Systemic enamel hypoplasia. Symptoms of the local form of the disease. Systemic form of hypoplasia

Hypoplasia of the teeth is congenital or acquired in childhood pathology leading to fragility, serious thinning of the enamel. It has various stages: from small lesions to complete absence of enamel. The main manifestations of the pathology include a change in the shape of the teeth, the appearance of grooves on the enamel, dark spots, indentations. Leads to possible complications: caries, different forms pulpitis, malocclusion The child has.

Pathology can manifest itself both in dairy and permanent teeth. In the article we will consider the types of hyperplasia, the causes and symptoms of the disease. As well as methods of treatment, possible complications and methods of prevention.

Disease Definition

Hypoplasia of tooth enamel is congenital disorder proper development teeth. If, when the first teeth appeared, the child immediately had problems (, grooves, strange shape tooth) it is recommended to consult a dentist . Timely treatment and careful dental care reduce the risk of complete tooth decay.

Depending on the age of the child and the severity of the pathology, the pathology can manifest itself in varying degrees. In mild cases we are talking about the thinning or absence of small areas of enamel. Sometimes the pathology may be accompanied by the absence of some teeth in a row.

With systemic hypoplasia, the enamel is completely absent, the teeth are deformed. This leads to a strong sensitivity of the teeth to cold, hot, chemical exposure.

The main reasons for the development of hypoplasia:

• chronic pathologies in children;
• various metabolic disorders due to an imbalance of minerals;
• toxic dyspepsia;
• brain dysfunction occurring between the ages of six months and 12 months;
• sharp infectious diseases.Yu

At local form The reasons are often:

• germ infection permanent teeth;
• chronic perioditis of milk teeth;
• even minor injuries and .

A severe (systemic) type of pathology develops as a result of:

• intrauterine infection of the child (transferred pregnant rubella, toxoplasmosis and others);
• taking certain drugs during pregnancy, such as tetracycline antibiotics (or treating a child under 12 months of age with them);
• unbalanced diet given to a child under the age of one year (leads to a violation mineral metabolism);
• violation of protein metabolism and other types of metabolism.

Untreated nasopharyngeal infections and lack of beneficial minerals before the age of 6 years lead not only to hypoplasia of milk teeth. The rudiments of permanent teeth are often damaged.

If a systemic form of hypoplasia is detected, the child is registered with a dispensary. He needs preventive supervision at least once every 2 to 4 months and regular treatment emerging problems.

Classification

There are 2 main degrees of localization of hypoplasia:

• local(there is a defeat of one or two permanent teeth, not typical for milk teeth);
• With systemic(leads to the defeat of all teeth from birth).

Systemic hypoplasia, in turn, has several varieties:

• Fournier's teeth(the central incisors have a deformation in the form of a “screwdriver” or “butterfly”);

• Pfluger's teeth(damage to large molars, which have underdeveloped tubercles and too wide a crown);
• Gechinson's teeth(deformation of the teeth, almost like in Fournier, but on the edge of the teeth there is a notch that is not covered by enamel in the form of a half circle).

The “tetracycline form” develops if a woman inadvertently took antibiotics of the tetracycline group during pregnancy or gave them to a child under 1 year old. Teeth acquire a characteristic yellow-brown tint and underdeveloped enamel. If the treatment was carried out after 6 months, even permanent teeth acquire a yellowish tint. Read more about whether caries can be treated during pregnancy.

Depending on the severity of the lesion, the following forms are distinguished:

• enamel color change(the mildest form, in which single spots of a white or yellowish hue develop on the surface of the teeth, may develop);

• slight underdevelopment of enamel(leads to the appearance of single defects on the surface of the teeth: grooves, stripes or waves);
• aplasia(complete absence of enamel, causing hypersensitivity to thermal, mechanical and chemical stimuli).

Rarely, scala hypoplasia develops, in which several grooves develop on the enamel of each tooth.

Enamel hypoplasia often leads to impaired dentin development. This becomes the main reason for the deformation of the teeth.

Symptoms

Signs of hypoplasia in each case are different. Most frequent symptoms diseases become:

At in large numbers foci of the absence of enamel or its complete absence, hypersensitivity of the teeth develops. This results in soreness with hot, cold, or hard foods, as well as sour, sweet, and other irritating foods.

If a child has proper care caries develops behind the teeth for up to a year, this is a reason to consult a dentist.

Treatment

There are no ways complete cure hypoplasia, since the development of this pathology is irreversible. Applies only systematic treatment, which reduces the consequences and development of complications. It includes:

With a systemic form of hypoplasia with total absence enamel undergoes orthopedic treatment. After complex diagnostics the doctor decides on the installation of permanent crowns or veneers.

At enamel hypoplasia Taking good care of your teeth and oral cavity is essential. Parents must learn themselves, and educate the child proper cleaning teeth, use of mouthwash, and floss. The choice of brush and toothpaste is important, especially for milk teeth.

Complications

Without permanent treatment and preventive measures mild form hypoplasia leads to the development of such complications in the future:

• fragility of teeth;
• decreased resistance to various diseases;
• formation of malocclusion;
• tendency to damage, chipping of enamel;
• enamel hypoplasia of permanent teeth (if milk teeth are not treated);
• development of caries,;
• acute or chronic periodontitis.

Even after successful treatment, it is too early for parents to “relax”. It is necessary to carefully monitor the standing of the child's teeth, attend preventive examinations without missing.

Prevention

Most importance has prevention. If a child has enamel hypoplasia, traditional methods are not enough for him. preventive examinations 1 - 2 times a year. When registering for a dispensary, it is necessary to visit a doctor every 2 to 4 months, depending on the severity of the problem. The main preventive measures include:

Video

For details on what is hypoplasia of tooth enamel, see the video

1. Enamel hypoplasia is a pathology, the main symptom of which is the partial absence of tooth enamel. On the early stages appears in the form 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 metabolic processes at 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 disease depends 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 usually there is the formation of grooves, as well as depressions in the tissues, and on final stages diseases, 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 cause of this pathology is 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 can lead to hypoplasia of milk teeth and birth trauma.

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 content fluorine 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 (received during the period prenatal development, at 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 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. One more important characteristic 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 specialist can use composite materials for filling foci of the disease or an alternative to them: veneers and lumineers - special tabs that cover the affected teeth.
4. With 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 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 milk 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 the aesthetic problems associated with this disease, 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.

Causes of hypoplasia

Local

General

1. Heredity:

- Amelogenesis imperfecta

Hypoplasia Turner

Turner hypoplasia, also known as Turner teeth, is a term for hypoplasia and a defect in the enamel of the crown of a permanent tooth. Most often, Turner's hypoplasia affects the lower premolars, since the milk molars located above them are very susceptible to infection. Also, quite often the disease manifests itself on the permanent central incisors due to trauma to the milk predecessors.

Description of the clinical case

Hard tissue examination

Histological examination

Photo 3: Tooth cut

Therapeutic measures

Discussion

A local infection at the apex or trauma to the primary tooth easily affects the underlying permanent tooth germ. If a infectious process occurs during the formation of the crown, this can lead to hypoplasia or hypomineralization of the enamel in the future.

Conclusion

The authors:
Sudhakar V
Ankur Shah
Harsh Pandey

Enamel hypoplasia is defined as the incomplete or defective formation of the organic matrix of tooth enamel at the germ stage. A hypoplastic defect damages the shape of the tooth. Often, hypoplasia is expressed in the local loss of tooth enamel, which looks like a single depression or a series of depressions surrounding the tooth horizontally. These depressions can also be combined into a furrow. The most severe forms of hypoplasia are enamel hypoplasia and enamel hypocalcification.

Enamel hypoplasia is the result of impaired formation of the enamel matrix and results in insufficient tissue formation.

Enamel hypocalcification is the formation normal amount enamel, but not calcified enough.

Causes of hypoplasia

Local

Injury or infection (Turner hypoplasia)

General

1. Heredity:
- Imperfect dentinogenesis
- Amelogenesis imperfecta

2. Genetic and idiopathic diseases:
- Dystrophic epidermolysis bullosa
- Claido-cranial dystrophy
- Imperfect osteogenesis. Syphilis of the newborn

Hypoplasia Turner

Enamel hypoplasia affecting a single permanent tooth is associated with infection in the deciduous tooth or trauma during the formation of the germ.

Description of the clinical case

An 18-year-old girl came to the clinic with complaints of misaligned and discolored upper front teeth, given state observed since childhood. In the anamnesis of life, the patient indicated a fall at the age of 5 years. The upper anterior teeth have been displaced and discolored since eruption.

Clinical examination revealed posterior displacement mandible and class II malocclusion.

Hard tissue examination

The upper anterior teeth are discolored, microdontia of the upper lateral incisors, displacement of the crown to the palatal side in relation to the upper left central incisor. The cutting edge of the crown faces the palatal side. A deep groove is visible on the crown (Photo 1). The tooth is dead.

Photo 1: Photo before treatment. Hypoplasia and hypomineralization of the upper left central incisor.

X-ray examination

on sighting x-ray an upper right central incisor was found with a defective root and open apex (Figure 2).

Photo 2: X-ray before treatment. Defective incisor root.

Histological examination

On the cuts of the presented samples, enamel underdevelopment and pathological dentin-enamel junction were found (Photo 3). The configuration of the enamel pattern is incorrect.

Photo 3: Tooth cut

Therapeutic measures

1. Fragments of the crown of the upper right central incisor sawn and sent for histopathological examination

2. Treatment root canal by one-step apexification using MTA and subsequent restoration of the crown. To strengthen the structure during filling, a fiberglass pin was used (Photo 4).

Photo 4: MTA apical filling and fiberglass post placement.

3. Composite veneers were made for the upper left central and lateral incisors (Figure 5).

4. Manufactured ceramic crowns for the upper right central and lateral incisors (Figure 6).

Discussion

Turner's hypoplasia is enamel hypoplasia affecting single permanent teeth. This disease is often associated with infection or trauma during the formation of the tooth germ.

A local infection at the apex or trauma to the primary tooth easily affects the underlying permanent tooth germ. If the infectious process occurs during the formation of the crown, then this can later lead to hypoplasia or hypomineralization of the enamel.

In this clinical case, the patient reported an injury that apparently caused a local anomaly of the anterior group of teeth on upper jaw. Examination revealed displacement of the incisors and the presence of a non-viable pulp. An X-ray showed a pathologically formed root.

Thus, in the above clinical case, the patient needed both aesthetic and functional rehabilitation, which required strengthening of the pathologically formed root.

The treatment was carried out conservatively by one-step apexifecation with MTA of the central incisor, followed by installation composite veneers on the upper left central and lateral incisors.

Conclusion

Enamel hypoplasia with damage to the central group of teeth causes large aesthetic problems which carries an important psychological aspect in young patients. The clinical case stresses the need early diagnosis, careful X-ray and clinical examination for a satisfactory outcome. It should be noted that the above situation was very favorable for achieving satisfactory aesthetic and functional standards.

The authors:
Sudhakar V, Senior Lecturer, Department of Conservative Dentistry and Endodontics, School of Dentistry, India
Ankur Shah, Senior Lecturer, Department of Periodontal Diseases, College of Dentistry, India
Harsh Pandey, Senior Lecturer, Department of Orthodontics, College of Dentistry, India

Hypoplasia of tooth enamel is a specific disease in which, as a result of metabolic disorders, enamel is formed and develops incorrectly. If metabolic processes are disturbed, then the body does not receive the necessary correct formation enamel contains microelements, as a result of which it becomes too fragile and thin, therefore, at the slightest load on the tooth, it can break.

However, hypoplasia indicates the presence serious violations metabolic processes and protein metabolism, therefore, it is both a disease and serious symptom, which indicates that the patient's health is not all right.

The reasons

For successful treatment disease, you need to know what causes it to occur. Dentists highlight the following reasons occurrence of hypoplasia

• violation of metabolic processes due to violation of protein and mineral metabolism;
• the presence of chronic somatic diseases in children (hypoplasia of milk teeth);
• rickets, toxic dyspepsia, acute infectious diseases, brain disorders that occurred in children between 6 and 12 months (hypoplasia of permanent teeth).

Depending on the age and severity of the disease, the localization of hypoplasia depends.

Kinds

In dentistry, systemic and local hypoplasia are distinguished.

Systemic

System form The disease affects all teeth at the same time and usually occurs for three reasons:

• in the prenatal period of the child's development, if the mother during pregnancy suffered from a metabolic disorder or suffered from serious diseases (such as rubella, toxoplasmosis);
• as a result serious illnesses or malnutrition of the child in the first year of life;
• as a result of being taken by a mother during pregnancy or by a child in the first year of life of certain medicines(mostly tetracyclines).

If a child is found systemic hypoplasia teeth, such a child is taken to the dispensary.

Depending on the shape of the teeth and the type of their damage, there are such varieties as the teeth of Getchinson, Fournier, Pfluger and tetracycline teeth.

Hutchinson's teeth

The upper central incisors are barrel-shaped or screwdriver-shaped and have a semi-circular notch on the cutting edge that is not covered with enamel. Such teeth at the neck are much larger than at the cutting edge.

Fournier teeth

The teeth resemble Hutchinson's but lack the semi-circular incisal notch.

Pfluger teeth

The first large molars suffer. They have underdeveloped tubercles, and the size of the crown at the neck of the tooth is significantly larger than at the cutting edge.

"Tetracycline" teeth

It is formed as a result of taking tetracycline either by the mother during pregnancy or by the child in the first year of life. Such teeth have a modified yellowish color and underdevelopment of enamel. If a child took tetracycline at the age of over six months, then permanent teeth will be stained, which are just being formed during this period.

local

Unlike the systemic form of the disease, which affects all teeth, the local form affects only one or two molars of the patient and does not occur on milk teeth.

Causes of local hypoplasia:

• mechanical trauma of the germ of the emerging tooth;
• infection in the germ of a permanent tooth;
• chronic periodontitis of a milk tooth.

It looks like a whitish or yellowish spot on the surface of the tooth enamel, while the enamel of the tooth crown may be completely or partially absent.

Forms of the disease

1. Discoloration of the enamel of the affected teeth.
2. enamel underdevelopment.
3. Aplasia, or complete absence of enamel.

Let's take a closer look at each form.

Color change

Discoloration of the enamel of affected teeth is the mildest form of hypoplasia, in which whitish or yellowish spots of the same size and with clearly defined boundaries appear on the enamel. These spots do not cause the patient discomfort, do not hurt, do not react to mechanical and thermal stimuli, do not stain with dyes (unlike spots in the initial stage of caries).

Underdevelopment

Underdevelopment of tooth enamel is a more severe form of hypoplasia, in which dots, waves or grooves appear on it. On the surface of the teeth you can see small or medium size grooves and depressions in which the enamel remains dense and smooth.

No enamel

Aplasia, or the complete absence of tooth enamel, is the most severe form of the disease. Fortunately, it is rare. With this form, the enamel is completely absent in a certain area of ​​the tooth crown. The patient may experience pain from mechanical, chemical or thermal stimuli.

Symptoms

• Whitish or yellowish spots with a smooth surface on the tooth enamel;
• dotted depressions and grooves on the surface of the affected teeth;
• the presence of foci on the crown of the tooth with a complete absence of tooth enamel;
• the bizarre shape of the teeth, due to the absence of enamel on almost the entire surface of the tooth.

Treatment

To date, tooth enamel hypoplasia is an irreversible process - there is no medicine that could eliminate the symptoms. Therefore, the treatment is symptomatic and consists mainly in the reconstruction of tooth enamel.

In the presence of small foci of local hypoplasia, no measures can be taken, since there are no painful sensations. For deeper stains and erosions on the tooth enamel, fill a tooth composite materials.

If there is a partial or complete absence of enamel on the surface of the tooth crown, the doctor may decide on the appropriateness orthopedic treatment and resort to crown prosthetics.

Prevention

The main prevention of dental hypoplasia is a complete balanced diet mother during pregnancy and the child in the first years of life. It is unacceptable to take medications, especially tetracyclines during pregnancy or in the first year of a child's life. It should also be warned systemic diseases, as they cause a violation of metabolic processes, which can lead to the occurrence of hypoplasia.

- 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, 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.

Enamel discoloration appears as symmetrical white spots various forms, 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 have a 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. With this symptom, the first molars are affected, the size of the crown at the cheek is larger than at 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. Second serious complication is the defeat of 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 diseases during the period of immunity formation.