Enamel hypoplasia and hypocalcification

Enamel and its development and importance:

Enamel is the hardest substance in the body and covers only the crown of the teeth (cementum does the same thing at the root of the tooth). Enamel is 99% inorganic and its task is to protect the underlying dentin. Even before the tooth itself cuts through the gum, on its surface are special cells called ameloblasts, which are responsible for the formation and enamel. Once the tooth has erupted (erupted), these cells are no longer present and enamel development is complete. This results in the enamel no longer being able to repair itself. The enamel provides a hard, smooth, impermeable and protective cover to the crown. If it breaks, the underlying dentin is exposed. The latter is rougher on the surface than enamel, allowing the plaque to adhere quickly and become discolored. Dentin is less hard than enamel (but still harder than bone) and contains tubules that allow contact between the external environment and the pulp of the tooth, and also contains sensory nerve endings from the cells in the pulp - this results in the sensitivity of the teeth to heat and cold. The tubules can also allow bacteria to enter the pulp from the mouth, causing infectious pulpitis.

What is the difference between enamel hypoplasia and hypocalcification?

Enamel developmental defects can be divided on the basis of quality and quantity.

  • Hypocalcification (impairment of enamel quality) - a normal amount of enamel is formed, but it contains less minerals, so the enamel is softer than normal. It is often possible to remove hypocalcified enamel using ultrasound during tooth brushing.

  • Hypoplasia (impairment of the amount of enamel) - the enamel is much thinner than usual and there may be pits on the surface.

Both types of defects can be found at the same time and it is not necessary to distinguish them, because therapeutically the approach is the same.

What causes enamel hypoplasia and hypocalcification?

Enamel hypocalcification can be the result of trauma to an unerupted tooth, which can affect one or several adjacent teeth and is the most common acquired cause - it is often associated with unprofessional extraction of persistent milk teeth.

Enamel hypoplasia can result from an inherited condition known as amelogenesis imperfecta. In these cases, almost all teeth are affected.

Serious systemic infectious diseases, such as distemper virus infection, can also lead to improper enamel formation.

Is there a treatment and what should it meet?

Treatment goals include:

  • Removal of tooth sensitivity

  • Prevention of endodontic infection by closure of dentinal tubules

  • Smoothing the tooth to reduce plaque build-up

Composite replacement is the most effective way to achieve these goals. For minor defects or non-strategic teeth, the application of only sealer (bond) can be considered. This achieves the closure of the dentinal tubules and thus the removal of sensitivity and prevention of endodontic infection. Another option is extraction, but it is generally not recommended.