restorative Dentistry. Dr Joseph & the teams' full biographical information can be found here.