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Contributions of genetics and of the environment to variation in human tooth size are discussed. A significant effect of the environment shared by twins, uterine or early in life, was found for mesiodistal (MD) and buccolingual (BL) diameters of maxillary first molars. Significant non-additive genetic variation was seen in MD diameters of canines and first premolars. That would be consistent with selective pressures at some stage in human evolution.

The major current overviews establish that generalized development stress between ages 0-5 underlines most permanent tooth hypoplasias. Fluoridation of metropolitan water has emerged as the statistically strongest hypoplasia-preventing factor.