Enamel is the hardest substance in the human body, and is therefore vital to the health of your teeth. Not everyone's is the strongest, though, and still others have teeth without enamel at all. Without enamel to protect the softer interior parts of your teeth, they can't stand up to the stress of natural biting and chewing. These abnormal developments require special care and treatment.
Teeth can come in without enamel as a result of inherited issues or because of exposure to certain substances while the teeth are erupting. Baby teeth and permanent teeth can both emerge with enamel that is weak, improperly formed or missing altogether. One of these conditions is enamel hypoplasia, which literally means "underdeveloped enamel." A disorder that causes the teeth to develop with thin, deficient enamel, it sometimes manifests as a pit in the tooth – or even a hole. In advanced cases, there is no enamel at all, leaving the more sensitive dentin exposed.
Under normal conditions, per the American Academy of Pediatric Dentistry (AAPD), special cells in the teeth called ameloblasts form the cells of the tooth enamel. If these ameloblasts are damaged or do not fully develop, the enamel can't develop normally either.
What Causes It
Many factors can cause enamel hypoplasia. These include:
- Poor nutrition during pregnancy or infancy.
- Infection during pregnancy or infancy.
- Genetic disorders.
- Trauma to the teeth or jaw.
- Exposure to certain substances during pregnancy or infancy.
Nonetheless, it's often difficult to determine exactly what caused the teeth to develop abnormally.
Another defect of enamel development is enamel hypomineralization. In this condition, the enamel is present but doesn't sufficiently mineralize, leaving it soft and easily damaged. Hypomineralization can occur due to excessive exposure to fluoride (also called fluorosis) – which, although important to the development of tooth enamel, can cause severe discoloration or improper enamel growth when too much is present as the teeth are developing. It's likely to affect the teeth between birth and six years of age.
Like hypoplasia, hypomineralization can also occur due to poor nutrition or systemic problems that make it harder for the body to absorb important minerals, like wheat in the case of Celiac disease.
How to Treat It
Teeth without enamel are highly susceptible to damage, decay and trauma. And although enamel cannot be replaced, the teeth can be treated to make up for their delicate state. The type of treatment depends on the extent of the enamel loss, which teeth need to be treated and the age of the patient. Adult patients, for example, will want permanent treatments, whereas treatments for baby teeth can be less extensive.
Some approaches to treating teeth without enamel include:
Sealants can help protect teeth in cases of minor enamel hypoplasia. Bonding is also a relatively conservative approach, using a tooth-colored resin to cover discolored or weak areas. Both approaches, however, need a certain amount of normal or near-normal enamel in order for bonding or sealants to adhere properly. In many cases, it's necessary to cover the teeth with crowns for complete protection. Of course, in the most complex cases, they may be extracted and replaced.
The most common replacement methods are dental implants and bridges. Implants can replace the entire tooth, including the root, and are implanted directly into the jawbone. Bridges, on the other hand, require adjacent teeth that are strong enough to support a prosthetic tooth – which is secured with a crown or a length of wire. Because hypoplasia significantly weakens the teeth, bridges are not always the most practical solution.
If you or your child have symptoms of enamel hypoplasia, you and your dentist should work together to decide on the best approach for treatment. To help support your teeth and keep your enamel healthy, use a toothpaste like Colgate Enamel Health.