You Asked: Are my bad teeth genetic?

A winning smile boosts both our confidence and our overall health, and taking care of our pearly whites is important. But, what happens when you still have oral health issues after you floss, brush twice daily and follow the advice of your dentist? You may be able to blame your genes for “bad teeth.”

“There are certain genetic diseases that will predispose a person to the development of cavities, and a few that can lead to periodontal disease,” said Harvey Kessler, DDS, professor and director of pathology with the Texas A&M College of Dentistry. “Genetic conditions can also influence the structure of your teeth and how many teeth you have.”

Enamel defects

The surface layer of the teeth—known as the enamel—is considered the hardest mineral substance in the body—even stronger than bone. Think of tooth enamel as the shield against tooth decay. But, when genetic defects occur, this protection can be hindered.

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Amelogenesis imperfecta

The genetic disorder amelogenesis imperfecta is responsible for enamel defects affecting the appearance of the teeth.  It can produce small and/or discolored teeth, pitted or grooved enamel surfaces, or chalky color changes.  Teeth of patients affected with amelogenesis imperfecta are prone to rapid wear and breakage. “There are a variety of patterns associated with this disease,” Kessler said. “Each pattern will create a different tooth appearance and will impact the quality and fitness of the enamel. Enamel defects often allow cavities to start and spread quickly.”

Dentinogensis imperfecta

Kessler said dentinogenesis imperfecta is another disorder that indirectly impacts enamel and tooth development. This disorder may cause teeth to appear blue-gray or yellow-brown and translucent.

“Dentinogensis imperfecta causes the inner layer (the dentin) of the tooth to become soft and weak,” he said. “As you chew, you put pressure on the enamel, which is a crystal-like structure. The enamel of the tooth will often fracture off if it’s flexed against the softer-than-normal dentin.  The dentin is the “live” layer of calcified tissue between the enamel and the dental pulp, where the nerves and blood vessels are found.

Disorders in tooth development

Ectodermal dsyplasia

When a human embryo develops, it advances through many different stages. The teeth form from the ectoderm, the outermost layer of cells in the embryo.  Ectodermal dysplasia is a type of genetic disease that impacts the development of all ectodermally derived structures:  the hair, nails and—yes—the teeth.

“Patients who suffer from this condition will often be missing large numbers of teeth and have malformed or cone-shaped teeth,” Kessler said. “This disorder occurs very early in life. Children diagnosed with ectodermal dysplasia may need special dentures to replace the numerous missing teeth and improve the appearance.  The dentures often must be remade periodically to keep up with jaw growth.”

Dentinal dysplasia

As we age, some people begin to lose teeth, and much of the time this is due to periodontal disease which destroys the attachment of the tooth root to the surrounding bone. The roots of the teeth anchor our pearly whites to our gums, and without strong roots, teeth tend to loosen and fall out easily.

However, if you’re losing teeth constantly (and at a young age) you may have a genetic disorder called dentinal dysplasia. “Dentinal dysplasia is responsible for ‘rootless’ teeth,” Kessler said. “It is still very rare, but directly hinders the ability of teeth to form their roots.”

Hypophosphatasia

This inherited disorder affects the development of both a person’s bones and teeth. Hypophospatasia disrupts mineralization (process where minerals like calcium and phosphorous are deposited into developing teeth). Mineralization is extremely important to form strong teeth that can withstand the rigors of chewing and grinding.

“This disease does not allow the formation of cementum, the outer covering of a tooth’s root,” Kessler said. “The roots are normally held in the bone by fibers that insert into the cementum.  In the absence of cementum, the fibers cannot anchor the tooth to the bone. The classic manifestation of this disorder is an infant whose baby teeth fall out for no apparent reason.”

Vitamin D-resistant rickets

Vitamin D plays an essential role in tooth development, and when vitamin D levels are insufficient, it can cause oral health problems.

“Vitamin D-resistant rickets is a genetic condition that typically produces infections at the root end of the teeth that seem to occur with no explanation,” Kessler said. “It can cause openings in the enamel surface of the teeth that extend all the way to the dental pulp, where the nerves and blood vessels are found. Germs will run rampant because they can, in a sense, walk right through these openings.”

Genetic disorders of the mouth are still rare

Genetic oral health diseases are still relatively uncommon. According to Kessler, only a small number of the population will be diagnosed with these conditions. “Still, if you’re having any abnormal oral health symptoms, you should always have a conversation with your dentist or health care provider to determine if any of these underlying conditions could be responsible,” he said.