Child getting teeth examined

Faculty of Dentistry undertakes ground-breaking study of chalky teeth in Ontario children

By Rachel Boutet

The Faculty of Dentistry is conducting first of its kind research in Canada on a developmental tooth defect affecting about one in five children worldwide.

Professor Bernhard Ganss, principal investigator (PI) and Co-PI Sonica Singhal, assistant professor at the Faculty, received a $75,000 U of T Community Partnership Research Program grant from the Connaught Fund for their research on molar hypomineralization (MH), also known as chalky teeth.

U of T is garnering support through its international collaboration with the global D3 Group, a translational network that is getting the word out about the condition via its Chalky Teeth Campaign. The team of researchers is also collaborating with other partners including The Regional Municipality of Durham, Health Department and the Indigenous Dental Association of Canada. Dr. Maryam Pezeshki plays a pivotal role as director of the Durham region’s Oral Health Division where she oversees the elementary school oral health screening program.

“Our research should yield the first scientifically sound prevalence rates of MH in a large cohort of Ontario school children,” says Ganss. “The study, named ‘Chalky Teeth Check – Durham’, is modelled on a national public health initiative being developed in New Zealand by The D3 Group and multiple local partners. This will be the first study in Canada to raise awareness for this condition and help alleviate the problems that children with chalky teeth face, including pain, bullying and expensive dental treatments.”  

Chalky teeth, which typically manifests as discoloured enamel spots or patches on newly erupted teeth, is a developmental deficiency in the mineral-hardening process. Over 200 studies conducted globally have shown that it affects about one in five children worldwide. The prevalence in healthy Canadian school children is unknown, but a study of hospitalized patients by Mike Casas, dentist-in-chief at SickKids and associate professor at the Faculty, revealed numbers near the worldwide average.

“The biggest challenges of chalky teeth are the lack of education and awareness about the condition and the fact that we don’t know exactly what causes it,” says Ganss. “It’s different from dental caries, or cavities, but often gets treated as such due to lack of awareness about this specific problem."

The most commonly affected teeth are the first permanent molars, which erupt around the ages of 6-7 years old. However, the second primary molars (2-3 years old), second permanent molars (12 years old), and front teeth can also be affected.


(MH affecting teeth of various school-aged children – courtesy of The D3 Group)

The project will entail screening about 5,000 students, from junior kindergarten, grade 2 and grade 7, in the Durham public school system as part of an ongoing dental health screening program.

“One of the biggest strengths about our study is that there will be a true representation of population demographics in terms of sex, social status, ethnicity, which will enhance the generalizability of the study’s results,” says Singhal, who is also the director of the Faculty’s dental public health graduate program. “We believe this is a dental manifestation of something that happened years previously, like some sort of medical condition or disruption that causes these teeth to form improperly; we just don’t know what this is yet. One of the strengths of having 5,000 participants is if we do a follow up with the children affected and dig into their history, perhaps into their first year of life, there might be some common denominators that will help us identify causes.”

Because MH has traditionally received minimal recognition on dental curricula, Ganss and Singhal are also working with the Faculty’s director of the pediatric dentistry graduate program and assistant professor, Jill Oxner.

“The lack of education and awareness results in a lower chance of this condition being correctly diagnosed,” says Singhal. “Our end goal is to ideally train the professionals who treat this vulnerable population so they know how to deal with mild, moderate and severe cases of chalky teeth.”

Ganss adds that the success they have seen in The D3 Group’s campaign, including the many practices in Australia and New Zealand that have supported the efforts to fight chalky teeth, gives them hope for the outcome of the Canadian study.

“It may take decades to figure out causation but we can at least work on diagnosis and treatment to keep kids’ suffering to a minimum.”

Top photo courtesy of Getty Images