Weak Teeth : The Frontal Cortex

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Jonah Lehrer is a contributing editor at Wired. He's also written for The New Yorker, Seed, Nature, and the New York Times and is a contributor to Radiolab. He's the author of Proust Was A Neuroscientist. His new book is How We Decide.

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Weak Teeth

Category: Culture
Posted on: February 2, 2007 9:59 AM, by Jonah Lehrer

Ezra Klein laments his dental inheritance:

I have weak teeth. Always have. My father has weak teeth, my mother has weak teeth, and I, their dutiful son, possess weak teeth. My sister doesn't suffer from this malady. I remember a joint dentist appointment we had, where the doctor returned with our X-Rays, informed me that I had no cavities, and told my sister she had eight. But I had barely commenced my big brotherly gloating when he glanced back at the films and said, "Oh wait, nevermind. Lili, you have no cavities, and as for you, Ezra..."

Well, today I beat my own record. I need eight fillings, a root canal, and, in a year or so, four wisdom teeth out. I'm off to jump out a window now...

Are "weak teeth" are a real phenomenon? Or are they just the excuse of people who eat too much sugar and don't floss? While it seems likely that some people might be more prone to getting cavities - their teeth are closer together, have deeper grooves, etc. - I'm curious if there are actual individual differences in the strength or density of dental enamel.* The insights of all dental experts is greatly appreciated.

*Assuming, of course, that you get proper nutrition.

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Comments (19)

I'm not a dental expert, but if anyone has weak teeth, it's me. My main problem is that I grind my teeth at night. I wear a night guard, but the damage has been done. I've cracked 2 teeth and have had crowns put on several others that were on their way to cracking. I'm not sure how many fillings I have, but it's a lot. No root canals yet, but I'm afraid a couple of teeth are going to need them. My teeth are almost always in pain. To top things off, I have a pretty extreme fear of dental work. My mother also has a lot of dental problems. My father, by comparison, has none. He's 76 years old and has had no cavities.

Posted by: Mark M | February 2, 2007 10:47 AM

Saliva generation is likely to be the culprit for many. One of the downsides of many chronic medications is dry mouth. While possibly uncomfortable, the lack of saliva definitely has an impact on tooth decay.

Posted by: Dan R. | February 2, 2007 12:05 PM

I am not a dentist, but instead work in the field of medical genetics. There are several genetic disorders (possibly in the low hundreds) that have include dental anomalies. In some, there are associated skeletal and/or skin defects, such as can be seen in Cranio-dermato-osseous syndrome and Lacrimo-auriculo-dento-digital syndrome. In others, such as Enamel Hypoplasia or some of the mild forms of Ectodermal Dysplasia, teeth can be one of the more noticeable problems - we have had patients referred for tooth abnormalities alone.

And perhaps relevant to the family described in your post, several of the genetic disorders that include dental anomalies are inherited in an autosomal dominant fashion. So it would not be surprising to find the trait running in a family, and observed in every generation.

A quick search for "tooth enamel" on OMIM http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM will yield you some of the known human disorders that can be associated with weak teeth. It isn't all sugar and poor dental hygiene!

Cheers, ctenotrish

Posted by: ctenotrish, FCD, PhD | February 2, 2007 12:10 PM

That's what my dentist said too. She said that certain people have risk factors that make them more vulnerable to tooth decay, but that there is nothing inherent in the enamel that makes it "weak". The risk factors she mentioned were grinding, inadequate spacing between teeth and dry mouth, especially during the night. Many anti-depressants and cholesterol medications cause dry mouth as a side-effect.

Posted by: Hygiene | February 2, 2007 12:12 PM

Human populations vary in enamel thickness. For example:
http://cat.inist.fr/?aModele=afficheN&cpsidt=14211529

(Note: The study should not be interpreted as lending support to a naive essentialist race concept, nor does it indicate that intra-population variation in traits is less important.)

Posted by: Colugo | February 2, 2007 12:43 PM

Thanks for all your comments. Here's a paper which might shed a little light onto the question:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4061610&dopt=Abstract

"It was concluded that within this tooth type, there is a large amount of individual variation not only in gross morphology but also in enamel ultrastructure."

Whether or not those differences in "enamel ultrastructure" lead to differences in tooth decay is still something I'm wondering about.

Posted by: Jonah | February 2, 2007 12:53 PM

Another example, this time including both autosomal recessive and dominant variants:

"#608563 Links
AMELOGENESIS IMPERFECTA, HYPOPLASTIC, AND OPENBITE MALOCCLUSION, AUTOSOMAL RECESSIVE

Alternative titles; symbols
HYPOPLASTIC ENAMEL PITTING, LOCALIZED, INCLUDED
Gene map locus 4q21

TEXT

A number sign is used with this entry because autosomal recessive hypoplastic amelogenesis imperfecta (AI) and openbite malocclusion is caused by mutation in the enamelin gene (ENAM; 606585)."

ENAM text "Dental enamel is a highly mineralized tissue with 85% of its volume occupied by unusually large, highly organized, hydroxyapatite crystals. This highly organized and unusual structure is thought to be rigorously controlled in ameloblasts through the interaction of a number of organic matrix molecules that include enamelin, amelogenin (AMELX; 300391), ameloblastin (AMBN; 601259), tuftelin (TUFT1; 600087), dentine sialophosphoprotein (DSPP; 125485), and a variety of enzymes. Enamelin is the largest protein in the enamel matrix of developing teeth and comprises approximately 5% of total enamel matrix protein."

Given this and some of the other references I ran across (many of them dating to the 60s and 70s, so pdfs not available), it seems likely that differences in enamel structure and tooth calcification certainly can lead to what a layperson would describe as 'weak teeth.'

Posted by: ctenotrish, FCD, PhD | February 2, 2007 1:42 PM

For what it's worth, I do floss ;-)

Posted by: Ezra | February 2, 2007 4:32 PM

I'm a dentist. I'm not familiar with the various genetic conditions alluded to above. And while I do know that there is individual variety in enamel density, I believe that variations in dental hygiene far outweigh these variations in enamel. You might have "weak teeth," (many of patients tell me this) but if you are committed to a proper course of dental hygiene, then you probably shouldn't have 8 cavities. I also believe that risk factors like spacing, grinding and dry mouth can seriously exacerbate dental decay much more than variations in enamel, at least for most people. (Again, I'm not familiar with any genetic conditions.)

Posted by: Michael Reed | February 2, 2007 4:51 PM

Some childhood or maternal fevers can lead to changes in enamel in developing teeth, which can increase the likelihood of cavities in those teeth.

I also read that the composition of mouth flora can sometimes be linked to tooth decay, and that there could be an infectious component.

Posted by: crf | February 2, 2007 11:39 PM

There are many factors that can make a person more prone to cavities other than not brushing your teeth or eating a lot of sweets. Yes, some people have weaker teeth due to defects in tooth development. Other factors include dry mouth which can be caused by certain conditions or medications. Also, some people have more cavity-causing bacteria in their mouths.

Posted by: Richmomd Hill Dentist | August 28, 2009 8:09 PM

There are many factors involved in dental tooth decay. The most obvious are diet (sugar) and dental hygiene. Other factors include tooth structure abnormalities, higher levels of cavity causing bacteria in the mouth and decreased saliva flow with can all increase a person's risk for dental tooth decay.

Posted by: emergency dental | January 11, 2010 6:08 PM

Don't worry, many people have weak teeth. I went last week to the dentist and found out that i need 7 fillings and 2 crawns and i'm in my early twenteis...Of course i was upset as well but now i'm looking for a good dentist.

Posted by: kate | July 23, 2010 1:32 PM

I think the strength or weakness of the teeth depends on how well you take care of your teeth. It's just like how people think that they'll eventually lose their teeth with old age, and then they meet an 80-year-old man who still has all of his real teeth.

Posted by: Dental Milpitas | August 9, 2010 1:33 AM

I definitely believe there is some hereditary reason for having weak teeth. I was made to believe by dentists for years that I had poor dental hygiene practices which caused my cavities, so I on top of brushing daily I have also been flossing daily for year. This has not stopped the cavities, in comparison my mother and brother have no cavities, poor dental hygiene and drink soft drinks often. My son and myself who have decent dental hygiene and do not drink any fruit juices or soft drinks have constant problems. Unfortunately, no dentists have been able to provide me with any answers to improve the situation. I guess they love people with weak teeth as it pays their mortgage and for their holidays.

Posted by: Ilias | January 17, 2011 8:37 PM

I am who you'd call a 'dental hygiene enthusiast'. I use a $100+ sonic toothbrush with 'floss action' head. I use a metal tongue scraper that looks like a torture device. I use multiple brands of strong non-alcoholic mouthwash. I often use a chewing gum just to generate saliva. (OK, I'm not a fan of flossing though.)

Still, just today I was struck with a torrent of bad news from my new dentist: I need a minimum of 3 more fillings, 1 crown, and I have gum disease. Believe me, it HAS TO BE genetics.

Posted by: Andras | February 8, 2011 2:22 PM

Don't let ANYONE ever tell you that weak teeth are only caused by poor dental hygiene! I am 32 and have such weak teeth it makes me really miserable, especially as I try so hard to look after them. I have known SO many people with high-sugar diets and NO cavities that there just HAS to be more to it! I was born two months premature and I've always felt there may be some connection, I was also bottle-fed rather than breast-fed. Dentists never quite know what to do with me, and it gets embarassing because it just looks like I don't care for my teeth at all. Once you realise you have weak teeth, you do have to be EXTRA vigilant of whatever you eat and drink and perhaps consider take a high quality multivitamin and mineral supplement. I think consciousness should be raised amongst all dentists as they need to acknowledge that good dental hygiene is NOT the whole story. If dentists were to become more aware of every single possible cause of weak teeth ( including genetic )then people suffering from bad teeth through no fault of their own will feel more supported and that would help with the inevitable depression that comes with dental problems.

Posted by: Jaycee | September 11, 2011 2:35 AM

8.NYeah,I have week teeth.I also brush(maybe too well)floss,am conscious of what I eat,drink etc.I was told by my dentist after breaking a tooth, that I need six fillings!(eating peanut brittle.I'm not perpect)I really want more preventions and solutions(if it's not too late.I'm 48)No one has mentioned calcium supplements.

Posted by: Angelina | November 22, 2011 4:25 PM

Posted by: Angelina | November 22, 2011 5:19 PM