Enamel hypoplasia of permanent and deciduous teeth

Pathology of the structure or mineral composition of dental tissue (partial or complete absence of it), developing due to a failure that occurred during the period of their formation - this is dental hypoplasia. This disease is quite common.

About 30% of the population suffers from it in one form or another. Permanent teeth are more often subject to this problem, while their baby teeth are less susceptible. The most severe manifestations of the disease include "underdevelopment" of dentin, and its extreme manifestation is the complete absence of enamel or the tooth as a whole.

Doctors state that the number of sick children and teenagers significantly exceeds the percentage of the adult population suffering from this disease. Most often, the most vulnerable place in dental hypoplasia is the enamel: it is less durable and the thickness of the enamel covering layer is less than the norm. The presence of this disease in a person often indicates a fairly serious pathology of metabolic and protein processes in the body, being, thus, both a separate disease and, at the same time, a symptom of a deeper pathology that has affected the human body.

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Causes of dental hypoplasia

In order to successfully combat the disease, it is necessary to thoroughly know the reasons for its occurrence. One of the main reasons for the development of pathology is associated with disorders that have arisen in the system of exchange of protein and mineral components of the metabolic process (the destructive activity of this disease is irreversible). What are the causes of dental hypoplasia:

• This failure can occur on the basis of a Rhesus conflict that develops between the mother and her fetus.
• If the expectant mother suffered from an infectious disease during pregnancy, especially in the first trimester.
• If the pregnancy was difficult, with severe toxicosis.
• The baby was born prematurely.
• The baby was injured during birth.
• Pathology of child development in infancy: rickets…
• The baby does not receive the required amount of food – dystrophy.
• Manifestations of gastrointestinal diseases.
• Disruption of metabolic processes. In particular, calcium.
• Present somatic diseases in the child.
• Disturbances in brain activity that manifested themselves between the ages of six months and one year…
• Infectious lesions.
• Mechanical injuries of the maxillofacial region.

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Symptoms of dental hypoplasia

There are symptoms of this disease, and the specifics of their manifestations largely depend on the severity and complexity of the factors and diseases that the patient had to endure.

There are several types of the disease, in which the symptoms of dental hypoplasia vary slightly.

Systemic hypoplasia (the pathology affects all teeth in the patient’s oral cavity):

• Deviation of color (in comparison with the norm) of tooth enamel. The presence of only this sign can be attributed to the manifestation of a mild degree of dental hypoplasia. The spots stand out with a clear outline, having a white, less often yellow, shade. These spots are located on the front wall of the tooth. Such a deviation does not cause painful discomfort. At the same time, the enamel surface does not change its texture (the same smooth and reflective, as in the norm).
• Insufficient thickness of the enamel layer or its complete absence.
• Underdevelopment of the layer covering the tooth.
• Individual cases of this type of disease can be called "tetracycline" teeth. They are very different in color from classic teeth. Their color was changed by the action of such a drug as tetracycline, which the mother actively took throughout the entire period of tooth formation, as well as from a lack of essential minerals during this period.

Local hypoplasia (pathology affects one or two teeth):

• In this type of disease, the pathology affects not only the enamel, but also the deepest layers - the rudiments from which permanent teeth subsequently erupt. For example. They can be subject to inflammation that occurs in the jaw (due to infection), or arose after mechanical trauma.
• Developmental defect of tooth enamel. This is a rather severe case of the disease. The tooth has suffered more significant damage. Structural defects (stripes and minor dents) are visible on its surface. There are no breaks in the integrity of the enamel surface. Pain symptoms do not appear. The patient is more concerned about the aesthetic side of his smile.
• Aplasia is the rarest, but the most severe form of dental hypoplasia. This pathology can only be congenital. The main and most unpleasant symptom is when the patient's teeth are completely or partially missing enamel material. In this case, psychological discomfort is accompanied by pain - the reaction of open, unprotected areas of dental tissue to external stimuli: touch, temperature fluctuations, various physical and chemical substances.
• There are cases of underdevelopment of dentin, which leads to deformation of the tooth itself (it can take on quite bizarre shapes).

Hypoplasia of dental enamel

It would be absolutely incorrect to state that enamel hypoplasia depends only on the quantitative and qualitative "filling" of the human body with minerals. And with demineralization, we get dental hypoplasia. If this were so, there would not be such a scale of this disease and problems with its treatment. The scale of the disease is increasing every year, because the adverse effect on the rudiments of teeth begins in the womb, at the time of laying the genetic information. And as a result, more than half of children suffer from dental hypoplasia to a greater or lesser extent. It has been scientifically proven that enamel aplasia is much more common in children whose mothers suffered from acute infectious and respiratory diseases, toxoplasmosis, or extreme toxicosis during pregnancy. A baby can also get enamel hypoplasia in the case of prematurity, as a result of an injury received during childbirth, as well as with a poor diet, severe forms of diseases suffered in infancy.

Enamel pathology occurs both in baby teeth and in permanent teeth, with the latter accounting for the largest percentage of diseases, which leads to an increased risk of developing other diseases in the future.

Dental hypoplasia in children

Hypoplasia of teeth in children is a fairly common pathology. Every second child suffers from it to a mild or more severe degree.

If the pathology of baby teeth has its “roots” in the disorders that the fetus received in the womb, then hypoplasia of permanent teeth is a disease acquired by the child (independently) after birth, it is provoked by failures that occurred in the baby’s metabolic system from the moment it reached six months of age. Since a child is sick much more often before the age of one year than the intrauterine pathologies that occur, then, naturally, hypoplasia of permanent teeth (and its systemic form) is diagnosed in most cases.

The pathology of permanent teeth is formed under the influence of diseases and their complications that overtake the baby at the age of 0.5 - 1.5 years. These are diseases such as rickets, acute infection, dystrophy, diseases of the gastrointestinal tract, and disorders of brain functions. The localization of such spots directly depends on the age of the child at which he suffered this disease, and the depth of the lesion depends on the severity of the course of this disease.

It has been noted that if the baby was very ill at the age of 5-6 months, the central incisors (cutting edge) and the tubercles of the 6th teeth, which are formed during this period, will be affected by enamel damage. If the disease falls on the period of 8-9 months, then the canines and second incisors will be affected. Since the time of tooth formation is different, the areas affected by hypoplasia are located in different zones of the teeth. But if the disease is long-term or has become chronic, then the baby can get aplasia - a complete absence of enamel on the surface of the teeth.

The bumpy texture of the enamel may indicate a long-term course of the disease with periodic relapses, and its severity affects the depth of damage to the hard dental tissue. That is, a mild disease can result only in the appearance of small spots on the tooth, while a severe infectious disease can lead to a complete absence of the enamel layer on the tooth.

Hypoplasia of deciduous teeth

Many years of medical research have proven that hypoplasia of baby teeth is caused by those harmful factors that affected the unborn child in the womb. Particularly dangerous in the development of pathology can be called infectious diseases suffered by the mother during pregnancy, acute respiratory diseases, Rhesus conflict with her baby, severe manifestations of toxicosis...

Forms of dental hypoplasia

Today, medicine does not have a specific and universally accepted classification of pathological forms. And yet, although not officially, this classification of the form of dental hypoplasia does exist.

• Stage of the spot. This form is caused by the appearance of rounded milky-white (somewhat less often yellowish) spots on the chewing, oral and vestibular areas of the dentition. It is interesting that the teeth are affected symmetrically, affecting the same teeth. Usually the configuration of the spot is not blurred, clearly outlined, and has not lost its shine. The shine and smooth surface of the spot may indicate that the affected tooth was exposed (not so strongly) to external, negative factors and this action was short-lived. Although, nevertheless, it was reflected in the texture of the enamel, its structural components and the amount of minerals included in this conglomerate.

If the affected area has a rough texture and a dull color, this indicates that the enamel was subjected to destructive influences during the period when the main stages of formation had already been completed. Such changes affect only the superficial areas, while the thickness of the enamel layer remains unchanged.

The patient does not feel pain, there is no increased sensitivity of the tooth to temperature, mechanical and chemical irritants.

Dental hypoplasia, in any form of its manifestation, will not disappear on its own; mandatory medical intervention is required.

• Cup-shaped (erosive) form. Round-oval cup-shaped defects, differing from each other in various sizes (depth and diameter). This form can be called paired. Erosion, as a rule, is located on symmetrical (identical) dental surfaces, while showing the same shapes and sizes. The closer to the base (bottom) of the cup, the thinner the enamel becomes. At the same time, dentine seeps out from deeper layers, giving the spot a yellowish tint. A more radical case can also appear - enamel aplasia. That is, the enamel layer at the bottom of the hole may be completely absent. At the same time, all surfaces of the hole are smooth.
• Grooved form. Upon visual inspection, one or more grooves are clearly visible in the vestibular area of the affected tooth. Most often, they are located parallel to each other and the cutting edge. The depth of the groove varies and depends on the severity of the lesion. The thickness of the enamel layer in the groove can vary from normal to its complete absence (dentin is clearly visible). Lesions occur symmetrically, on the same teeth. This form of dental hypoplasia is clearly visible on an X-ray and can be detected even at the eruption stage. The image clearly shows lightened grooves with clearly defined edges. They are located horizontally.
• Linear (wavy) form. This variety can be characterized as a set of multiple horizontally located grooves that are localized in the vestibular area of the tooth surface. This fact makes the enamel structure wavy.
• Aplastige form. A severe case of dental hypoplasia. In this case, the enamel surface is completely absent from the hard tissues of the tooth, or is present partially, in small areas. It occurs with abnormal amelogenesis disorders.
• Mixed form of dental hypoplasia. The name speaks for itself - a combination of several forms. More often, one person may have both spotted and cup-shaped forms of manifestation of this disease. This somewhat complicates diagnosis.

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A specific form of dental hypoplasia

This form includes (they were named after the scientists who described them in detail):

• Hutchinson's teeth. These are usually incisors that can be located on both the upper and lower jaws. The shape of the tooth is barrel-shaped, the cutting edge is a crescent.
• Pfluger's teeth. The shape is very similar to Hutchinson's tooth, but in this case the crescent edge is missing.
• Fournier teeth. Most often, these are permanent molars that erupt first. The shape of the tooth is conical, with weakly expressed tubercles. This shape is often associated with a congenital pathology - intrauterine syphilis.

Diagnosis of dental hypoplasia

The diagnosis of dental hypoplasia is made by a dentist based on a visual examination of the patient. One of the main difficulties is to differentiate this disease from carious superficial tooth damage, although quite often these two diseases go "hand in hand".

Caries usually produces a single spot on the surface of the enamel at the neck of the tooth, while dental hypoplasia most often manifests itself as multiple whitish spots that are scattered over different areas of the tooth.

A 2% solution of blue methylene can be used as litmus in diagnosing the disease in question. In the case of caries, the spot is colored, and in the case of dental hypoplasia, the color does not change. Also, in the case of caries, the surface of the spot becomes rough, while in the case of the disease in question, the surface remains smooth.

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Treatment of dental hypoplasia

If the disease is diagnosed in its mild degree, the spots are small and slightly noticeable, in this case, treatment of dental hypoplasia is not carried out. If the symptoms of this disease are perfectly differentiated when smiling or talking, especially if the deep layers of dental tissue are affected, treatment is definitely necessary. And it must be carried out as quickly as possible. Delay can provoke unpleasant consequences:

Complete loss of the affected tooth or all teeth.

• The edge of the teeth wears down much faster than normal.
• Destruction of hard dental tissues.
• A bite defect develops, which can later lead to gastrointestinal diseases.

The treatment protocol is somewhat different for different forms of the disease. If the disease has not acquired global proportions, then the basis of treatment may be teeth whitening, in severe cases - filling. If the shape of the tooth is defective, the dentist goes to grinding the irregularities that are possible with pathology. If necessary, the dentist carries out not only filling of the affected teeth, but also their prosthetics.

Whitening can be performed under the supervision of a dentist, both professionally and at home.

Whitening at home will be cheaper and more comfortable for the patient, but will take longer than with a clinical approach to the problem.

The most popular method of whitening today is a special device (mouth guard). It is made individually for a specific patient on the recommendation of a doctor. The device is filled with a special whitening gel and worn for 3-10 hours at home. The procedure is quite long, but more effective than whitening with pastes and chewing gum.

• Plus White Whitening Booster Gel

1. Before the whitening gel is applied to the tray, it must be rinsed and dried.
2. Sanitize the oral cavity with toothpaste after brushing your teeth (it is advisable to use a fluoride-containing compound).
3. Using a special syringe container, apply the gel evenly onto the mouth guard.
4. It is necessary to put it on the row of teeth, pressing it well. Remove excess gel with a napkin.
5. The procedure time depends on the percentage concentration of the drug.
   • 10% - overnight or six to ten hours.
   • 15% - four to six hours.
   • 20% - two to four hours.
   • 35% - half an hour.
6. After use, rinse the mouth guard and rinse your mouth thoroughly with warm water.

This gel was specially developed for home use.

• Colgate Simply White Night Gel

1. This gel is used once a day and is applied before going to bed to teeth previously cleaned with toothpaste. It is important to remember that the whitening gel is applied to dry enamel.
2. The gel is carefully applied to each tooth separately using the included brush. One dip of the brush into the bottle is enough for three teeth.
3. After application, the preparation is quickly absorbed by the dental material, so there is no need to dry or, conversely, rinse the oral cavity with teeth.
4. After this procedure, you should not eat or drink for 15 minutes.
5. Three to five days are enough for the result to become obvious.
6. With prolonged use of the whitening gel, tooth enamel can become three to four shades lighter.
7. It is also necessary to take precautions: make sure that the drug does not get into the eyes (if it does, rinse them immediately with clean water), this medical and cosmetic product should not be used by children under 12 years of age.
8. Store in a cool place.
9. The whitening effect lasts for about a year.

• ROCS Pro Gel "Oxygen Whitening"

This product owes its excellent whitening effect to the properties of active oxygen included in its composition. This medical product perfectly stops the inflammatory process in the oral cavity, thereby removing the unpleasant odor that comes from the mouth.

The gel perfectly penetrates into the deeper layers of enamel and dentin, thereby lightening the tooth by two to three shades. The optimal treatment course is four weeks. The low abrasive index allows using this gel when cleaning with both a classic and an electric brush. But this is also a disadvantage of this drug, since it does not have a polishing property, which reduces the effectiveness of removing surface shades.

Any whitening gels should be used with caution and not for a long time, since during treatment procedures using whitening preparations, the enamel becomes thinner, and the sensitivity of the teeth increases. The frequency of using such pastes for preventive purposes should not exceed twice a week, and for treatment - as prescribed by the attending physician.

The chewing gum advertised for whitening can only be conditionally called an effective whitening agent.

• Professional approach to whitening. This procedure is performed only in a specialized dental clinic.
• Airflow is a professional in whitening. Today, it is one of the most popular professional whitening methods in dentistry. The procedure allows you to lighten the enamel of your teeth by several tones. This is one of the quick and safe ways to achieve the desired result.

During the treatment process, not only does the enamel become lighter, but the tooth is also cleaned of tartar and plaque, which give the tooth a yellowish tint and are a breeding ground for pathogenic bacteria. This is what allows us to achieve the whitening effect, bringing the enamel closer to its natural color.

This procedure can be called a litmus test in the diagnosis of dental hypoplasia. By bringing the shade closer to their natural color, the dentist can examine the enamel surface in more detail, identify lesions and decide on the need for further treatment.

The whitening procedure itself using the Airflow method is carried out using a special device that creates excess pressure, and in this environment, using specialized pastes, gels, and medicinal mixtures, the tooth surface is treated.

The principle of operation of the device: In the tip of the nozzle, which is inserted into the oral cavity, sodium bicarbonate powder is mixed with a water suspension and air under pressure. The result of this procedure is the removal of plaque, bacteria, minor dental deposits, light polishing of the surface. The procedure does not take much time, it does not cause pain. Thus, the patient will spend a few minutes in the clinic and get the same result as in a few weeks at home.

To consolidate the success and prolong the result, a special protective varnish is applied to the treated surface.

During the treatment, the tooth loses its cuticle. Therefore, for two to three hours after the procedure, it is not allowed to drink coffee or tea, smoke, or consume products that contain coloring enzymes. The formation of a new cuticle occurs from saliva after this period of time.

The Airflow whitening method is safe, but still has some limitations:

• A number of periodontal diseases.
• Hypersensitivity to citrus taste.
• Pregnancy.
• Breast-feeding.
• Children of early and early adolescence.
• Asthma.
• Chronic form of bronchitis.
• Diseases that require a salt-free diet.

• Laser teeth whitening. This method is quite popular today in domestic and world dentistry. It does not cause any discomfort to the patient, while not taking much time. But the effect of the procedure can last for several years.

Whitening is performed in clinical conditions using a medical device that produces a laser beam with Whitening Accelerator diodes. Cleaning agents are special gels or pastes. Contraindications for use are the same as in the previous case. But if when using the Airflow method, fillings are not a contraindication, then with laser correction, fillings on the front of the dental row can lead to uneven shades.

• Photo bleaching. It is carried out strictly in a dental clinic. The activation of a special bleaching paste or gel occurs thanks to specialized medical equipment - a photo lamp. The durability of the obtained result reaches one to three years.

In parallel with this, the patient must receive medications that will help restore the mineral composition of tooth enamel.

• Remodent

For rinsing, which lasts 3-5 minutes, prepare a 3% solution (dissolve 3 g of the preparation in 100 ml of boiled water). For therapeutic purposes, rinse four times a week, but no more than 40 rinses. Preventively - for ten months, from two to eight rinses per month. An allergic reaction to the preparation may be a side complication. After rinsing, it is not recommended to eat or drink for two hours.

• Calcium gluconate solution

This medicine is slowly (over 2-3 minutes) administered intramuscularly or intravenously at 5-10 ml, preheated to body temperature. The injection schedule is every one to two days, depending on the severity of the disease.

When taking the drug, side effects may occur: nausea, up to vomiting reflexes, as well as bradycardia and diarrhea. The drug should not be taken by people suffering from blood diseases: thrombosis, increased blood clotting.

Prevention of dental hypoplasia

Prevention of dental hypoplasia includes a set of measures that can prevent diseases that can be complicated by systemic metabolic disorders in humans. Therefore, it is necessary to treat any disease in a timely manner, without turning it into a chronic disease.

It is important to remember that the teeth of the future little person are formed in the mother's womb (milk teeth), therefore, in order to prevent the development of dental hypoplasia, nutrition must be balanced. This especially concerns both the expectant mother and the newborn, because permanent teeth develop already in the first months after birth.

The diet of a mother and child, as well as any person, must include the following products:

• With a high content of fluoride and calcium: cottage cheese, milk, cheese and others.
• Vitamin D. In tablet form or by sunbathing for a sufficient amount of time.
• Vitamin C. These are citrus fruits, Brussels sprouts and broccoli, green onions, spinach, currants, rose hips...
• Vitamin A. This is liver, garlic, seaweed, seafood, butter, broccoli and others.
• B vitamins. These are nuts, pork, poultry, cereals, legumes (especially lentils), mushrooms, fish and others.

As the baby grows, the consistency of the food consumed should also change, since improper nutrition can lead to the development of gastrointestinal diseases, which can also lead to disruptions in metabolic processes. A child aged 0-3 months should eat only liquid food, from 4 to six months - homogeneous liquid, from six months to 9 months - mashed food, the last two months (up to a year) - the products should be chopped, from one year to one and a half years - in pieces, and from three years - a full-fledged classic dish.

To prevent the development of dental hypoplasia, a child, under the supervision of an adult (and an adult independently), should maintain oral hygiene: brush teeth twice a day with a properly selected toothpaste and brush. After each meal, rinse your mouth, removing any food residue.

When eating, you need to chew your food thoroughly. And also visit your dentist in a timely manner, preferably for preventive purposes.

Introduce foods into your diet that will strengthen your gums and teeth.

For example:

• Spring salad: Wash and chop young nettle and dandelion leaves thoroughly, add green onion feathers. Dress the salad with vegetable oil. To improve the taste, you can add a boiled egg and lightly salt.
• French salad. Take sprouted wheat and oat flakes (two tablespoons of each component is enough), grind. This gruel is poured for an hour with six tablespoons of boiled water. After the product has been infused, add 3 tablespoons of warm boiled milk, 1 tablespoon of sugar, the juice of one lemon and one apple grated together with the peel on a coarse grater.
• Refreshing salad. Peel and core one large apple, cut into pieces, chop 250g of cheese into small cubes. Pre-boil celery in salted water and chop. Mix everything thoroughly, season with herbs (parsley and dill), pour in 4 tbsp. of vegetable oil and 1 tbsp. of vinegar.
• Vegetable salad. Chop carrots and celery (1-2 small root vegetables each), pepper, fresh cucumbers and leeks, add 300 g of canned or boiled corn. Season the salad with vegetable oil or mayonnaise.

This list of dishes to prevent the occurrence of dental hypoplasia can be continued indefinitely. If desired, they are not difficult to find in specialized literature, on the Internet, or, using imagination, invent yourself.

Prognosis of dental hypoplasia

In many ways, the prognosis for dental hypoplasia depends on the form and type of the disease that is detected in the patient. If mild local dental hypoplasia is observed, then the defects are stable and do not cause any complications. In this case, treatment is not required, it is only necessary to adhere to the norm of nutrition and hygiene. If the dentist observes systemic dental hypoplasia, he draws up a treatment protocol, which is then implemented. The level of development of modern dental science allows us to solve this problem with honor. Even if the patient suffers from the most severe form of the disease - aplasia, there is also a way out of this situation - partial or complete prosthetics of the oral cavity.

Such a mild and such a complex disease - dental hypoplasia. A third of the world's population and every second child under 12 suffer from it to varying degrees. But the steps that dentistry has made and is making in recent years inspire hope. The main thing is not to discount the preventive measures that will protect you and your baby from this unpleasant disease. But if trouble has come - do not delay your visit to the dentist. This specialist will do everything to make your smile radiant and snow-white.