AUSTRALIAN DENTAL ASSOCIATION INC.

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Tooth Enamel Defects

A guide on enamel hypoplasia, opacity defects and molar-incisor hypomineralisation (MIH)

namel is a protective glass-like outer layer on the visible part of the tooth (crown). Normal tooth enamel is harder than bone. The formation of enamel is very sensitive to any disturbances or disorders during the growth of a foetus or an infant. Enamel defects can occur during the early stages of tooth development, affecting the primary (baby) teeth or permanent teeth. For primary teeth, enamel defects may result from factors occurring from the third month of pregnancy. For permanent teeth, enamel defects may result from factors occurring at or soon after birth.
Molar-incisor hypomineralisation (MIH)

Enamel Dentine Pulp Gum Bone Cementum Root end opening

TYPES OF ENAMEL DEFECTS

Enamel hypoplasia

Restored tooth MIH

Nerves and blood vessels

A normally developed tooth has an outer layer of enamel, which is hard, protective, regular in shape and is nearly transparent. The dentine is a bone-like layer and is sensitive to temperature if exposed. A tooths centre contains the pulp, nerves and blood vessels.

ENAMEL HYPOPLASIA: This is seen as smooth-edged surface defects (pits, lines or missing enamel). This type of defect can be related to a specific time of development.
Enamel opacities

ENAMEL OPACITIES: These are opaque, white or yellow areas of enamel on or below the surface. The opacities may be discrete (localised areas) or diffuse (widespread).

MOLAR-INCISOR HYPOMINERALISATION (MIH). Over the past 15 years, dentists have increasingly seen a different type of enamel defect where the enamel is soft and discoloured, and may be absent. This is known as molar-incisor hypomineralisation (MIH). MIH teeth are typically discoloured, with an uneven surface (due to loss of enamel) and irregular shape. The cause of MIH is unknown. Researchers are trying to discover more about MIH and its cause. Hopefully, this may lead to prevention of MIH. Amelogenesis imperfecta: If every primary and permanent tooth has abnormal enamel formation, the enamel defect is inherited and is called amelogenesis imperfecta (AI). One type of AI looks very similar to MIH.

Risk factors
More than 120 different risk factors have been linked to enamel defects. The most common risk factors include: Mothers health during pregnancy; a severely deficient diet or certain illnesses. Prematurity enamel defects are four times more likely in premature babies than in full-term babies. Birth difficulties, especially with any breathing problem or blood disorder. Certain medications given to the mother prior to birth or to the baby after birth. Childhood diseases illnesses during the childs first year that result in high fever (such as pneumonia or middle-ear infection) and later viral infections such as measles or chicken pox. Chronic or frequent childhood illness during a childs first four years. Childhood nutrition a poor and deficient diet, particularly during the first three years of life. Adequate

TALK TO YOUR DENTIST

he aim of this pamphlet is to provide you with general information. It is not a substitute for advice from your dentist and does not contain all the known facts about enamel defects or every possible side effect of treatment. Use this pamphlet only in consultation with your dentist. Some terms in this pamphlet may need further explanation by your dentist who will be pleased to answer questions. Your dentist cannot guarantee that treatment will meet all of your expectations or that treatment has no risks. If you are uncertain about the advice you have been given, you may wish to seek a second opinion from another dentist. Consent form: If you decide to undergo treatment, the dentist will seek your consent and may ask you to sign a consent form. Read it carefully. If you have any questions about the consent form, the procedure, risks or anything else, ask your dentist.

Crown of tooth

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calcium, phosphate and vitamins A, C and D are needed for healthy tooth development. Trauma injury to the mouth may damage the enamel of one or more unerupted primary teeth. Injury to an older childs primary teeth or gums may result in localised defects of the enamel DENTAL AND MEDICAL HISTORY The dentist will inspect the patients teeth and may take X-ray films. Tell the dentist the patients medical and dental history, including: whether other present or past family members have had similar dental problems of the developing permanent teeth. If left untreated, enamel defects (especially MIH) can cause a range of problems, including: Affected teeth can be fragile and may wear or lose enamel easily. The risk of tooth decay and abscess is often increased because enamel is

an important defence against cavitycausing bacteria. Hot or cold foods and drinks may cause pain (tooth sensitivity) due to the porosity of the enamel or if the underlying dentine layer is exposed. Socially, the person may feel embarrassed to smile.

Treatment options

FLUORIDE TREATMENT Fluoride treatment in children strengthens enamel, which reduces tooth sensitivity and protects against decay. Various fluoride treatments are available at the dental surgery. For example, an applicator tray that is contoured to fit around the teeth can be lined with fluoride gel and put inside the patients mouth or a fluoride varnish may be applied to the teeth by the dentist. The dentist may prescribe a fluoride rinse to be used either daily or weekly when your child is over six years of age and able to spit out properly. The rinse should not be swallowed. Use strictly as directed. Keep fluoride medicines out of the reach of children. Your dentist may also recommend the use of a remineralising cream, which can be applied at home by rubbing it on the teeth with a finger. Discuss with your dentist your childs need for fluoride and remineralising cream.

Costs of Treatment

ou should ask for an estimate of fees before agreeing to the procedures. The estimate will include dental fees, medical and hospital fees, and other items. If applicable, ask your health insurer or dentist about which costs receive a rebate. As the actual treatment may differ from the proposed treatment, the final account may vary from the estimate. It is better to discuss costs with your dentist before treatment rather than afterwards.

YOUR DENTIST

This pamphlet, or portions of it, should not be photocopied and handed out, nor reproduced in any electronic format.

Edition number: 1 09January2007 Mi-tec Medical Publishing Telephone 03 9888 6262 Facsimile 03 9888 6465 e-mail: orders@mitec.com.au

he aim of dental treatment is to reduce tooth sensitivity, strengthen teeth and improve their appearance. Repeated visits to your dentist for professional treatment may be needed to achieve this outcome. While the permanent molars are erupting, children with enamel defects should see their dentist regularly (at least six-monthly). The dentist will give instructions on how best to care for the teeth at home and may suggest referral to a paediatric dentist.

RESTORATION OPTIONS The dentist may suggest some of the following restoration options to improve the look and function of the teeth. Very badly formed or decayed teeth may need to be extracted. However, before extraction, your dentist may recommend that an orthodontist provide an opinion about the effect of such extractions on the occlusion (bite). Restoration options include: DIRECT TOOTH COLOURED an adhesive restoration that is bonded directly onto the tooth surface. VENEER a thin sheet of plastic or porcelain is individually shaped in the laboratory to fit the front surface of the tooth. The dentist bonds the veneer onto the tooth. CROWN the dentist prepares the natural tooth so that an artificial crown fits snugly over it. Crowns are strong and have a long life. BRIDGE an artificial tooth is permanently fixed between adjacent crowns if a tooth is missing or has had to be extracted. DENTAL IMPLANT an artificial tooth root is inserted into the jawbone. After healing, a crown is fitted on top. This treatment is usually for people older than 18 years who have had one or more teeth extracted. Not every dental restoration yields a perfect result. Some restorations are challenging for the dentist, and the outcome may be less satisfying than hoped for. This may be due to, for example, a tooths dark colour or the

poor quality of its structure. Discuss your expectations with the dentist and make sure you have a realistic understanding of the benefits, risks and limitations of the treatment and restoration. The following ADA patient education pamphlets on these topics contain more detailed information and are available from your dentist: Veneers, bonding, bleaching and composites Crowns and bridges Dental extractions The fitting and care of dentures Dental implants.

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any infection, severe cold (viral infection) or other abnormal event that affected the mother of the patient during pregnancy or the patient at birth, or during the first year of life childhood diseases use of products that stain teeth such as coffee, tea and cigarettes

the patients dietary habits the patients dental hygiene habits previous dental trauma prior dental treatment. This confidential information helps the dentist to diagnose the cause of enamel problems, which may influence decisions on treatment.