Children Dentistry
in Milton Keynes

Dental Enamel Hypoplasia

Dental enamel – the outermost layer of our teeth – is the hardest substance in the human body. It needs to be, because enamel is what protects the sensitive, nerve-filled centers of our teeth against hard chewing and biting forces. Unfortunately, dental enamel does not always form properly. Disruptions to the enamel formation process can lead to several different types of enamel defects in children, one of which is enamel hypoplasia.

What Is Dental Enamel Hypoplasia?

Dental enamel hypoplasia is an enamel defect characterized by thin or absent enamel. In some cases, the defect occurs on only part of a tooth’s surface, resulting in pits or grooves in the tooth’s enamel. In other cases, an entire tooth may have an overly thin layer of dental enamel or may have no enamel at all.

Enamel hypoplasia is a developmental enamel defect, meaning that is already present at the time the affected tooth first erupts from the gums. In contrast, enamel wear, such as dental abrasion and erosion, occurs after a tooth has erupted.

What Causes Enamel Hypoplasia in Children?

Enamel hypoplasia occurs when the special cells that produce dental enamel are disturbed during a particular stage of enamel formation (the matrix formation stage). A wide variety of factors can potentially cause such a disturbance, including both genetic and environmental factors.

The hereditary factors that lead to enamel hypoplasia in children consist primarily of relatively rare genetic disorders, such as amelogenesis imperfecta and Ellis van-Creveld syndrome.

Current research suggests that environmental factors that may increase the risk of enamel hypoplasia in children include the following:

• Premature birth
• Low birth weight
• Malnutrition, including vitamin D deficiency rickets
• Hypoparathyroidism
• Diabetes
• Gestational diabetes in the child’s mother
• Viral and bacterial infections, including congenital syphilis
• Inflammation
• Dental trauma
• Ingestion of large amounts of fluoride

Can Enamel Hypoplasia Affect Both Baby Teeth and Permanent Teeth?

Yes. Formation of the enamel on a child’s baby teeth begins in utero and continues into infancy. Disturbances to the matrix formation process during this time period can lead to enamel hypoplasia in baby teeth.

Formation of the enamel on permanent teeth begins during infancy and continues until the child is approximately eight years old. Disturbances during this time period can lead to enamel hypoplasia in the child’s permanent teeth.

In the case of both baby teeth and permanent teeth, the precise teeth affected by enamel hypoplasia will depend on the timing and the cause of the disturbance. For example, the enamel on a child’s permanent front teeth is typically formed by the time the child is five years old, whereas the enamel on a child’s second molars (the molars that are next to a child’s wisdom teeth) is not typically formed until around age eight. This means that if a child contracted certain types of infections at age seven, his front teeth probably would not be affected, but his second molars might be.

Does Enamel Hypoplasia in Children Require Treatment?

Depending on the location and severity of the defect, enamel hypoplasia may cause aesthetic concerns, tooth sensitivity and/or bite issues. In addition, numerous studies indicate that children with hypoplastic teeth are at increased risk for cavities.

In order to minimize their risk of cavities, children with enamel hypoplasia should be especially diligent about brushing and flossing regularly and should minimize their consumption of cavity-causing foods and drinks. Professional fluoride varnish treatments may be recommended to further protect against decay and to help minimize any tooth sensitivity.

When enamel hypoplasia creates significant bite issues or aesthetic concerns, your child’s paediatric dentist might recommend dental restorations such as white fillings. However, white fillings do not always adhere as well to defective enamel as they do to healthy enamel and may not be the right option in certain cases.

In severe cases, your child’s dentist may recommend covering hypoplastic teeth with dental crowns to protect them and to restore their shape and function.