What Are Chalky Teeth?

What are Chalky TeethNot surprisingly, being a colloquialism, "chalky teeth" means different things to different people. But what we can all agree on is that chalky teeth look different – most often the enamel has an abnormal colour, either being whiter than normal or having shades of cream, yellow or brown. This discolouration is usually restricted to a small spot or bigger patch, but the whole tooth surface may be affected in severer cases. Sometimes the enamel appears dull and opaque and also crumbles easily (i.e. "chalky", in contrast to the shiny hard surface and translucency of normal enamel). Other times the surface enamel is shiny but irregular, with pits or grooves being visible from some angles.

The D3 Group has adopted "chalky teeth" as a public-friendly catch-all, meaning we're not at all fussy about Different Teethhow the term is used. If you think one or more of your child's teeth looks a bit different and you're able to discuss this with a dental professional then that's great. Sometimes it might turn out that "chalky white spots" are actually the beginnings of tooth decay, rather than a problem with tooth development, and other times it might be a bit of both. You'll also know there are other reasons for teeth being discoloured, such as when a tooth has died after a knock. Leave it to a professional to sort out the details of what's what – but they can only do so if you make an appointment, and usually the sooner the better.

That all said, we think "chalky teeth" is a good term to use when beginning a conversation about teeth that haven't developed properly, leading to enamel that isn't as hard and resistant to decay as normal – and our second step in such conversations is to talk about D3s.

And for those who didn't arrive at this page from our Chalky Teeth Campaign, why don't you check out this world-first public-awareness initiative which seeks to convert medico-dental science into fewer cavities in our children?


The Chalky Teeth ProblemWe say "the chalky teeth problem" has three parts to it. First, there are the chalky teeth themselves which can trigger a variety of problems including toothache and accelerated tooth decay as noted above (more detail here) – these outcomes can be troublesome not only for people with chalky teeth but also for the dental professionals who deal with them. Second, there are major gaps in education about chalky teeth – these deficiencies extend across the healthcare professions and out to the public worldwide. Third, not much research has been done into chalky teeth, leaving numerous unanswered questions about what
causes them and how best they can be managed.

The D3 Group is tackling all three parts of this problem through this website and our other educational resources, and via the Chalky Teeth Campaign which advocates for research into the prevention of chalky teeth. Learn more about the chalky teeth problem and how we're fighting it at our Social Impact page.


Academic History of Chalky Teeth

"Chalky teeth" have significant history in the academic literature, making D3G's translational use of this term all the more justified. Notably, "chalky" was used previously to describe three major D3s and the earliest stage of tooth decay (enamel caries) as follows.

Way back in 1945 when hereditary enamel defects (AI) were classified for the first time, malformed enamel was described as being chalky – both in terms of appearance ("chalky white" or yellow or brown) and abnormal hardness ("consistency of chalk"). It was further recognised that enamel may appear chalky in other types of developmental defect. In 1949, the original description of "discrete developmental opacities" referred to areas of soft enamel as being "chalk-like". An accompanying photograph showed front teeth with distinct white spots that equate to the "demarcated opacities" we associate with Chalky Molars (and other teeth) today. Soon after in 1952 and 1955, porous enamel defects (probably opacities and/or early decay) were described as "chalky spots" or "chalky white enamel". A year later, while categorising various types of AI, enamel was described as chalky if
somewhat softer than normal, or cheesy if much softer – given the
author came from England, it seems likely the phrase "like chalk and
" was being referenced.

Roll on to 1986 and enamel was described as chalky white by the inimitable Grace Suckling studying severe dental fluorosis. This description was also applied to early decay (so-called "white spot lesions") by others three years later. In 1995 and 2001, "chalk and cheese" resurfaced in the Netherlands with hypomineralised enamel being described as soft and porous like discoloured chalk or old Dutch cheese – leading to the term "cheese molars" for what today we call chalky 6-year molars or Molar Hypomin. At the turn of the century, cheese molars were reborn as Molar-Incisor Hypomineralisation ("MIH"), and demarcated opacities were later categorised as being "white/chalky", yellow or brown (in order of increasing softness or crumbliness; see our "chalky picture").

In 2013, D3G introduced its Chalky Teeth Campaign hoping that a simplified "chalky teeth terminology" would help laypeople navigate the scientific and clinical complexities of D3s. Following widespread acceptance of "chalky teeth" by the public and healthcare professionals alike, allied terms (chalky enamel, chalky spots, chalky molars) were introduced via mass media avenues (Chalky Teeth Campaign and D3G websites, children's storybook, We Fight Chalky Teeth initiative). Finally, having gained public and professional mandates, D3G's chalky teeth terminology was "reverse translated" into academia with high-profile publications in 2017 & 2018.


I Fight Chalky Teeth logo

It's clear that the term "chalky teeth" spilled over into society from the dental profession and academia many decades ago – at least "down under" in New Zealand. An interview-based study revealed that the diagnosis of "chalky teeth" was a major reason for Kiwis having all their teeth extracted at relatively young ages in the 1940s and 50s – many said they understood their chalky enamel would "inevitably succumb to dental caries and breakdown". The investigators concluded "chalky teeth" was used by dental professionals to describe developmentally malformed enamel that was "prone to decay and crumble". Moreover, this tenet was traced back to influential publications by dental pioneer Henry Percy Pickerill who contended in the 1920s that "the key to understanding an individual's susceptibility to dental caries was faulty enamel". The parallels between "chalky teeth of old" (per the Kiwi study, which only came to our attention in 2019) and D3G's adoption in 2013 of "chalky teeth" as a translational tool are quite remarkable – and further evidence that this is a worthwhile path to follow.

A tangential but perhaps much-broader societal connotation for "chalky teeth" came from a series of toothpaste advertisements shown in Australia and New Zealand during the 1970s and 80s (e.g. here and here). A simple "stick of chalk" analogy was used to educate about the enamel-hardening properties of topical fluoride. This led to the schoolteacher ("Mrs Marsh") becoming a pop culture icon, with resulting successes for the toothpaste company concerned.


Tiza means ChalkGiven that "chalky teeth" has long proven to be a useful analogy for communicating the clinical and scientific complexities of D3s, how might this term work in languages other than English? As the history
of chalk
extends right back to the time of cave drawings, it's unsurprising that many "tongues" have a word for "chalk" (nouns are given for 84 languages here). Equivalents for "chalky" are less common however (68 adjectives given here), making it sometimes necessary to say "chalk teeth" or "teeth of chalk" (e.g. dientes de tiza in Spanish).

Please help us expand the following list of "chalky teeth" being used in languages other than English (contact the Secretary).

Language "Chalky teeth" equivalent Literal translation Examples
French dents crayeuse chalky teeth dents crayeuse
German kreidezahne chalky teeth kreidezahne
Spanish dientes de tiza teeth of chalk dientes de tiza
Italian denti gessosi chalky teeth denti gessosi

Tiza means Chalk