Amelogenesis Imperfecta: No Enamel on Teeth

Your teeth are complex structures made up of many different components. The tooth's enamel is the visible, outer layer. It's primarily composed of calcium phosphate, making it the hardest substance in the body. Enamel protects the inner parts of the teeth and gives your smile its white appearance. But did you know that sometimes, children develop teeth that don't have this protective layer? This condition is known as amelogenesis imperfecta, which can increase the risk for several dental issues. Learn more about this dental condition and its available treatment options.

What Is Amelogenesis Imperfecta?

Healthy enamel acts as a protective buffer against tooth decay. This hard exterior shields the inner layers of the teeth from the effects of acids and plaque. It also prevents tooth sensitivity that can be caused by extremely hot or cold foods and beverages.

According to the National Institute of Health, one in 14,000 people in the United States have amelogenesis imperfecta (AI). This condition can affect baby teeth and adult (permanent) teeth. AI is caused by mutations in genes that can be passed down in families, but new gene alterations can occur even without a family history of the condition.

What Does It Look Like?

Amelogenesis imperfecta affects the appearance and strength of teeth. Teeth appear small, discolored, pitted, and prone to breaking. There are four classifications of amelogenesis imperfecta, with each presenting various symptoms:

• Hypoplastic: This type of AI is characterized by small or normal dental crowns (the top of the teeth), misalignment in the upper and lower teeth, and tooth discoloration. The enamel can be thin, smooth, or normal, with grooves, lines, and/or pits.
• Hypomaturation: Type II AI also affects teeth alignment. People with this type of amelogenesis imperfecta often have an open bite where the upper front teeth and lower teeth don't touch when the mouth is closed. The tooth's surface may have a creamy white or yellow-brown, rough texture that may be tender or sore. Generally, the enamel will be normal in thickness but may look chipped or scraped.
• Hypocalcified: Type III is also associated with an open bite and creamy white to yellow-brown tooth surface that may be tender and sore. Like type II AI, people with type III tend to have chipped tooth enamel.
• Hypoplasia: Type IV, also known as hypomaturation or taurodontism, occurs when teeth have a white to yellow-brown look, with spots. The enamel is thinner and softer than normal.

Are There Complications?

Teeth with thin, soft, or no enamel are at risk of early tooth decay, gum disease, and tooth sensitivity. Healthy enamel protects your teeth against these dental issues. Without this buffer, the sensitive parts of teeth are left exposed. Dentin is the second layer of the tooth, which contains thousands of microscopic tubules that lead to the tooth's pulp (which consists of nerve endings and blood vessels). When these parts of the tooth are exposed to hot or cold foods and beverages, it results in uncomfortable pain.

Treatment and Home Care

Treatment will depend on the type of amelogenesis imperfecta you are diagnosed with. Your dental professional may recommend restorative treatments like crowns, implants, and bonding. These will restore the size, shape, strength, and appearance of the affected teeth. Malocclusion (an abnormal alignment of the upper and lower teeth when the jaws are closed) is a common characteristic of AI. But orthodontic appliances such as traditional braces can help correct a misaligned bite.

Because of the high risk of decay and gum disease, it's important to take special care of your oral health by maintaining good oral hygiene. Thoroughly brush your teeth twice a day and use an interdental cleaner to remove plaque, bacteria, and food particles in hard-to-reach places.

Teeth with no enamel is a condition that can affect you or your child's self-confidence, as it impacts the appearance and functionality of the teeth. If you or your child experience a rough tooth surface, discoloration, and sensitivity, you shouldn't hesitate to speak to your dental professional. They can find the best treatment options to improve your oral health and give you confidence in your smile!