Enamel Hypoplasia

Enamel Hypoplasia

Question: Write a short note on enamel hypoplasia.
Answer.

Enamel Hypoplasia

It is defined as an incomplete or defective formation of the organic enamel matrix.

Enamel hypoplasia is of two types, i.e.

• Acquired enamel hypoplasia.
• Environmental enamel hypoplasia.

Enamel hypoplasia diagnosis

Hypoplasia Acquired Enamel 

Factors Associated with Acquired Enamel Hypoplasia

Two types of factors are associated with acquired enamel hypoplasia:

• Hypoplasia Local factors:
• • Local factors are infection, trauma, and radiotherapy
  • Idiopathic factors.
  • When local infection or trauma causes damage to ameloblast cells during odontogenesis, it may lead to a defect in enamel formation in an isolated permanent tooth. This is known as focal enamel hypoplasia.
  • Focal enamel hypoplasia is caused by to periapical spread of infection from a carious deciduous tooth or trauma to the deciduous tooth; the permanent tooth bud affected in this process is known as Turner’s tooth.

2. Environmental or systemic factors:

Systemic or environmental disturbances in the functioning of ameloblasts at a specific period during odontogenesis of teeth manifest as a horizontal line of small pits or grooves on enamel surfaces. This line on the tooth surface indicates a zone of enamel hypoplasia and corresponds to the time of development and duration of the insult.

The following are the various factors that lead to systemic or environmental disturbances:

Turner’s tooth

Prenatal period: The prenatal infections are rubella, syphilis.

• There is a presence of internal disease
• There are excess fluoride ions.

Hypoplasia Neonatal period: During this period, enamel hypoplasia is caused due to:

• Hemolytic disease of the newborn
• Birth injury
• Premature delivery
• Prolong labor
• Low birth weight.

Hypoplasia Postnatal period: During this period, enamel hypoplasia is due to:

• Severe childhood infection
• Prolonged fever due to infectious disease in childhood
• Nutritional deficiency
• Hypocalcemia
• Rickets
• Celiac disease.

Enamel hypoplasia symptoms

Environmental Enamel Hypoplasia

In it, either primary or permanent dentition is involved.

Both enamel and dentin are affected.

Enamel Hypoplasia Causes 

• Nutritional deficiency
• Exanthematous diseases
• Congenital syphilis
• Hypocalcemia
• Birth injury, prematurity, Rh-incompatibility
• Local infection/trauma
• Ingestion of chemicals.

Enamel hypoplasia in children

Enamel Hypoplasia Types

• Mild: Few small grooves, pits, or fissures in the enamel surface.
• Moderate: Deep pits are arranged horizontally across the tooth.
• Severe: A Considerable portion of the enamel may be lost.

Enamel Hypoplasia Clinical Features 

• Usually pitting type of hypoplasia is seen in deficiency of vitamin A, C, and during tooth formation.
• In case of congenital syphilis, incisors show Hutchinson’s teeth characterized by screw driven-shaped incisors and mulberry molars characterized by irregular enamel on the occlusal surface of the crown.
• Presence of Turner’s teeth in local infection.

Acquired enamel hypoplasia

Enamel Hypoplasia Management 

• Teeth that are affected by enamel hypoplasia are more susceptible to dental caries as compared to normal teeth. Restoration should be confined to the area of involvement.
• In severe enamel hypoplasia chrome steel crown is given. Severe forms need composite restoration or a full ceramic crown.
• If sensitivity is present, desensitizing paste is prescribed.
• In mild hypoplastic molars, pits and fissures are placed over the occlusal surface, and 6 6-month re-evaluation is done.
• In patients with more demineralization, affected enamel should be removed, and the tooth should be restored with composite.
• Reduction of tooth and crown placement can also be done.
• In severe cases, extraction can be done.
• In anterior teeth, porcelain veneers or zirconia crowns are indicated.