Enamel hypoplasia

File:Enamel celiac.jpg discoloration, or other causes.{{cite web|url=https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/diagnosis |title=Diagnosis of Celiac Disease |publisher=National Institute of Health (NIH) |access-date=6 June 2017 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20170515223010/https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/diagnosis |archive-date=15 May 2017 }}[http://celiac.nih.gov/PDF/Dental_Enamel_Defects_508.pdf Dental Enamel Defects and Celiac Disease] {{webarchive |url=https://web.archive.org/web/20160305124250/http://celiac.nih.gov/PDF/Dental_Enamel_Defects_508.pdf |date=March 5, 2016 }} National Institute of Health (NIH){{cite journal | vauthors = Pastore L, Carroccio A, Compilato D, Panzarella V, Serpico R, Lo Muzio L | title = Oral manifestations of celiac disease | journal = Journal of Clinical Gastroenterology | volume = 42 | issue = 3 | pages = 224–32 | date = March 2008 | pmid = 18223505 | doi = 10.1097/MCG.0b013e318074dd98 | hdl-access = free | type = Review | s2cid = 205776755 | hdl = 10447/1671 }} The National Institutes of Health include a dental exam in the diagnostic protocol of celiac disease. ]]

Enamel hypoplasia is believed to result from the dysfunction of ameloblasts—enamel-producing cells—either for a short period of time or throughout their lifespan. Enamel hypoplasia has a wide variety of known causes. Some causes are hereditary and others are from environmental exposure. The severity and localization of disease presentation is dependent on the timing and stage of tooth development in which the defective enamel formation occurred.

Hereditary causes of enamel hypoplasia include:

• Primary abnormalities in enamel development, such as amelogenesis imperfecta
• Certain dermatological conditions, such as Ehlers-Danlos syndrome
• Other complex hereditary conditions such as Usher syndrome, Seckel syndrome, Treacher-Collins syndrome, Heimler syndrome & Ellis-Van Creveld syndrome, Down syndrome, Hypophosphatasia, Regional odontodysplasia, Cleft lip and palate, Vitamin D-resistant rickets.{{Cite web |last=bhong |first=akash |date=2023-05-10 |title=Is Tooth decay hereditary? - Healthy bano |url=https://healtybano.com/is-tooth-decay-hereditary-healthy-bano/ |access-date=2023-05-10 |website=healthy bano |language=en-US}}

Environmental causes of enamel hypoplasia include:

• Nutritional deficits, such as Vitamin D, iron or calcium deficiency{{cite journal | vauthors = Kanchan T, Machado M, Rao A, Krishan K, Garg AK | title = Enamel hypoplasia and its role in identification of individuals: A review of literature | journal = Indian Journal of Dentistry | volume = 6 | issue = 2 | pages = 99–102 | year = 2015 | pmid = 26097340 | pmc = 4455163 | doi = 10.4103/0975-962X.155887 | doi-access = free }}
• Birth injury or preterm birth
• Smoking during pregnancy
• Trauma
• Radiation
• Certain infections (e.g. congenital syphilis, cytomegalovirus, congenital rubella)
• Certain diseases (such as undiagnosed and untreated celiac disease,[http://celiac.nih.gov/PDF/Dental_Enamel_Defects_508.pdf Dental Enamel Defects and Celiac Disease] {{Webarchive|url=https://web.archive.org/web/20160305124250/http://celiac.nih.gov/PDF/Dental_Enamel_Defects_508.pdf|date=2016-03-05}} National Institute of Health (NIH){{cite journal | vauthors = Ferraz EG, Campos E, Sarmento VA, Silva LR | title = The oral manifestations of celiac disease: information for the pediatric dentist | journal = Pediatric Dentistry | volume = 34 | issue = 7 | pages = 485–8 | year = 2012 | pmid = 23265166 }}{{cite journal | vauthors = Giuca MR, Cei G, Gigli F, Gandini P | title = Oral signs in the diagnosis of celiac disease: review of the literature | journal = Minerva Stomatologica | volume = 59 | issue = 1–2 | pages = 33–43 | year = 2010 | pmid = 20212408 }} chicken pox, congenital syphilis)
• High fever
• Hypoxia (i.e. from severe cardiac defect)
• Excessive fluoride exposure (dental fluorosis)
• Tetracycline
• Vitamin A, C, or D deficiency[https://doctorstaci.com/enamel-hypoplasia/ Enamel Hypoplasia] Doctor Staci Whitman (2021)

File:Teeth displaying Enamel hypoplasia lines.jpg

Enamel hypoplasia is a risk factor for dental caries in children including early childhood caries (ECC), which continues to be a burden for many children. This association has been identified as significant and independent, and is believed that the formation of pits and missing enamel provides a suitable local environment for adhesion and colonization of cariogenic bacteria. Historically, enamel hypoplasia has been under-appreciated as a risk factor for ECC.

Developmental defects in enamel that affect tooth appearance in the esthetic zone (i.e. upper front teeth) may cause individuals to experience social embarrassment or anxiety regarding the appearance of their teeth.

Dental sealants may be indicated for the prevention of caries in hypoplastic pit & fissure systems.

According to clinical trials, topical fluoride treatment in the form of gel or varnish is effective in preventing tooth decay in children with enamel defects. Treatment with other topical agents, such as calcium phosphate (CPP-ACP), may also be effective in the remineralization of areas with congenital or carious enamel defects.{{cite journal | vauthors = Lacruz RS, Habelitz S, Wright JT, Paine ML | title = Dental Enamel formation and Implicateions for Oral Health and Disease | journal = Physiological Reviews | volume = 97 | issue = 3 | pages = 939–993 | date = July 2017 | pmid = 28468833 | pmc = 6151498 | doi = 10.1152/physrev.00030.2016 }}

In decayed teeth with enamel defects, only bonded restorations (e.g. glass ionomer, polyacid-modified composite resin and not amalgam) should be placed and cavity margins should not be placed in areas of defective enamel as this may lead to marginal leakage and recurrent decay. Stainless steel crowns with conservative preparation may be an effective method to eliminate sensitivity and prevent further breakdown in teeth with enamel defects requiring full-coverage crowns.

Hypomineralization or hypocalcification, as opposed to hypoplasia, refers to a decrease in the mineral content of the enamel, not the total amount present. It can vary in its presentation, and teeth may appear visually normal or highly translucent. Affected enamel is softer and more susceptible to acid, wear and decay.

Molar-incisor hypomineralization (MIH) is a condition in which there are areas of hypomineralized or hypomatured enamel on the crowns of permanent molars and incisors. In these cases, teeth may lose their weakened enamel shortly after eruption and are highly susceptible to dental caries. Affected teeth are highly sensitive to chemical and thermal irritants, and may also be difficult to obtain anesthesia. The causes of MIH are thought to be similar to those of other forms of enamel hypoplasia, but occur concurrently with crown development in the permanent molars and incisors (birth to approximately 3 years of age).{{Cite journal|last=Seow|first=W. K.|date=2014|title=Developmental defects of enamel and dentine: challenges for basic science research and clinical management|journal=Australian Dental Journal|language=en|volume=59|issue=s1|pages=143–154|doi=10.1111/adj.12104|pmid=24164394|issn=1834-7819|doi-access=free}}

Turner's hypoplasia or Turner's tooth is a presentation of enamel hypoplasia that normally affects only a single tooth. Its causes can be the same as other forms of enamel hypoplasia, but it is most commonly associated with trauma to a primary maxillary central incisor and the subsequent developmental disturbance of the underlying permanent tooth.{{Cite journal|last1=Bhushan|first1=B. A.|last2=Garg|first2=S.|last3=Sharma|first3=D.|last4=Jain|first4=M.|date=2008|title=Esthetic and endosurgical management of Turner's hypoplasia; a sequlae of trauma to developing tooth germ|url=https://pubmed.ncbi.nlm.nih.gov/19127030|journal=Journal of Indian Society of Pedodontics and Preventive Dentistry|volume=26|issue=Suppl 3 |pages=S121–124|issn=0970-4388|pmid=19127030}} This may also result in dilaceration of the root of the permanent tooth.{{Cite journal| vauthors = Altun C |date=April 2009|title=Hypoplasia of a Permanent Incisor Produced by Primary Incisor Intrusion: A Case Report|url=https://www.cda-adc.ca/jcda/vol-75/issue-3/215.pdf|journal=JCDA|volume=75|issue=3 |pages=215–218}}

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Category:Dental enamel

Category:Developmental tooth disorders