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Posted on June 10, 2021 By Staci Whitman, DMD

                                                                                                                                                                                                                                                                                                      

Enamel hypoplasia is one of the less-discussed conditions that can affect children’s teeth as they come in. If you’re interested in prevention or your child has been diagnosed, don’t panic! Here’s what you need to know about the signs, prevention, and treatment of enamel hypoplasia.

What is enamel hypoplasia? Enamel hypoplasia occurs when a growing tooth has too thin or incomplete enamel. Dental enamel is the hard outer layer of the tooth that protects the inner, sensitive parts of your teeth from injury and bacteria. 

When a tooth doesn’t have enough enamel, it’s more likely to develop cavities (also called dental caries or tooth decay). 

Enamel hypoplasia is primarily diagnosed in children. Sometimes dentists notice it in the primary teeth (also called baby teeth or deciduous teeth), but occasionally it happens in the permanent teeth. Early detection is one of the reasons I recommend a first dental visit within the first year.

Pediatric dentists are trained to look for enamel defects that can cause problems later in life. Because enamel hypoplasia can cause so many major dental issues, treatment is an essential part of an affected child’s oral health.

Can you fix enamel hypoplasia? Enamel hypoplasia is treatable, fortunately. Pediatric dentistry can use a variety of methods to treat enamel hypoplasia. These treatments include applying materials to strengthen the enamel and protect the layers underneath. 

You can even help protect and repair enamel at home using diet, oral hygiene, and proper breathing.

Enamel Hypoplasia Symptoms

What are the symptoms of enamel hypoplasia? The symptoms of enamel hypoplasia include changes in how the teeth look and feel. Patients with hypoplastic enamel can have discolored, sensitive teeth with lesions that are prone to decay.

What does enamel hypoplasia look like? Enamel hypoplasia often looks like:

  • Small grooves on the surface of the tooth enamel
  • Pitting of the enamel
  • White spots on the surface of the teeth, often on the central incisors
  • Yellow-brown discoloration

Thin enamel lets you see through to the dentin, the second layer of the tooth. Dentin is generally a grayish-yellow color, which is why teeth with hypoplastic enamel often look yellowed or dingy.

Other symptoms of enamel hypoplasia include:

  • Tooth sensitivity (because there isn’t enough enamel to protect the tooth)
  • A high number of cavities (caries)

Is enamel hypoplasia painful? Yes, enamel hypoplasia can be painful. Enamel helps protect the sensitive pulp of the tooth. The thinner the enamel is, the more sensitive the tooth will be. 

Mild cases of enamel hypoplasia may experience general tooth sensitivity, but severe cases may be painful.

Causes of Enamel Hypoplasia

What causes hypoplastic enamel? Enamel hypoplasia is caused by genetics, environment, or sometimes a combination of both. During tooth development, something goes wrong with the matrix formation of enamel. The enamel is very thin and weak or is deposited unevenly.

Genetic Causes of Enamel Hypoplasia

There are a handful of genes that are strongly associated with enamel hypoplasia. In these cases, the condition is called amelogenesis imperfecta. 

In amelogenesis imperfecta, the genes that control enamel formation and development don’t function properly in the ameloblasts, cells that create the teeth. Teeth often develop with very little enamel. Thankfully, there is a very low prevalence of this condition.

Environmental Causes of Enamel Hypoplasia

Enamel hypoplasia can also be caused by environmental factors. When an infant or child experiences certain conditions while the teeth are developing, they may grow hypoplastic enamel.

Common environmental factors that cause enamel hypoplasia include:

  • Tooth injury
  • Infections
  • Calcium deficiency
  • Vitamin A, C, or D deficiency
  • Maternal health
  • Premature birth
  • Low birth weight
  • Celiac disease
  • Fluorosis (too much fluoride)

The good news is that we can address many of these environmental factors to reduce the risk of your child developing enamel hypoplasia.

Do humans have thick enamel? Humans have thick enamel when compared to the dentition of closely related species like chimpanzees and gorillas. In fact, it’s roughly as hard as steel.  Scientists think that our thick enamel helps us chew hard foods that other animals can’t eat. 

Risks and Complications

The primary complication of enamel hypoplasia is tooth decay. Because the enamel layer is so thin, people with hypoplastic enamel are at a much higher risk of developing caries. Untreated tooth decay can lead to severe pain, root canals or tooth extraction, or even infections.

What happens if you have no enamel on your teeth? If you had absolutely no enamel on your teeth, they would be quite sensitive to hot and cold food and drinks. They would be a brownish-yellow color and have a rough texture. 

Your teeth would also decay and get cavities quickly. Fortunately, it is rare to have no enamel whatsoever. Most people have at least some enamel on their teeth. 

Treatment Options

What is the best way to fix enamel hypoplasia? There are several very effective treatments for enamel hypoplasia. These treatments all focus on maintaining a thick protective layer over the tooth, either by strengthening the existing enamel or putting another material on top.

Maintaining Thin Enamel

It’s best to maintain the existing enamel, if possible. In mild and moderate cases of enamel hypoplasia, dentists will apply treatments to the enamel to help harden it. Severe cases generally require more extensive procedures to preserve the tooth.

At home, make sure your child is brushing your teeth twice a day with a hydroxyapatite toothpaste and a soft toothbrush. It’s also important to floss at least once a day to protect the enamel between the teeth. 

Tongue scraping will help remove harmful bacteria from the mouth so they can’t cause tooth decay. Consider adding oil pulling, too, to reduce inflammation and balance the microbiome.

 

What Your Dentist Can Do

There’s a lot your child’s dentist can do to help keep their enamel and teeth healthy. Here are a few of the most popular in-office treatments for enamel hypoplasia:

  • Resin-bonded sealant: Sealants are frequently used on the permanent molars to provide an extra protective barrier over the enamel. 
  • Dental bonding: A dentist bonds resin to the tooth, covering any weak enamel. This is similar to a composite filling.
  • Composite fillings: If there is already tooth decay, your dentist may recommend a composite filling. (Amalgam fillings are not recommended for children under 6 years of age. However, I suggest avoiding them for all ages since they contain mercury).
  • Dental crowns: Dental crowns may be the best choice for teeth with a lot of damaged enamel. It completely covers the tooth, fully protecting it.
  • Tooth extraction: As a last resort, highly damaged teeth may need to be removed.

Some dentists recommend a fluoride varnish, but I think there are preferable and less risky ways to protect young teeth. As mentioned in one of the previous sections, fluorosis can cause some cases of hypomineralization.

How much does it cost to fix tooth enamel? Here are the average costs of the most common enamel hypoplasia treatments:

  • Sealant: $30-$40 per tooth
  • Bonding: $200-$600 per tooth
  • Fillings: $150-$550 per tooth
  • Crowns: $500-$2,000 per tooth
  • Tooth extraction: $150-$650 per tooth

Insurance often covers at least part of the cost of these procedures, so your out-of-pocket expense may be lower.

How To Prevent Enamel Hypoplasia in Kids

Prevention is critical, especially when it comes to the enamel of your kids’ teeth. Enamel can be strengthened and reinforced, but it can’t be replaced.

Here are some great ways to help your children take care of the enamel on their teeth:

  • Healthy diet for breastfeeding mothers: Your baby’s teeth are developing inside their gums as you’re breastfeeding. It’s vital that they get the vitamins and minerals from breastmilk they need to build strong teeth. Make sure you’re eating plenty of whole foods and a variety of fruits and vegetables. I recommend taking vitamin D3 and K2 supplements as well.
  • Wipe your baby’s gums: Wiping your baby’s gums with a soft cloth or toothbrush breaks up bacterial colonies that might be growing on the surface. Practicing good oral hygiene with your infant can prevent infections that might lead to enamel hypoplasia later. It also sets the stage for healthy brushing habits once their teeth come in.
  • Feed your kids healthy foods: As I always say, be sure to eat the rainbow! Avoid the malnutrition that causes developmental defects of enamel by eating a diet full of healthy, whole foods. They should be eating foods rich in calcium, vitamin A, and vitamin D.
  • Avoid sugary, gummy foods: Certain foods like fruit snacks or crackers can stick to teeth and promote tooth decay. Try to keep processed, high-sugar, and high-carb foods out of your kids’ diet as much as possible, or choose xylitol candy when a sweet tooth strikes.
  • Practice good oral hygiene: Patients with hypoplastic enamel need to do everything they can to prevent tooth decay. Regular brushing with a hydroxyapatite toothpaste and flossing can also help strengthen the enamel your child does have. 
  • Use alkalizing mouthwash: Acids can weaken and break down tooth enamel. Alkalizing mouthwash counteracts the acids by neutralizing the mouth’s pH, which can help kill harmful bacteria growing in the mouth. 
  • Don’t breathe through the mouth: Mouth breathing dries out the mouth, which creates a friendlier environment for harmful bacteria. Help your child breathe through their nose as much as possible to keep bad mouth bugs at bay.
  • Oral probiotics: You may already take a probiotic to support the beneficial bacteria in your gut. Consider adding oral probiotics to your kid’s daily routine to support the good bacteria in their mouth.

A diagnosis of enamel hypoplasia may sound scary, but there are a lot of things you can do to protect your child’s teeth. Better yet, it’s possible to prevent it from happening in the first place, whether in baby or permanent teeth.

When To See A Dentist

If your child has any of the symptoms of enamel hypoplasia, you should bring them to see a dentist. A pediatric dentist will look for proper enamel development at each exam. I recommend bringing children in before their first birthday.

The most effective enamel hypoplasia treatments will address both the teeth and the root cause of the weakened enamel. Functional dentistry encourages parents to take an active role in their child’s oral health by feeding them the right foods and practicing good dental hygiene.

No matter how much enamel your child has, you and your dentist can create a plan for a nutritious diet and fantastic oral hygiene that improves their oral health and quality of life.

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