Enamel Hypoplasia

What is enamel hypoplasia?

Enamel hypoplasia is when your tooth enamel doesn’t develop properly, causing it to be too thin or missing on parts of your tooth. Tooth enamel is the hard layer covering your teeth. It protects the sensitive inner parts, including dentin and tooth pulp.

Unlike tooth erosion, where enamel wears away over time, enamel hypoplasia involves not having enough enamel to begin with. Medical conditions or environmental factors prevent your enamel from forming correctly before your teeth ever erupt (or become visible) in your mouth.

Depending on the cause, enamel hypoplasia can affect your baby teeth, your permanent teeth or both. The enamel may be thin or absent on just one tooth, or you may have several hypoplastic teeth.

How common is enamel hypoplasia?

Problems with enamel development are common. One of the most common causes of enamel hypoplasia — a condition called amelogenesis imperfecta — affects approximately 1 in every 700 people in underdeveloped countries. It’s less common in the U.S., where it affects every 1 in 14,000 people.

These numbers don’t account for all the potential conditions or environmental factors that can prevent enamel from forming correctly.

Signs and symptoms of enamel hypoplasia include:

• Teeth with pits, grooves or cracks.
• Teeth that are worn down or chipped.
• Yellowish or brown stains on your teeth.
• White spots on your teeth.
• Sensitivity to hot and cold foods or drinks.

What causes enamel hypoplasia?

If you or your child have enamel hypoplasia, this means a condition or event disrupted enamel development at a key moment. With baby teeth, enamel starts forming during fetal development and continues into infancy. With permanent teeth, enamel starts forming in infancy and continues up until around age 8.

Your individual teeth develop enamel at different times. Depending on what’s causing your condition, some teeth may have little or no enamel while other teeth are fine.

Inherited conditions

Several rare conditions can cause enamel hypoplasia. They involve inheriting a gene from one or both biological parents that causes the enamel to be too thin or absent.

Syndromes that can cause enamel hypoplasia include:

• Amelogenesis imperfecta.
• DiGeorge syndrome.
• Ellis-van Creveld syndrome.
• Heimler syndrome.
• Otodental syndrome.
• Seckel syndrome.
• Treacher Collins syndrome.
• Usher syndrome.

Environmental factors

Various factors can impact enamel development both during pregnancy and after you’re born.

Pregnancy-related issues can interfere with how your baby teeth develop before birth. Factors that can lead to enamel hypoplasia include having a mother (gestational parent) who:

• Has gestational diabetes.
• Has a vitamin D deficiency.
• Doesn’t have access to prenatal care.
• Smokes.

Other factors that can interfere with enamel development include:

• Injuring your teeth.
• Not getting enough vitamins A, C or D.
• Not getting enough calcium.
• Viral and bacterial infections.
• Certain conditions, including liver disease, cerebral palsy and celiac disease.

What are the complications of this condition?

Hypoplastic teeth don’t have as much protection as teeth with more enamel. This can cause your teeth to soften and wear down, leading to several dental issues, including:

• Cavities (tooth decay).
• Tooth erosion.
• Misaligned bite.
• Brown teeth.
• Severe tooth sensitivity or pain. (It may hurt to brush them.)
• Anxiety. (You may feel self-conscious about your smile.)

How is enamel hypoplasia diagnosed?

Your dental care provider will check for signs of enamel hypoplasia, like pitted teeth or white spots, during a dental exam.

It’s important to schedule your child’s first dental visit within six months of their first tooth coming in or before their first birthday. At that first visit, your provider will check for problems related to tooth development, like enamel hypoplasia.

Early diagnosis allows your provider to take steps to preserve hypoplastic teeth — before there are issues like cavities or stained teeth.

How is enamel hypoplasia treated?

Your dental care provider may monitor your teeth at first and only recommend treatments if there’s damage or a risk of injuring your teeth. Treatments can also help if you or your child feel self-conscious about how your teeth look.

Treatments may also involve substances, devices and procedures, including:

• Casein phosphopeptide amorphous calcium phosphate (CPP-ACP): Adds minerals to your teeth that help strengthen your enamel.
• Dental bonding: Uses tooth-colored resin to conceal chipped, cracked or discolored teeth.
• Dental crowns: A tooth-shaped cap that covers and protects weak or damaged teeth.
• Dental fillings: A substance (like metal, plastic or glass) that fills an empty spot where your dentist removed a cavity. Fillings can also repair areas where teeth are cracked, broken or worn down.
• Dental veneers: A thin covering that fits over the front surface of your teeth to hide imperfections, like tooth discoloration or chipped teeth.
• Enamel microabrasion: Removes yellow and brown stains from your tooth enamel.
• Resin infiltration: Uses resin to minimize the appearance of white spots on your teeth.
• Whitening: Uses a bleaching gel to lighten your teeth so they look closer in color to the white spots.

Can enamel hypoplasia be fixed?

You can’t reverse enamel hypoplasia, but you can manage the condition with your dental care provider’s help.

Tooth enamel is a hardy protector that allows you to chew tough foods and consume foods and beverages that are hot or cold, without feeling tooth pain. But once the enamel is gone, it can’t regenerate to make more.

This is why treatment involves preserving the enamel you do have to strengthen your teeth and preserve your smile.

How do I take care of myself?

Your dental care provider can recommend ways to preserve and protect your teeth if you have enamel hypoplasia. This may include:

• Getting regular dental cleanings (twice a year).
• Getting treated for conditions that can wear down your teeth (like teeth grinding).
• Practicing good oral hygiene (including brushing twice a day and flossing daily).
• Brushing with warm water if your teeth are super sensitive.
• Eating foods with the vitamins you need for strong teeth (like vitamins A and D).
• Consuming foods or drinks high in calcium (like cheese and milk).

What foods should I avoid?

Avoid or reduce foods or drinks that can stain or wear down your enamel. This includes:

• Sugary foods, including candy and starchy foods that can get stuck in your teeth.
• Sugary drinks, including sweetened sodas and fruit juices.
• Foods or drinks that dry out your mouth, like coffee, tea and alcohol.
• Gooey foods, like caramel.
• Acidic foods, including citrus.

Your dental care provider can review your go-to food and drinks with you and recommend alternatives if they’re harmful to your teeth.