What is Tooth Enamel?

Tooth enamel is pretty remarkable as it is the hardest substance in the human body. This highly mineralized outer layer protects the softer parts of the tooth. Enamel mainly consists of hydroxyapatite, a crystalline calcium phosphate. The color of tooth enamel can vary considerably and is affected by the underlying layer of dentin which contains the natural color of the tooth. Some people have naturally thin tooth enamel, showing more of the natural tooth color which can sometimes be quite dark, while a thicker layer of enamel tends to make teeth look brighter and whiter.

What is Enamel Hypoplasia?

Enamel hypoplasia is where a person has hard but thin tooth enamel, caused by the tooth enamel being defective in some way. Usually this condition is characterized by teeth which have a pitted appearance. In some cases the tooth may actually have a hole in the enamel, or the enamel will not be present at all, leaving the tooth vulnerable to tooth decay and infection.

Causes of Enamel Hypoplasia

Enamel hypoplasia can be caused by several different factors. Some children will have congenital hypoplasia or hereditary enamel hypoplasia where tooth enamel fails to develop due to insufficient calcification. This might occur if a child is unable to metabolize vitamin D which prevents the absorption of calcium. It might also result due to a deficiency in vitamin D or because of a disorder called vitamin D resistant rickets which prevents the normal absorption of inorganic phosphate required for the development of teeth and bones.

Another common cause can be due to a child having an infected primary or baby tooth. This might be as a result of an injury to the tooth or because of a large untreated cavity. When this occurs the very root of the infected baby tooth can dissolve as it will be exposed to acids in the mouth, affecting the permanent tooth underneath. As a result, when the adult tooth emerges it may have an irregular or pitted appearance.

The development of tooth enamel may be affected by other events such as malnutrition or fever while the teeth were forming. This can occur during early childhood and it’s possible for a dentist to estimate the timing of abnormal enamel formation by examining the teeth and areas affected. If the six year molars and front teeth are affected then it’s likely the event occurred during a child’s first year. If the second molars and bicuspids are effective then it’s more likely this would have happened around age 3.

Treating Enamel Hypoplasia

The exact method of treatment will depend on the location and severity of the hypoplasia. Teeth with only minimal hypoplasia may be treated by being bonded with tooth colored resin composite filling material. This covers up any thin or missing spots of enamel, preventing tooth decay and infection. If the hypoplasia is more serious than the tooth might need to be covered up with a crown or as a last resort will be removed altogether and replaced with a bridge or implant.