Caring for Teeth With Defective Enamel

Last week, my seven-year-old son had sealants applied to his six-year molars. Our dentist had explained at our regular January cleaning that enamel had not formed properly on my son's molars and that decay could occur. He asked me if anything significant had occurred during my 3rd trimester of pregnancy as these teeth actually were forming at that time. Nothing came to mind. While we are waiting and hoping that the sealants will save these four teeth, I have purchased Enamelon toothpaste and have begun to have my son brush with it in place of the usual toothpaste he has used. He also rinses each evening with ACT for children. Are we on the right track? His teeth are described as very clean and healthy otherwise.


A variety of factors can cause defects in enamel formation. A general term applied to inherited defects of enamel formation is amelogenesis imperfecta. Amelogenesis imperfecta can be autosomal dominant, autosomal recessive, or X-linked. It may or may not occur in conjunction with various syndromes. Defective enamel formation may also be caused by illnesses or medications taken during tooth formation.

I agree with your plan to keep your son's teeth healthy. The placement of sealants is an excellent choice. A good sealant bond depends upon: 1) the amount of enamel on the teeth; and 2) the health of the existing enamel. Accordingly, the sealants should be checked about every 6 months to ensure they are still clinically sound. Your son should also be brushing at least twice daily with a fluoride toothpaste and flossing at least once daily.

Enamelon toothpaste is a new formulation that has just entered the market as about March 1998. It is purported to be an improvement over regular toothpastes because it contains minerals, such as calcium, which are important for the strength of the teeth. These minerals, in addition to the fluoride, may provide more protection against the acids produced by bacteria which cause tooth decay.

You should also check with your local water district, your dentist, or your pediatrician to see if the community water is fluoridated. If not, consider having your dentist or pediatrician write a prescription for fluoride supplements. Chewing fluoride tablets can have a great topical effect for the teeth already present in the mouth, and then swallowing the fluoride can help strengthen the teeth which are still forming. Caveat: too much fluoride can be harmful. Work with your dentist to be sure that your son receives the optimum amount of fluoride.

Nutrition also can play a role in cavity formation. It is important to eat a healthy, well-balanced diet for many reasons, including your oral health. Many vitamins and minerals play a role in oral health. In addition, limiting the number of times sugar is ingested during the day can be helpful. For example, your son wants to have 5 cookies during the day. It is more harmful to his teeth to have one cookie every 2-3 hours than it is for him to have all 5 cookies in one sitting. Keeping a watchful eye on your son's diet, in addition to good oral hygiene practices and regular dental checkups, will help keep his teeth healthy.

Disclosure: In keeping with the highest ethical and journalistic standards, Dr. Kimberly A. Loos would like you to know that she owns a small amount of individual stock in Enamelon, Inc.

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