Could we have prevented poor enamel formation?

My daughter is 3 years old. We took her to the dentist today for the first time because she complained of pain in her back teeth. When I looked at them, they were very dark looking. We have been brushing her teeth 2 times a day regularly. The dentist said she has poor enamel formation and needs 2 crowns and has several cavities. I feel so bad. Was I a bad parent? Is there something I could have done to prevent this? What can I do now to help promote her enamel growth? Also where can I get more information about this and what causes it etc.?


Dear Michelle,

It sounds as if your daughter has what is termed amelogenesis imperfecta, a defect in the formation of enamel. The latest statistic I have read says this happens to about 1 in 14,000 people, and it may affect both primary and permanent dentitions in some instances. This is genetically determined, and depending upon the type of imperfection, it may be autosomal dominant, autosomal recessive, or x-linked dominant.

These enamel defects may be very localized or generalized. Local defects may present as a row of pits or linear depressions. The generalized version may present as smooth, glassy enamel which may vary from opaque white to translucent brown. Some enamel may be completely missing. There is also a rough version in which the enamel appears hard with a granular surface. This type of enamel will easily chip away from the underlying tooth structure, and these teeth appear white to yellow-white in color. The hypomaturation form of amelogenesis imperfecta presents enamel which is soft, cavity-prone, and has a brown-yellow-white mottled appearance. The hypocalcified form is the most common form in North America and is most commonly autosomal dominant. The enamel is of normal thickness on newly erupted teeth, is honey-colored or yellow-orange-brown in appearance, and is soft, causing it to be lost soon after eruption of the tooth.

At this point, crowns and fillings to restore the primary dentition are the best option. Continue brushing and flossing her teeth to maintain good oral hygiene. Fluoride supplements may be somewhat beneficial for both primary and permanent dentitions if your daughter receives the drops or chewable tablets which can offer a topical effect for the primary dentition. Careful, regular dental check-ups will help to diagnose and treat any problems before they become too large. Because it is unknown if this condition will affect her permanent dentition, careful monitoring of these teeth will also need to be done. Some of the types of amelogenesis imperfecta are distinctive on radiographs; therefore, radiographs which will help diagnose problems with the primary dentition and reveal development of the permanent teeth can be helpful in preparation for the permanent dentition.

This condition is not caused by anything you did wrong as a parent or anything you could have prevented. Please don't feel bad about this condition. Also, realize that other children you may have will not necessarily develop this condition. Resources for further information may include a local pedodontist, dental schools, textbooks of pediatric dentistry, and the American Academy of Pediatric Dentistry.

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