Treatment for missing enamel?

Our 4.5 year old has a small area on each of her top front two teeth that is missing the enamel. The last few days she has been complaining that one of these teeth is bothering her a little. I have her an appointment for next week with the dentist, but I wanted to know options. My parents dipped my soother in rosehip syrup, and by age two, I had to have all of my rotten top teeth removed (7 in all). I don't want my daughter to go through being toothless till her permanent teeth erupt (this was very traumatic for me). Because of my situation as a child, and also because I am a paediatric nurse, we have been vigilant with her dental care. Is there any way to coat these teeth and save them until they are replaced by her permanent teeth?


Dear Karen,

Your daughter may be experiencing sensitivity for several reasons. Without the enamel layer to protect it, the exposed dentin (next layer of tooth structure) can be quite sensitive. There are many microscopic "fingers" of nerve tissue which course through the dentin. If any of these fingers are close to the surface, this can cause sensitivity; therefore, cold, sweet, sour, and touch may cause tooth pain. If any decay has started in the exposed dentin, which is possible due to its softer structure than enamel, this can accelerate any sensitivity. In addition, the pulp chamber (area underneath the dentin which contains the nerve and blood vessels for the tooth) is closer to the tooth surface in primary teeth than in permanent teeth.

The solution may actually be quite simple. First, the dentist should determine if any decay exists. This should be removed prior to any type of restoration which might be placed on the tooth. If the defect does not intrude on the pulp tissue, a simple tooth-colored filling (composite resin) may be placed to treat the condition. Depending upon the severity of the sensitivity in the tooth, a small amount of anesthetic may be needed. The preparation of the tooth for the composite may require some slight drilling and some blowing of air and rinsing with water. If the tooth is very sensitive, your daughter may be more comfortable with a little bit of anesthetic.

If the pulp tissue is affected, however, more extensive treatment may be necessary. This may require either removal of the pulp tissue or removal of the tooth. You and the dentist can determine the best course of action, given the circumstances. If extraction is necessary, and it appears that the permanent teeth may not erupt for a while, restorations to replace the missing tooth or teeth are available.

Thanks for the question, and keep up the vigilance. Your daughter will thank you in the future!

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