Enamel Hypoplasia: What Is It & How Do You Treat It?

Enamel hypoplasia is a condition that impacts the normal development of enamel while your teeth are still forming. It can lead to thin or no enamel.

Enamel hypoplasia can be a hereditary condition as part of the disorder amelogenesis imperfecta, a condition affecting tooth development.¹

This condition is most often caused by outside factors. It is not technically considered its own disease. Instead, it is a condition of an additional stressor, such as disease, environmental factors in infancy, or prenatal issues.

Enamel hypoplasia is signified by pitting, white spots, and grooves on the outside of your tooth. The condition needs to be treated as early as possible, with excellent oral hygiene, to keep tooth decay and dental issues from occurring.

What Is Enamel Hypoplasia?

Enamel is the important outer layer of your teeth that is made up of minerals to protect the inside.

Once enamel is destroyed, it cannot regenerate on its own.² For this reason, it is important to protect your enamel from tooth decay and demineralization that happen when you eat and drink.

Enamel hypoplasia is a condition that causes you to have thin enamel, which is more difficult to protect and easier to wear away, exposing the inside of your teeth. The condition can also cause there to be no enamel at all. It can make your teeth more brittle and have spots, grooves, and pits on them.

Enamel hypoplasia can be systemic, which means it impacts a group of teeth, or local and regulated to a single tooth.

Enamel hypoplasia is often a component of the hereditary disorder amelogenesis imperfecta, which impacts around 1 out of every 14,000 births in the United States. Enamel hypoplasia impacts teeth as they are developing. It is often caused by a specific stressor, either during pregnancy or infancy.

Potential Complications

Thin or weak enamel caused by enamel hypoplasia can make you more prone to cavities, as it can be harder to keep the enamel of your teeth from further breaking down.

A cavity forms when the bacteria in your mouth mixes with acids from food and drinks, and causes plaque formation. If not removed, the plaque can harden into tartar, which can then cause tooth decay.

This decay can destroy the enamel, leaving holes in your teeth. When the teeth already do not have enough enamel to start with, this can happen much faster than in someone without enamel hypoplasia.

Significant enamel loss and tooth decay can lead to lost teeth, trouble eating and speaking, and discomfort in your appearance.

Causes of Enamel Hypoplasia

Enamel hypoplasia is caused by a disruption to normal teeth development. This can happen when a baby is still in the womb or as an infant.

There are several factors that can impact dental development and lead to enamel hypoplasia, including the following:³

Issues during pregnancy:

• Low birth weight

• Vitamin D deficiency in the mother

• Maternal weight gain

• Smoking during pregnancy

• Insufficient prenatal care

• Drug use during pregnancy

• Birth injury or trauma

• Illness or infection of the mother during pregnancy

• Malnutrition of the mother during pregnancy

Environmental factors in infancy:

• Too much fluoride exposure

• Jaundice or liver disease

• Infection

• Injury or trauma to the teeth

• Celiac disease

• Cerebral palsy, caused by infection to fetus or mother during pregnancy

• Calcium deficiency

• Vitamin A, C, or D deficiency

Hereditary syndromes:

• Usher syndrome

• Heimler syndrome

• Seckel syndrome

• Otodental syndrome

• Treacher-Collins syndrome

• Ellis-van Creveld syndrome

• Velocardiofacial syndrome

Recognizing Enamel Hypoplasia

Enamel hypoplasia is most often recognized by the following symptoms:

• White spots on the teeth

• Pits or grooves on the outside of the teeth

• Yellow or brown stains, indicating exposed dentin underneath the enamel

• Heightened vulnerability to tooth decay and cavities

• Tooth sensitivity to heat and cold

• Teeth wearing down in an irregular pattern

• Teeth not connecting properly

Signs of enamel hypoplasia can often be difficult to spot until there is a bigger issue, such as advanced tooth decay. It is important to watch closely for symptoms to allow for quick and early intervention.

Treatment Options

Enamel hypoplasia requires close monitoring by a dental professional to ensure that tooth decay remains at bay and the enamel does not wear down any further. Since this condition occurs as teeth are developing, it can be beneficial to see a dentist soon after the first baby tooth erupts. Enamel hypoplasia can impact both baby and adult teeth.

Early treatment and intervention is focused on:

• Preventing tooth decay.

• Maintaining the integrity and structure of the teeth.

• Ensuring that the bite is effective.

• Keeping the teeth looking as good as possible to enhance self-confidence around smiling.

Depending on the severity of the condition, a dentist may wish to place crowns on weaker teeth to strengthen and protect them. Fluoride treatments can keep up the mineralization process to repair weakened, but not destroyed, enamel. A dentist can also use tooth bonding or sealants to protect and maintain weakened or sensitive teeth.

Once tooth decay and cavities set in, a dentist will need to remove the decay and then use a filling or crown to restore and reshape the tooth. If the tooth cannot be saved, it may need to be extracted and replaced with an implant, dental bridge, or dentures to save the space.

Managing Enamel Hypoplasia & Preventative Efforts

The best methods for preventing enamel hypoplasia are proper nutrition and prenatal care during pregnancy, especially in the third trimester.⁴

The prenatal period is an important time for tooth development of an unborn baby, and it is essential that the mother gets the right nutrients and minerals passed to the baby during this time. This is equally important in early infancy.

Enamel hypoplasia can be managed, and teeth can be protected from further damage to the enamel, by practicing good oral hygiene.

• Brush with a soft-bristled toothbrush at least two times per day with fluoride toothpaste.

• Limit sugary, starchy, sticky, and acidic foods.

• Rinse with a fluoride mouthwash.

• See your dentist regularly for checkups and cleanings.

If you or your child has enamel hypoplasia, it is important to watch the condition closely and maintain good oral health care to prevent further destruction of the enamel. The earlier the condition is recognized, the quicker you and your dentist can come up with a plan to protect your teeth.