Enamel Hypoplasia

Enamel Hypoplasia is the most common abnormality of development and mineralization of human teeth. The lesion is characterized by a quantitative defect in enamel tissue resulting from an undetermined metabolic injury to the formative cells – the ameloblasts. Clinically, enamel hypoplasia is seen as a roughened surface with discreet pitting or circum- ferential band –like irregularities which posteruptively acquire a yellow brown stain. Enamel hypoplasia is endemic in many countries of the world and is commonly reported in association with disease of childhood.

Some years ago population surveys in several countries showed that 3-15% of children exhibited some degree of enamel Hypoplasia in permanent teeth. However, the incidence of this lesion is significantly higher in vitamin D deficiency, hereditary vitamin D dependency rickets, hypoparathyroidism, and a wide spectrum of prenatal disorders. Earlier repots which implicated German measles (Rubella) during pregnancy as a major factor in enamel hypoplasia have been definitely disproven.

A specific type of enamel hypoplasia of primary teeth called linear enamel hypoplasia (LEH) is common in some economically underdeveloped countries. For example, its prevalence has been reported to be about 30-40% in Guatemala and in parts of the Caribbean coast. In children, who have signs of severe malnutrition, linear hypoplasia was present in up to 73%of the population. Enamel Hypoplasia resembling the linear type has been reported in association with acute diarrheal disease in preschool Apache Indian children. Although the pathophysiology of LEH is undetermined, many authors have suggested the synergistic action of malnutrition and infection as the most probable causative factors. A more probable factor is hypocalcemia induced by gastrointestinal diarrhea.

Hypocalcaemia  It is a specific Cause of Enamel Hypoplasia. Recently evidence has suggested that the etiology of enamel hypoplasia is highly specific. Enamel

Hypoplasia is seen in children having disorders of calcium homeostasis but it is not seen in children having phosphate homeostasis. It is not seen in children having hypophosphatemia 9X-linked hypophosphatemic rickets).this proves that serum phosphate level does not effect the enamel but in the conditions where hypocalcaemia is the major symptom like diarrhea etc the enamel Hypoplasia is coonly seen. This all proves that low Calcium level in serum is one of the major cause of enamel hypoplasia.

Enamel Hypoplasia and Caries Enamel Hypoplasia is clinically significant not only because it is disfiguring and the restorative treatment costly, but because it may affect caries susceptibility. There was a strong correlation between hypoplasia in the teeth of British schoolchildren (which she thought was caused by vitamin D deficiency) and caries susceptibility. For example, out of a collection of 1,500 extracted teeth, 74% of very hypoplastic teeth were carious, whereas 80% of the nonhypoplastic teeth were caries – free. Caries has also been associated with hypoplasia in many parts of the Third World There is no information about the chemical composition of hypoplasia enamel soothe exact reason for its greater proneness to caries is uncertain, but it is possible that its irregularity and pits may favor the development of more plaque compared with smooth well formed enamel.

In an important study of children with LEH it was found that significantly higher incidence of caries even in the posterior hypoplasia- free teeth of children whose incisors had LEH than in those who did not have this condition. Also,the incidence of caries and the enamel hypoplasia is higher in prematurely born children than in controls. Thus, evidence is strong that the factor responsible for hypoplasia of the linear type also predisposes to dental caries. Prevention of enamel hypoplasia in the Third World would portend a major reduction in caries prevalence in the affected populations.


 User Comments on -  Enamel Hypoplasia

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Posted By : Karen L. on 22-Mar-2014 03:28 PM
Please advise parents of children presenting with dental enamel hypoplasia (especially in combination with leg, or foot pain,joint pain, or peripheral neuropathy) to be screened for Celiac disease, which causes malabsorption of nutrients (calcium, vit D, etc.) in the small intestine. I wish i had made the connection so my daughter could have been diagnosed much younger.

Posted By : jamie trosin on 21-Jan-2014 07:35 AM
Hi, My daughter cheyane has been having issues all of her life from when she was a baby until now at 15 year old with Enamel Hypoplasia. We have seen numerous dentists and have had tons of work done for her teeth. I know it took alot of going to the orthodontist as things would not stick or break off due to weak enamel and not enough surface to stick the compound to. I have been told that my daughter would need either crowns/caps on all of her teeth to save them or veniers to make her feel better later on as she is forever cracking her teeth or having teeth pain as they are very sensitive. Any suggestions?

Posted By : Dr. Ritz on 05-Jul-2013 06:14 AM
Though outwardly the amelogenesis imperfect and the enamel hypoplasia seems similar but the cause varies. The amelogenesis imperfect is hereditary while the enamel hypoplasia has many causes like in can be because if nutritional deficiency or high fever or some sort of trauma. The treatment is the same. For esthetic reasons, as she is very young for crowns ,so direct veneering can be done but before going for the treatment the condition of the teeth has to be assessed.

Posted By : April on 25-Jun-2013 03:50 PM
I believe that my eleven year old daughter has hypoplasia or amelogenisis imperfect. They sound like different names for the same condition. Most of these posts are in reference to young children. Her baby teeth were perfect except for a couple of molars that had spots of missing enamel. Every single one of her permanent teeth have malformed enamel. Do you think this is a nutritional deficiency or a genetic problem? She would never drink milk. She is very healthy otherwise. Her enamel is chalky in spots, very white in places, horizontal lines and very rough. What options do we have? Veneers? Any thoughts would be appreciated. Especially on cause and treatment for cosmetic appearance. Other children sometimes make remarks about her not brushing her teeth.

Posted By : Dr.Ritz on 24-Feb-2013 09:23 PM

As your son is 8 years old ,most of his teeth must be the milk teeth. Only the 6 year molars and the front teeth are permanent. You have to take him to the paedodontist and the crowns which are given are temporary and has to be changed when he is around 15 to 16 years of age.


Posted By : Michelle Marsicano on 23-Feb-2013 06:55 AM
My son who is 8 has been diagnosed with enamel hypolasia- most ofhis teeth are crowned including his two front teeth- I am heart broken about the appearence and the pain his teeth cause him. I live in Indiana and i am having a hard time finding a pediatric dentist that can be paitent enough and caring enough to really help my son- he has also been diagnosed with austism spectrum disorder which causes him to have alot of anxiety at the dentist. Currently I am really unhappy with the crowns that he has on his 2 front teeth. They are very large and look unnatural- he gets gets picked on a lot by other kids for his teeth. Wondering if anyone could direct me or reccomend a dentist that would take the time to work with us and come up with a treatment plan etc- I feel like I cant find my son the help he needs- I am heartbroken.

Posted By : Dr.Ritz on 21-Jan-2013 10:12 PM

Sorry dear, it is better you check up with your physician or pediatrician. It is difficult to comment for a dentist without clinical examinations and other relevant history.


Posted By : Samantha on 03-Jan-2013 07:02 AM
We discovered yesterday that my daughter who is 6 yrs old has this condition. she also has a rare condition called linear iga which is an autoimmune problem and we have also been told she has a hypoplasia nose and joint hypermobility. could all this be connected? any advice?

Posted By : Dr.Ritz on 22-Dec-2012 12:37 AM

Hi Vikki,Treatment options depend on the hypoplasia's location and severity.For teeth with limited hypoplasia,bonding them with a composite material is the most common treatment.This synthetic enamel covers bare spots,protecting the tooth against bacteria. After the material dries,a dentist sculpts it so that the tooth has a normal cosmetic appearance.If the amount of natural enamel is too low,the composite material does not have a natural bonding area.In these situations, a patient has two options.The first is to cover the tooth with a metal crown.The second is to remove the tooth and later replace it with an implant or bridge.Hope this helps.


Posted By : Vikki on 21-Dec-2012 06:52 AM
My daughter has recently been "diagnosed" with this... yesyerday in fact. i say "diagnosed" as we have yet to go back and get it confirmed, but im pretty sure thats what it is. She is 6 years old. what can i do to help her, and to help the appearance of her teeth.

Posted By : Dr.Ritz on 31-Aug-2012 01:35 AM

Dear Fiona eltroxin is known to treat hypothyroidism and till now no such cases have been reported for enamel hypoplasia in new born to the ladies consuming eltroxin. So, you should get it clinically evaluated to know the correct diagnosis.


Posted By : Fiona Keogan on 29-Aug-2012 12:52 PM
My five year old daughter has enamel hypo plasma, when pregnant with her I was taking eltroxin 150mg, my third daughter is 2 should I get her checked as well, is it this medication that causes this. I also have a 7 year old with perfect teeth. I was not on this medication when pregnant with her??

Posted By : Dr.Ritz on 13-Jul-2012 09:44 PM
Mark , there are a few percentage of people only who may develop the hypoplasia even in permanent teeth but that appears in few teeth only that is on back molars and front teeth sometimes . The growth of primary teeth occurs much earlier as compared to permanent teeth so the causes that lead tro primary teeth hypoplasia may not be present at the time of permanent teeth development. So dont worry and remember to take her regularly for dental checkups ,go for fluoride applications as fluoride helps a lot in such conditions , it will be taken up by the developing teeth making them more harder and resistant to decay.And also use fluoride rinses and toothpastes as permanent teeth starts to erupt.

Posted By : Mark on 13-Jul-2012 08:36 PM
Drs., Thank you for your responses to the comments. I just discovered my 18 month old has enamel hypoplasia in her primary teeth which appears severe. I am terrified she will have it in her permanent teeth. Is there a chance she will. It have it in her permanent teeth? What percentage of children with primary hypoplasia develop it in permanents? Please help

Posted By : DR.RITZ on 08-Jul-2012 09:36 PM

Samantha ,sometimes overzealous brushing may cause certain enamel defects like enamel erosions ,abrasion leading to senstivity and cavities.Brushing twice daily is very important to maintain adequate oral hygiene and prevent permanent stains and decay of tooth.So always brush ur teeth before u go to sleep other wise the food that is attached to tooth surface causes tooth decay throughout night and bad breath in the morning.


Posted By : Samantha on 07-Jul-2012 04:28 AM
I wanted to ask if enamel defects can be caused by improper or less brushing? i brush daily but sometimes i forget to brush at night. Can this cause enamel defects?

Posted By : Dr.Ritz on 30-Jun-2012 02:31 AM
Dear VANDANA, no the treatment will not have any side effect on the permanent teeth plus caries is an irreversible disease so taking medicines will not treat it but it is always recommended to get it treated as early as possible.

Posted By : vandana on 29-Jun-2012 03:14 AM
Thank u doc for your comments, also I need to ask if her permanent teeth too will be affected and also i want to know, if i will go with some ayurvedic medicines which will arrest further reduction of her teeth n some supplements of calcium, will it be ok ??? Also guide me what are some food which she need to take compulsorily and which ones need to be avoided totally???

Posted By : Dr.Ritz on 30-May-2012 01:25 AM
VANDANA, you need not worry as RCT in milk teeth/children is very easy, less traumatic and gets completed in no time. Doctors have rightly suggested you RCT as getting tooth extraction as this age will create an empty space that will lead to spacing problems and some speech problems like not able to pronounce th,t and v sounds...

Posted By : Vandana on 29-May-2012 11:18 PM
Hi, My 2.7 Year old baby Girl has got enamel Hypoplasia in almost all her teeth save the lower 6, she had all the habits of sleeping with bottle n she even took bottles in between while sleeping, her upper 4 teeth are drastically reduced n only little portion above the gums can be seen, Am very tensed as docs r advising 4 RCT of all her 16 teeth under 12 hours Anesthesia which seems too risky for her, she has left her bottle habits, brushes her teeth now. Pl Guide me as am very nervous about this teeth n her permanent teeth, also what are the other tests which i need to get done for knowing the exact reason

Posted By : Dr Ritz on 04-Mar-2012 10:03 AM
Konka, Enamel hypoplasia is sequelly of some systomic disease in which there is deficiency of certain harmones which affect the calcification and mineralisation. So there can be relationship between the limb pain and enamel hypoplasia. It is better you go to your physician who can better advise and make diagnosis. You can also go to a Oral Medicine Specialist.

Posted By : konka on 04-Mar-2012 06:13 AM
my 6 yr old has enamel hypoplasia affecting her lower permanent incisors and four newly errupted molars. She also frequently complains of leg and hands. I thought this is growing pain. But is there any relationship between hypoplasia and limb pain?

Posted By : Dr. Ritz on 13-Feb-2012 07:50 PM
Beth, Enamel Hypoplasia makes the tooth weak. In this the enamel keeps on eroding which has to be reinforced in permanent teeth, porcelain crowns are given but in milk teeth, they are re-enforced with staninless steel crowns, which is the best treatment option. Otherwise also in pediatric dentistry, using stainless steel crowns for these kinds of treatment is standard practice. You can validily raise your concern with insurance company.

Posted By : Beth on 12-Feb-2012 04:02 PM
Dr. Ritz, my son is having stainless steel crowns placed on two of his 6 year molars that are severly affected with enamel hypoplasia. Insurance has denied the claim, stating that stainless steel crowns are unnecessary. I am appealing the denial, and want to know if stainless steel crowns are considered the standard of care in pediatric patients. Thank you,

Posted By : Dr Ritz on 24-Jan-2012 02:01 AM
Kelly, Enamel hypoplasia will not lead to problems with temper. Medicines may or may not affect teeth. Some medicines when taken during time of tooth development can lead to enamel hypoplasia.

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