Enamel hypoplasia

My 7 year old daughter has enamel hypoplasia in her permanent teeth. It is not the looks that worries me but she had a cavity and when the dentist tried to make a filling the tooth crumbles! Does that mean she has weak teeth?

Could you tell me what can be done to correct this condition or protect her teeth?

I will appreciate any advice.


Dear Johany,

Enamel hypoplasia is an enamel defect resulting from incomplete formation of the enamel matrix due to a problem with the ameloblasts. Ameloblasts are cells which participate in the formation of enamel. Enamel hypoplasia is usually due to illness or injury during tooth formation or due to a genetic disorder. When the enamel is affected in this manner, the teeth are weakened. Enamel is one of the hardest substances in the body; therefore, normal enamel offers more protection than defective enamel or no enamel.

The genetic forms of enamel hypoplasia are generally considered to be types of amelogenesis imperfecta. In some forms of this defect, the enamel chips away easily.

Fluoride treatment normally is most successful when enamel is present. Studies have shown, however, that fluoride has more benefits than just helping the enamel to be stronger. Fluoride can inhibit bacterial enzyme systems which convert sugars into acids (which "eat away" at tooth structure) and inhibit storage of intracellular polysaccharides which prevents acid formation between meals. At high concentrations, fluoride is toxic to bacteria. For short periods after topical application, certain bacteria may be eliminated. Fluoride may also help reduce plaque buildup on the tooth surface. While some of these benefits are only temporary, they may help somewhat to reduce the cavity formation in your daughter's teeth.

In the future, she may need to have crowns (or caps) placed on her teeth. She may even have to have some teeth extracted depending upon the severity of the condition. For now, I recommend scrupulous oral hygiene at home, regular and frequent (at least every 6 months) visits to the dentist, and topical fluoride application. This may necessitate custom trays being constructed by your dentist and close attention paid to instructions to prevent too much ingestion of the fluoride. Discuss this possibility with your dentist.

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