Aplasia of the teeth. Hypoplasia of tooth enamel - treatment in adults and children. Treatment of enamel hypoplasia in children and adults

Enamel hypoplasia is a malformation consisting in the underdevelopment of teeth, the cause of which is a violation in the process of embryogenesis. A frequent manifestation of dental hypoplasia in children is hypoplasia of tooth enamel. Hypoplasia can appear on dairy and on permanent teeth, but on milk teeth it is much less common.

In most cases, dental hypoplasia is incurable. Enamel cannot be restored.

The answer to the question is on the surface - tooth enamel hypoplasia begins during the period of bearing a child. Genetic information about milk and permanent teeth is laid even under the heart of the mother. Therefore, during pregnancy, the mother should eat well, consume vitamins and minerals so that the baby does not need anything.

The main reasons for the formation of dental hypoplasia:

• Toxicosis in early and late pregnancy, infections carried by the mother. Doctors have established a direct link between toxicosis in the mother, infections and the formation of various pathologies of the child's teeth. Also, do not forget about good nutrition during pregnancy. Vegetarianism is not allowed!
• Prematurity baby, difficult childbirth, hemolytic disease is bearing fruit. It is believed that a baby born prematurely did not go through all the stages of development assigned to him. For this, the crumbs need great effort and energy, which does not pass without a trace.
• Enamel hypoplasia is characteristic of dairy and permanent teeth. The reason for the formation of pathology on permanent teeth is nutrition artificial mixture rather than breast milk. Nothing can compare with mother's milk, it is very useful for the baby, it has a lot of vitamins and minerals that are not in the artificial mixture.
• On the enamel of permanent teeth, the disease can develop due to infectious diseases, allergic reactions that the child suffered as an infant.
• Hypoplasia in children can signal problems with internal organs, consult a specialist.

How to understand that it is hypoplasia?

If you carefully consider the photo, then at first glance the pathology is similar to the early stage of formation carious cavity. But only a highly qualified doctor can distinguish hypoplasia from caries.

It will take some time, but the spots will not change, much less go away. When changing milk teeth, nothing will change. The permanent ones will grow, but they will be sick.

Often, in order to make a diagnosis of enamel hypoplasia, it is necessary to completely dry the tooth and carefully examine it. On it you can see the recesses and grooves that are in different parts. In other words, the child's tooth has a wavy shape.

Treatment of hypoplasia in children

First of all, the dentist must protect or restore teeth that have fallen under the influence of the disease.

Treatment is based on the general condition little patient. If milk teeth have fallen under the influence of hypoplasia, and their color has changed, then treatment is not carried out. If there are grooves or point neoplasms, then a filling is used. In this way, the top layer of enamel is restored. If the patient has severe pain, then doctors remove the source of pain.

Treatment in adults is the same as in children:

• Changing the color of the enamel, therapy is not prescribed;
• Deepenings, a method of sealing are observed;
• Sometimes patients are offered treatment with remineralizing therapy.

Methods of therapy:

• Sick teeth are treated with a special composition with minerals;
• Physiotherapy treatment. Fluoride ions with calcium are carried out to diseased teeth;
• Before such treatment, preparation is necessary: ​​removal, treatment with hydrogen peroxide and drying;

For the treatment of spotted hypoplasia, highly professional bleaching methods are used:

• Whitening with the use of chemistry (preparations, gels, which contain hydrogen peroxide);
• Laser exposure;
• Irradiation with ultraviolet.

Each method has contraindications. Before use, it is necessary to weigh all the pros and cons, after consulting with a specialist.

Recesses are removed by filling. Apply special composite materials. The procedure has several steps:

• All deposits are removed;
• The surface is leveled;
• The enamel is etched;
• Dental adhesive is applied;
• With the help of a filling, the color and shape of the tooth is restored;
• Cosmetic correction.

Subsequently, veneers are attached. If there have been major changes or there has never been enamel at all, then experts recommend wearing crowns as a treatment.

Protecting yourself from hypoplasia

Basic rule: you want healthy and beautiful teeth Clean them regularly in the mornings and evenings. But Golden Rule dentistry does not provide a 100% guarantee against development enamel hypoplasia teeth. People who carefully monitor their health are recommended to do professional cleaning of the oral cavity every six months.

The foundation healthy body – proper nutrition. Metabolic disorders can occur due to the use harmful products such as fatty fried and spicy foods. And this is a good soil for the development of dental hypoplasia and other disorders in the body.

A lifeline can be fissure sealing, that is, closing a recess in the tooth.

Many microorganisms live in fissures, from which simple daily brushing will not save you (even if you spend an hour in the morning and evening on it, diligently clean with different pastes, and so on). - a relatively inexpensive procedure, but the benefits of it are even greater. Since the treatment of caries will take much more funds. The procedure will help you forget about caries on long years, but you still have to visit the dentist once every six months.

Remember that hypoplasia develops due to the influence of diseases, microorganisms, and so on. Therefore, it is necessary to support general state body, support immune system, harden.

Nowadays, you can not do without vitamins and minerals that will keep you in good shape, according to at least Vitamin C is a must! Pregnant mothers need to take care not only of themselves, but also of the baby, drink vitamins and minerals. Yes, and everyone will benefit from taking care of their health. Be sure to visit the dentist - he is our friend, do not be afraid of him!

Remember, enamel hypoplasia on early stages it is much easier to fix than in a running state. Therefore, at the slightest suspicion of the development of the disease, you should consult your doctor, and not let everything take its course.

The rudiments of milk teeth in a child are formed during the period of intrauterine growth and development. Their health is influenced by many factors: a woman's nutrition during pregnancy, the functioning of cardio-vascular system fetus, intake medicines and synthetic vitamin complexes. Milk teeth, like molars, consist of cement, dentin, dental crown, pulp, root and enamel coating. Tooth enamel covers the crown and protects it from penetration pathogenic bacteria and development of caries. This is the most hard tissue human body, more than 90% of which are minerals inorganic origin.

If the mineral metabolism in the tissues of the fetus is disturbed for some reason, the tooth enamel becomes thinner and cannot fully perform its functions. This condition is called hypoplasia (underdevelopment). It is not always possible to determine the pathology visually, therefore it is necessary to undergo preventive examinations at the dentist regularly. The first time to show the child to a specialist is necessary after - at 6-8 months. The doctor will be able to notice violations in time and prescribe necessary treatment, which will prevent caries and the destruction of tooth enamel.

What is the reason?

Approximately 60% of children suffering from enamel hypoplasia, the causes of violations are associated with pathological course pregnancy or fetal malformations in the embryonic period. If a woman during gestation suffers severe infectious diseases, the risk of improper formation of tooth germs will be higher than in women whose pregnancy proceeds without deviations. Particularly dangerous during pregnancy are the so-called childhood diseases - measles, chicken pox rubella.

Other factors that increase the likelihood of enamel underdevelopment include:

• premature birth and associated prematurity ( maximum risks in children born before 33-34 weeks);
• pronounced toxicosis in the mother at the beginning of pregnancy and on later dates gestation;
• birth injuries (including injuries resulting from the application of obstetric forceps or applying a vacuum);
• congenital malformations of the heart system or blood vessels;
• insufficient lactation or conditions leading to a deterioration in the quality of breast milk in women who are breastfeeding (smoking, drinking alcohol, taking strong drugs, poor nutrition);
• hemolytic disease- incompatibility of the blood of the mother and child for antigens, resulting from the Rhesus conflict.

All these causes cause improper formation of tooth germs, thinning of the enamel layer, active leaching of phosphorus, fluorine and calcium from bone tissues, which include teeth. In some cases, hypoplasia may be the result of a woman's increased consumption of foods with high allergenic properties during pregnancy. These include honey and bee products, oranges and other types of citrus fruits, strawberries, products with the addition of dyes, flavor enhancers and preservatives.

Important! Do not forget about the genetic predisposition. If parents have dental problems or have a history of deciduous teeth hypoplasia, there is a little over 10% chance that the child will also have enamel problems.

How to understand that a child has enamel hypoplasia?

In most cases, it is impossible to recognize the pathology on its own. To make the diagnosis more accurate, the teeth must be dried with air currents - this will make it easier for the specialist to examine the grooves, dimples and indentations that result from deformation and thinning of the enamel.

To clinical signs improper formation of the enamel coating can be attributed to:

• darkening or excessive lightening of the enamel;
• the appearance of spots of a milky, creamy or yellowish hue, which outwardly may resemble the initial stage of caries;
• painful reaction on contact with hot or cold food, air and other irritants.

The child may have one of the listed signs or several symptoms at once - in this case, the doctor diagnoses "mixed enamel hypoplasia".

Non-carious lesions of milk teeth - enamel hypoplasia

Important! To differentiate enamel hypoplasia with the initial stages of caries, the doctor applies a special dye to the child's teeth. This method diagnostics is suitable only for the spotted form of pathology, because the mechanism of action is based on obtaining a response. The spots that form on the surface of the enamel when its development is disturbed will not interact with coloring pigments.

Types and forms of pathology

Hypoplasia in children can appear in three clinical forms Oh. The most common of these is patchy hypoplasia, in which the only symptom existing disorders are milk spots. If the degree of demineralization is high enough, the spots may become dark yellow, beige or brown and look like the early stages of caries. At this stage, you can cope with the problem with the help of mineral applications with solutions containing calcium and fluoride compounds.

Distinctive features of this type of hypoplasia are:

• smooth surface of spots (with initial stage caries spots are usually rough);
• symmetry (the lesion concerns tooth groups located symmetrically with respect to the central axis);
• clear contours of spots.

If parents do not turn to a specialist, pathology can lead to the penetration of bacteria into the layers of dentin and the formation of carious cavities.

Non-carious lesions of milk teeth - enamel hypoplasia, amelogenesis imperfecta

A less common form is striated hypoplasia, which is characterized by the formation of furrows and depressions on the surface of the enamel. With a strong pronounced hypoplasia on the teeth, areas with total absence enamel or a heavily thinned enamel coating. If there are enamel defects on the surface of the teeth, mainly round shape, we are talking about the erosive form.

Table. Diagnosis frequency various types hypoplasia in childhood.

Note! In rare cases, the pathology can take a mixed form, when signs of several or all known clinical forms of hypoplasia may be present on one tooth. In this case, the child is diagnosed with "mixed hypoplasia". Treatment of this type is quite complicated, and its success directly depends on the timeliness measures taken and seeking dental care.

Treatment Methods

Enamel hypoplasia on milk teeth can lead to serious diseases and defects when the dentition changes and the child grows molars, therefore, it is necessary to take action at the first signs and symptoms. If parents regularly show the child to the dentist, the progression of the pathology can be stopped at an early stage. For these purposes, applications with therapeutic solutions based on fluoride and calcium are usually used. The number of procedures depends on the severity of the existing disorders, the form of the disease and associated complications and can be from 5 to 20 procedures.

In some cases, a doctor may recommend the use of fluoride medications. They contain increased concentration fluoride, help prevent demineralization of tooth enamel and positively affect its density and structure. In no case should drugs of this group be used without a doctor's prescription, since many of them have age restrictions. The concentration of fluoride substances in such products is 30-35 times higher than allowable rate therefore, improper use can cause enamel pathologies and the development of caries.

Important! AT advanced cases the doctor may prescribe a specialized treatment using. This is necessary if there are signs on the teeth carious process. Failure to treat may result in deep defeat milk teeth and the appearance of caries on permanent molars.

Prevention is the basis of health

Preventive measures are needed long before the birth of a child. Future mom should regularly undergo dental examinations and timely undergo sanitation of the oral cavity. Any diseases are a source of infection and increase the risk of violations in the formation of fetal tooth germs, therefore, dental health must be approached responsibly. Modern anesthetics are safe for the health of a woman and a child and can be used even in late pregnancy, allowing for treatment with virtually no pain and discomfort.

If removal is necessary, the operation can also be performed in the third trimester, but with certain restrictions. If the pregnancy is complicated, the doctor may recommend a procedure after the baby is born. In clinically difficult cases, when extraction must be performed before childbirth, but there is a possibility of complications during or after the operation, the woman is hospitalized in the department's hospital. maxillofacial surgery. The duration of hospitalization can be from 3 to 10 days.

To provide the body of a growing fetus with all the necessary micro and macro elements, in daily diet you need to enter the following products:

• greens and lettuce leaves;
• fruits (apples, pears, bananas, kiwi);
• vegetables;
• meat and fish (rabbit, veal, lamb, cod, salmon, tuna and trout are especially useful);
• nuts;
• eggs of chickens and quails;
• dairy products and milk-based products prepared with the addition of natural sourdough;
• vegetable oils obtained by cold pressing (almond, pumpkin, corn oil).

Nutrition should be balanced and varied even after the birth of the child, so that the baby receives everything essential vitamins and minerals along with breast milk. This will prevent many serious disorders, such as rickets, neurological disorders and pathology of tooth enamel.

Enamel hypoplasia is a pathology that must be treated at an early stage. If this is not done, the child's molars may already grow affected by caries. It is almost impossible to notice existing disorders at an early stage on your own, so the child needs to be shown regularly. pediatric dentist- at least 2 times a year.

Video - Treatment of enamel hypoplasia

1. Enamel hypoplasia is a pathology, the main symptom of which is the partial absence of tooth enamel. In the early stages it appears as age spots on the surface of the tooth, grooves, pits, chips. The last stage of this disease is considered aplasia or the complete absence of enamel. In all cases, this pathology is congenital in nature and is the result of a violation of metabolic processes in the embryo. Hypoplasia of the teeth is a frequently diagnosed deviation. Currently, about 40% of clinically healthy children suffer from this disease. reverse process This disease is enamel hyperplasia - the appearance of excess tooth tissue.
2. The disease can be detected both in a preschooler who has only milk teeth, and in older children who already have molars. You can identify the disease during the first examination by a specialist. By localizing the spots, the dentist can determine at what point in the development of the fetus this disease was laid and what led to it.
3. When diagnosing hypoplasia of the enamel of milk teeth, the child is registered with the dentist, and in the future he will have to visit the doctor's office several times a year and undergo prophylaxis. If the disease is detected in the early stages, it is possible to quickly cope with aesthetic defects, as well as prevent further development ailment.
4. Clinical manifestations of the disease depend on its stage and type. If the metabolic processes have mild disturbances, there is mainly a change in the color of the enamel. They usually appear as single yellowish spots. Unlike carious formations, they do not cause discomfort and are not stained with food coloring. With more deep processes the formation of grooves is usually observed, as well as depressions in the tissues, and on the latter stages of the disease the enamel layer may be absent altogether.

Causes of the appearance and development of the disease

The main factors provoking the development of tooth enamel hypoplasia are acute infectious diseases suffered by the mother during pregnancy or by the child in the first months of life, as well as a hereditary tendency to this disease and metabolic disorders.

The most common culprits of this pathology are the following processes during pregnancy:

• acute toxicosis;
• SARS, rubella, toxoplasmosis in the mother;
• diseases associated with a violation of the metabolism of minerals in the body, for example, rickets.

Also in this period, premature birth of a child and birth trauma can lead to hypoplasia of milk teeth.

In older children, the causes of development this disease consider:

• injuries of the rudiments of the teeth;
• pathologies associated with impaired phosphorus metabolism: periodontitis, pulpitis;
• chronic, somatic, infectious diseases;
• unbalanced diet;
• increased fluorine content in water;
• tissue anemia due to iron deficiency;
• severe forms of allergies.

Of great importance for the development of pathology is the hereditary tendency to the disease. It will be a determining factor in the presence of diseases in the mother during pregnancy, as well as injuries or infections received by the child during passage through birth canal or under other conditions in the first months of life.

Types of disease

Hypoplasia of tooth enamel has a wide classification depending on the prevalence of damage, genetic predisposition, involvement of hard tissues, clinical picture, and also the period of development.

By clinical picture defeat distinguish the following types of disease:

1. Erosive - deep damage, cup-shaped.
2. Spotted - the enamel is covered with flat spots of a characteristic size and contour.
3. Furrowed - there are linear recesses located horizontally relative to the upper edge.

By hard tissue involvement share:

• hypoplasia of the entire tooth;
• enamel damage (this pathology accounts for about 50% of cases of defects found in adolescents and mature people).

By having a genetic predisposition to the appearance of the disease are distinguished:

• hereditary;
• acquired (obtained during fetal development, during childbirth or in the first months of life).

Regarding the period of development, hypoplasia of the enamel of milk and molars differs.

There are several types of non-carious damage (hypoplasia) according to the extent of the lesion, specially allocated by doctors:

• systemic - in which almost the entire row is damaged;
• localized - 1-2 teeth are affected, the disease does not spread to others;
• aplasia - with it there is a complete absence of enamel on several teeth.

Systemic and localized (local) dental hypoplasia are more common in people, so these types need to be discussed in more detail.

Systemic hypoplasia

Systemic enamel hypoplasia is a lesion of hard and soft tissues of teeth that form at the same time. Has three stages:

1. Enamel discoloration.
2. Underdevelopment of enamel.
3. Complete absence of enamel.

A variety of systemic enamel hypoplasia are:

• Pfluger teeth: have not fully developed tubercles, due to which the tooth can acquire a conical shape. Also an indicator of this particular form of hypoplasia is larger size crowns at the cheek than at the chewing surface.
• Hutchinson's teeth: the main feature of this disease is the barrel-shaped front incisors, which have a neck thicker than the cutting surface. Another important characteristic of this type of pathology is the presence of a crescent-shaped depression near the cutting edge.
• Fournier's teeth - similar in shape to Hutchinson's pathology, however, in this case hypoplasia does not provide for the presence of a recess in the form of a crescent.

Another form of systemic hypoplasia is tetracycline teeth in children. This pathology can be triggered by taking drugs containing tetracycline during pregnancy, as well as in the first months of a child's life. It gives the teeth a yellow, sometimes brown color, most often appears on the incisors and can have a non-uniform color and structure, most often lies in stripes. Such pigmented teeth cannot be whitened in the future. The intensity of the color, its color, as well as the type directly depends on the doses and when exactly pregnant or already born child the drug was prescribed. Knowing this feature, it is advisable to avoid taking substances containing tetracycline during pregnancy.

Local hypoplasia

This type of ailment is more often acquired and often manifests itself in the form small spots on teeth or shallow grooves. Local hypoplasia of the teeth occurs more often as a result of trauma to the rudiments of the molars and rarely has genetic predisposition.

The premolars (4th teeth) of children are most often affected. As in the case of systemic hypoplasia, with local hypoplasia, not only partial lesion enamel, but also its complete absence. However, this form is rare.

Treatment and prevention of enamel hypoplasia

1. Measures for the treatment of enamel hypoplasia, as well as enamel hyperplasia, they are chosen in accordance with the stage of the disease, as well as the rate of its progression. If it manifests itself exclusively in the form of age spots on the teeth, has a localized character and does not lead to a noticeable destruction of the enamel, the doctor may limit himself to preventive measures and assign the patient remineralization of the tooth.
2. If the spots are pronounced, the dentist will decide on the grinding of the damaged part of the tooth. This method prevents the further development of the disease and gives a good aesthetic effect.
3. With erosive depressions or lesions of a mixed form a specialist can use composite materials to fill the foci of the disease or an alternative to them: veneers and lumineers - special tabs that cover the affected teeth.
4. In severe stages of the disease, when the patient does not have significant areas of tooth enamel, the doctor will prescribe prosthetics with crowns. This measure will prevent the further development of caries, and will also help achieve the desired aesthetic effect.

It is important to understand that all of the above remedial measures are aimed mainly at eliminating the consequences of the disease, but they cannot completely stop the processes of enamel destruction.

Patients, especially those with a hereditary tendency to hypoplasia, are advised to visit a doctor from time to time, undergo an examination and eliminate new foci of the disease.

As for the prevention of hypoplasia, it is based on a set of measures aimed at preventing metabolic disorders, primarily during the formation of the fetus (in pregnant women), also in children before adolescence. Such measures include:

• healthy balanced diet with the necessary content of vitamins and minerals;
• prevention of child injury;
• timely treatment various infectious diseases;
• a set of measures aimed at increasing immunity and ensuring proper metabolism;
• timely productive treatment of children's caries and other diseases of the teeth and gums.

At an older age, the prevention of hypoplasia of the child's enamel should also be given due attention. Here important aspect prevention of the disease can be considered remineralization of teeth. It must be carried out every six months in a clinic setting. Enamel hyperplasia provides similar measures to prevent the disease.

Complications of the disease

Hypoplasia of the milk teeth of a child contributes to further penetration into the tissues of the embryos of the molars of the infection, therefore, the development of such diseases:

• caries;
• development of bite anomalies;
• increased abrasion teeth;
• increased sensitivity.

With hypoplasia, all processes of tooth damage are faster, there is a high probability of rapid damage to the dentin, pulp, and then the roots. It is with this disease that the complete destruction of tooth tissues is most often observed.

hypoplasia baby tooth also damages the germ of the root that follows it, which is why it is so important in childhood to monitor the development of this problem and do everything possible to eliminate it in the early stages.

As for aesthetic problems associated with this disease, then they should include the appearance of chips on the teeth, indentations, as well as the unnatural color of the enamel. Such symptoms appear in many sick adults and children, and require special work of the dental technician.

In general, enamel hypoplasia of milk teeth, although it is unpleasant disease, almost at all stages, its consequences can be eliminated. To do this, you should consult a doctor in a timely manner, even in early periods life of the child, undergo regular examinations and follow the instructions for the treatment and prevention of pathology.

Enamel hypoplasia- non-carious lesions of the teeth, which occurs before the eruption of the tooth during the development of its tissues. The term "enamel hypoplasia" is arbitrary, since changes are also observed in other tissues of the tooth - dentin and pulp.

Terminology of tooth enamel hypoplasia

Hypoplasia of tooth enamel – This is a qualitative and quantitative violation of tooth enamel. This definition of the disease is most often found in the Russian-language literature. In international sources, enamel hypoplasia (including prenatal, neonatal) refers only to its quantitative changes - thinning, pits, grooves. Qualitative changes (changes in color, transparency) in foreign literature are turbidity ( opacity), hypomineralization, dismineralization and non-endemic mottling of enamel (ICD-C).

Enamel hypoplasia in children

Enamel hypoplasia in children can develop in utero, during the neonatal period, before and after the first year of life, up to the age of three. Despite the period of its occurrence, the mechanism for the appearance of changes in the enamel is the same. At the beginning, the function of ameloblasts is reduced or impaired during the formation or secretion of enamel substance. As a result, the construction of the protein matrix of enamel and its mineralization are damaged. In the latest and most severe stages diseases, vacuolar changes in ameloblasts and their destruction are detected. Cells can no longer function and amelogenesis stops.

Causes of enamel hypoplasia

There are several groups of causes of enamel hypoplasia. Depending on the period of their exposure, temporary or permanent teeth are affected.

Hypoplasia of the enamel of milk teeth

In the occurrence of enamel hypoplasia of milk teeth, the key etiological factors are:

1. Causes of prenatal hypoplasia (main period of exposure negative factor- pregnancy):

1. The causes of neonatal hypoplasia (in the neonatal period - the first 56 days of a child's life) may be prematurity, birth injury, asphyxia, hemolytic disease of the newborn.

Enamel hypoplasia of permanent teeth

Enamel hypoplasia of permanent teeth is most often associated with diseases of the child that disrupt the metabolism in the body.

These are diseases:

1) CNS: the mineral metabolism of phosphorus and calcium is disturbed, the amount of magnesium and potassium in the blood and bones decreases;

2) Endocrine system:

• Hyperthyroidism promotes the supply of calcium and phosphorus to the teeth and bones. With hypothyroidism, these elements are washed out.
• Against the backdrop of lack parathyroid glands the content of calcium and phosphorus in the blood increases, decreases in the bones, nails, hair, and the lens are also affected;

3) Toxic dyspepsia and other diseases of the digestive system (due to insufficient absorption of calcium and phosphorus);

4) Hypovitaminosis C,D,E(up to rickets);

5) Acute infectious diseases;

6) Allergic diseases;

7) Inadequate nutrition.

Also, the quality of the enamel of permanent teeth depends on the condition of their temporary predecessors. Chronic apical periodontitis, mechanical trauma and extraction of milk teeth with trauma to the follicle of a permanent tooth can lead to its hypoplasia.

Classifications of enamel hypoplasia

The most common classification enamel hypoplasia is the classification of M.I. Groshikov. It is based on different etiology, the number of affected teeth. Based on this, methods of treatment and prevention differ. various forms hypoplasia.

Systemic enamel hypoplasia

Systemic enamel hypoplasia - violations in the structure of all teeth, but more often groups associated with close terms of formation and eruption.

Such diseases in the ICD-C (1995), as prenatal enamel hypoplasia, neonatal enamel hypoplasia, enamel hypoplasia, non-endemic mottling, are nothing more than " systemic hypoplasia enamel" according to M.I. Groshikov.

Peculiarities clinical manifestation defects in systemic enamel hypoplasia:

- appearance from the moment of eruption;

- symmetrical, the same size on the teeth of the same name;

- localized parallel to the chewing surface or cutting edge, more often on the tubercles or the vestibular surface.

There is also a relationship between the defect and the action of the damaging factor:

• Type of defect (quality or quantitative change enamel) depends on the intensity of the factor;
• Localization of the defect - from the time of its impact;
• The width of the defect - from the duration;
• The number of defects indicates the multiplicity of the damaging factor.

Forms of enamel hypoplasia

Clinically, the following forms of enamel hypoplasia are distinguished: spotty, cup-shaped (erosive), striated (wavy) forms, thinning or aplasia of enamel.

The spotted form is spots and stripes, most often white or yellow color with clear or indistinct contours. Their surface can be smooth and shiny or rough and dull. Shiny smooth enamel means demineralization of its subsurface layer, dull and rough enamel means changes in the surface layer at the end of the enamel formation process.

Cup-shaped, striated forms, thinning, aplasia of enamel are manifested by areas of hypoplasia through which dentin is visible, grooves, aplasia (complete absence) of enamel. Edges, walls and bottom of defects sometimes with yellow-brown pigmentation, smooth.

Separately, it is necessary to mention molar-incisor hypomineralization. Her feature- defeat from one to four permanent molars often associated with damage to the incisors. Clinically it is cloudy spots white, yellow or Brown color, sometimes capturing the entire crown of the tooth. Children may be disturbed by chipping of teeth, sensitivity. Because of this, they may refuse to brush their teeth, which soon leads to the development of caries. Parents may be concerned about the unaesthetic appearance of the teeth.

Hutchinson, Fournier and Pfluger teeth

Also manifestations of systemic enamel hypoplasia are the teeth of Getchinson, Fournier and Pfluger. They are characterized by a change in the shape of the tooth. main reason- late congenital syphilis.

local enamel hypoplasia

Local enamel hypoplasia (Turner's tooth) is a violation of the development of enamel (sometimes dentin) of individual permanent teeth. As a result, the tooth changes color: it acquires a white or yellow-brown opacity, and areas of hypoplasia appear on it. Turner's tooth is directly related to the periapical inflammatory process of a temporary tooth.

Focal enamel hypoplasia

With focal enamel hypoplasia (regional odontodysplasia), underdevelopment of all tooth tissues is observed. Usually several teeth located nearby are involved in the process. For these temporary, and subsequently permanent, teeth, it is characteristic late development and cutting. After eruption, the teeth are yellowish, with a rough surface. The characteristic name of such teeth is “ghost teeth”, which is also due to their special appearance on the radiograph. Enamel and dentin are thin, their density is reduced, the pulp chamber is large, the roots are wide and short, with open apexes.

Treatment of enamel hypoplasia

In the treatment of enamel hypoplasia, several methods are used. The choice of each depends on the violation of aesthetics, type, depth, area of ​​the defect, the degree of mineralization of the enamel, the motivation of the child and parents, technical capabilities.

essence conservative method is to increase the mineralization of hard tissues of the tooth. This is both endogenous and exogenous use of vitamins, preparations containing fluorine, calcium, phosphorus. Used both on its own and as initial stage before other methods.

Microabrasion and/or bleaching carried out after the completion of the mineralization of the tooth. The technique consists in etching the enamel with its subsequent grinding with a bur of minimal abrasiveness and polishing rubber cup. This method is effective if the defect is in the surface layer of the enamel or when it becomes cloudy.

Operational Method- preparation, and then filling. It is also carried out either after conservative therapy, or after the completion of tooth mineralization. It is used for the most deeply located defects in the enamel. Options include filling with CIC (with subsequent replacement with a composite), composite materials, veneers, laminates and crowns.

Another tactic of treatment in focal hypoplasia. The optimal approaches to restoring teeth in this case are crowning teeth shortly after eruption or extraction with prosthetics.

Prevention of enamel hypoplasia

The main directions for the prevention of enamel hypoplasia:

• Prevention of diseases in a pregnant woman, her rational nutrition;
• Prevention and treatment somatic diseases in young children;
• Sanitary and educational activities of a dentist in antenatal clinic, children's polyclinic;
• Treatment or removal of temporary teeth with complicated caries;
• Prevention of temporary tooth injury;
• Atraumatic extraction of a temporary tooth.

The article was written by O. V. Titenkova. Please, when copying the material, do not forget to indicate the link to the current page.

Enamel hypoplasia updated: January 24, 2018 by: Valeria Zelinskaya

- insufficient development of the surface layer (enamel) of milk or permanent teeth. An extremely pronounced form of enamel hypoplasia is aplasia - its complete absence. Manifested by a change in shape and appearance teeth, the presence of whitish or depigmented areas, grooves, depressions, with aplasia - painful sensations on the various stimuli. Most often, enamel hypoplasia leads to the development of deep caries, pulpitis, and the formation of malocclusion.

General information

- This is a congenital malformation of the underdevelopment of the tooth or its tissues associated with metabolic disorders in the fetus. Enamel aplasia is an extreme expression of hypoplasia and is manifested by the complete absence of enamel coating or the absence of a tooth.

Reasons for development

Enamel hypoplasia occurs due to serious metabolic disorders in the fetus. And the main reason is either the pathology of the embryonic cell anlage, or adverse factors that adversely affect the fetus.

It is not entirely correct to say that enamel hypoplasia occurs only due to a violation of mineral metabolism and areas of hypoplasia are nothing more than a demineralization zone. If this were the main cause of enamel hypoplasia, then the pathology would not be so widespread. Today, the incidence is constantly increasing, as harmful factors begin to act on the rudiments of teeth long before the formation and birth of the fetus. The conclusions that toxicosis and infectious diseases in a pregnant woman lead to abnormalities in the development of the fetus are quite reasonable. Studies confirm that enamel aplasia and other dental anomalies are more common in children whose mothers suffered SARS, rubella, toxoplasmosis during pregnancy. Or if part of the pregnancy proceeded with serious toxicosis. Enamel underdevelopment is observed in premature babies and in children who have been injured during childbirth. Predisposing factors are encephalopathy, atopic dermatitis, rickets and other disorders of calcium metabolism.

Enamel hypoplasia to one degree or another is found in almost half of preschool and younger children. school age. At the same time, it is systemic in nature and damage to several teeth is more often observed. Enamel hypoplasia with profound changes is diagnosed in 40% of clinically healthy children.

Enamel hypoplasia is diagnosed on milk and permanent teeth, while it is more common on permanent teeth, which leads to an increased risk of dental disease at an older age. Violations of the enamel coating of milk teeth are associated with pathologies that occur in a woman's body during pregnancy. Whereas hypoplasia of the enamel of permanent teeth is due to metabolic disorders in the child's body, which develop starting from 5-6 months of age. And since diseases during the first year of life are much more common than serious pathologies during pregnancy, then, accordingly, enamel hypoplasia of permanent teeth prevails, which is a serious problem.

Localization and group affiliation of teeth with enamel hypoplasia depends on the age period the child had a disease, which became the main pathogenetic link. Thus, diseases suffered in the first months of life lead to enamel hypoplasia of the cutting edge of the central incisors and tubercles of the sixth teeth. This is due to the formation of these teeth at 5-6 months of a child's life.

At 8-9 months, the formation of the second incisors and canines occurs, and diseases at this age lead to hypoplasia of the enamel of the lateral incisors and the cutting edge of the canines. That is, metabolic disorders affect all teeth that have formed by given period. But after complete teething, areas of hypoplasia are on different levels, since the timing of the formation of teeth is not the same.

If the disease causes profound changes in the child's metabolism or continues for a long time, then areas of enamel hypoplasia are observed along the entire length of the crown and on the surface of the tooth. The uneven structure of the enamel indicates the duration and undulation of diseases suffered during the period of tooth formation. severity past illnesses also affects the depth of enamel changes. So, minor pathologies can appear only as chalky spots, and serious illnesses can cause enamel underdevelopment up to its aplasia.

With local enamel hypoplasia, only part of the teeth are affected. Usually its occurrence is associated with localized metabolic disorders near the rudiments of permanent teeth. Inflammatory processes in the area of ​​the apex of the roots of milk teeth contribute to the occurrence of local enamel hypoplasia. This type of hypoplasia is more common on small molars, then as their rudiments are located between the roots of milk molars.

Clinical manifestations

Systemic hypoplasia

Depending on the severity, systemic enamel hypoplasia can be manifested by a change in the color of the enamel, its underdevelopment or complete absence.

The change in the color of the enamel appears as symmetrical white spots of various shapes, which are located on the teeth of the same name. Chalk spots are found on the vestibular surface and are not accompanied by unpleasant or painful sensations. diagnostic sign is that the outer layer of enamel on the affected area is smooth, shiny and does not change color when interacting with dyes. Throughout life, the stain will not change color or shape.

More severe manifestations hypoplasia is often not noticeable during routine examination. Wavy, pitted and striated enamel appears after the surface has dried. Upon careful examination, the dentist notices alternations of small ridges and depressions with unchanged enamel. More often this form of hypoplasia manifests itself in the form of pinpoint depressions in the enamel, which are located at different levels. At first, these areas are normal color, but as the tooth grows further, these areas gradually become pigmented. In some cases, enamel hypoplasia appears as a single hyperpigmented band on the crown of the tooth. Sometimes this groove is quite deep and there is a noticeable decrease in the size of the crown of the tooth in the form of interception, this form of hypoplasia is called striated. Very rarely, scalene hypoplasia is observed, when several grooves form on the crown of the teeth. But it is characteristic that even with severe forms such enamel hypoplasias, its integrity is not broken.

Less common than other changes is enamel aplasia in a certain area. Wherein pain syndrome It is formed upon contact with an irritant and disappears after its elimination. Clinically this pathology manifested by the absence of enamel on a part of the tooth crown, but more often at the bottom of the cup-shaped recess, or in the groove covering the tooth crown. Often with enamel aplasia, there is also underdevelopment of dentin. This is manifested by changes in the shape of the teeth, characteristic of this group.

Changes in the shape of teeth with enamel hypoplasia

• Hutchinson's teeth. With this pathology, the upper central incisors have a screwdriver-shaped or barrel-shaped shape. Their size at the neck is somewhat larger than at the cutting surface and there is a semi-lunar notch at the cutting edge. It was previously believed that this symptom is observed only with congenital syphilis, but later it was found that the anomaly occurs for other reasons.
• Pfluger teeth. At given symptom the first molars are affected, the size of the crown at the cheek is larger than that of the chewing surface. The tubercles are underdeveloped, which makes the teeth look like a cone.
• Fournier teeth. Clinically, they look the same as with Hutchison's symptom, but without the semilunar notch.

Local enamel hypoplasia.

Such hypoplasia occurs on permanent teeth due to involvement in inflammatory process rudiments of teeth or due to mechanical injury developing germ. Clinically, this type of hypoplasia appears as white or yellowish-brown spots, and more often as punctate depressions over the entire surface. In some cases, the enamel of the tooth crown is completely or partially missing.

Hypoplasia of tooth enamel leads to the fact that microbes act more aggressively on dentin, freely penetrating into it and causing deep caries. The second serious complication is damage to other tissues of the tooth - cement, dentin and pulp, since enamel hypoplasia rarely occurs in isolation. Many children subsequently develop a malocclusion.

Treatment

The tactics of treatment depends on the severity of hypoplasia, so with single spots and shallow lesions of the enamel, etiotropic treatment is not carried out. Prevent caries and pay more attention to oral care. Sometimes, if the spots are located on the vestibular surface of the teeth, they become cosmetic defect, as they are clearly visible during a conversation. To eliminate them, filling with composite materials is carried out. If there are changes in the enamel in the form of pinpoint depressions and interceptions, then they are also eliminated with the help of filling.

Pronounced enamel and dentine defects are an indication for orthopedic treatment with the installation of ceramic-metal crowns. Prevention of enamel hypoplasia is the harmonious development of the child, in order to prevent serious illnesses during the development of immunity.