Plane-form enamel hypoplasia

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Example of an individual with plane-form enamel hypoplasia. From a British Roman site. Plane-form enamel hypoplasia.jpg
Example of an individual with plane-form enamel hypoplasia. From a British Roman site.

Plane-form enamel hypoplasia is often seen as the most severe type of enamel hypoplasia, and results from enamel matrix formation stopping, resulting in areas of crown with little or no dental enamel deposition. [1] [2] With plane form meaning the surface is smooth and flat. A relatively short period of severe stress can potentially lead to a very large defect. Plane-form enamel hypoplasia can be caused by a variety of factors, including severe illness/malnutrition, as well as specific conditions such as amelogenesis imperfecta and congenital syphilis. In severe cases enamel can be completely missing from areas of the crown, exposing the underlying dentine. [1] This condition has been recorded in history since atleast the 18th and 19th century. A study was done on a 15 year old female that was alive during the 18th and 19th century, and she presented enamel hypoplasia. [3]

Contents

Signs and symptoms

Example of teeth grooving and enamel discoloration. beobrangjiljeohyeongseongjeung.jpg
Example of teeth grooving and enamel discoloration.

Signs of plane-form enamel hypoplasia can be observed through pitting, depressions, and grooves seen on the surface of the teeth. This disease can solely affects a person's teeth, causing the enamel on one's teeth to erode. Common signs include white spotting and yellow or orange discoloration on the tooth surface. Patients with this condition often experience weakened and sensitive teeth. Progressive eroding of the enamel causes the teeth to become more sensitive, leading to discomfort when eating or drinking. [4]

Cause

Plane-form enamel hypoplasia is a dental condition that is distinguished by defects in the teeth enamel, that can occur due to genetic or environmental factors. It is common for the disease to occur during the developmental stages of the teeth, and childhood illnesses, such as respiratory infections, are often linked to disturbance of the enamel formation. [5] [6]

A lack of essential nutrients can delay enamel development, leading to weaker, underdeveloped enamel and contributes to cases of plane-form enamel hypoplasia. Proper intake of vitamins such as A,C, and D, along with minerals like calcium are crucial for ensuring enamel strength. To prevent this condition, maintaining a balanced diet or supplementing a diet deficient in these nutrients is vital. [7]

Example of amelogenesis imperfecta along with pitted enamel. B amelogenesis imperfecta.jpg
Example of amelogenesis imperfecta along with pitted enamel.

Prenatal factors can also affect enamel development. Health conditions such as maternal malnutrition, infections, and exposure to harmful substances during pregnancy have been linked to enamel deficiency in the fetus. [6] Preventative measures include limiting exposure to harmful chemicals, maintaining a nutrient-rich diet, and attending regular checkups during pregnancy. [4]

Amelgoenesis imperfecta, Usher syndrome, 22q11 syndrome, and Heimler syndrome are all associated with enamel hypoplasia, due to these condition disrupting the normal enamel process. [4] [5]

Mechanism

Plane-form enamel hypoplasia is a condition resulting from disruptions within the normal enamel development process. Enamel formation beings during the early stages of tooth development and is commonly affected during childhood. Enamel formation is facilitated by specialized cells known as ameloblasts. [8] These specialized cells secrete an enamel matrix that mineralizes over the teeth, forming the hard outer surface of the teeth. [9] [5]

Disruption in the function or production of ameloblasts can lead to deficiency's within the enamel formation. Factors such as nutrients intake, prenatal factors, and genetic conditions can disrupt the formation of enamel in any of the growth stages leading to things such as plane-form enamel hypoplasia. [8]

The severity of Plane-form enamel hypoplasia is dependent of the duration and intensity of the contributing factors. Longer or more severe disruptions within the enamel formation are associated with more pronounced effects on tooth deformation and integrity. [7]

Diagnosis

Teeth displaying plane-form enamel hypoplasia. Teeth displaying Enamel hypoplasia lines.jpg
Teeth displaying plane-form enamel hypoplasia.

If Plane-form enamel hypoplasia is suspected, it is imperative to consult a dental professional for further evaluation and management. Diagnosis typically beings with a visual examination, with the dentist looking for common signs such as pitting, depressions, and grooves on the tooth surface. Comprehensive medical and developmental history will likely be reviewed to identify any preexisting or underlying causes. [10]

Imaging, such as X-ray's are often used to assess the extent of the underdevelopment/deficiency of the enamel and identify any other dental complications. This imaging helps the dentist evaluate the severity of the condition and determine a necessary treatment plan. Early detection is imperative in order to plane preventative options or treatments. [4] [10]

Treatment

Treatment for Plane-form enamel hypoplasia varies depending on the severity of the case.

For mild cases, dentist may recommend applying fluoride or using fluoride toothpaste to strengthen the enamel and reduce tooth sensitivity. Another treatment for mild cases would be the placement of dental sealants, dental sealants fill the grooves and pits on the teeth, reducing the risk for further bacteria buildup and decay. [11] [10] [5]

in more severe cases, more restorative measures may be needed. If the tooth is untreatable or significantly weakened, a dental crown may be placed over the tooth allowing the tooth function to restore. in extreme cases, the tooth would be extracted and a dental implant may be considered as a replacement option. [11] [10] [5]

Prognosis

Although prognosis information is limited, it has been found that Plane-form enamel hypoplasia is common within children, due to the tooth development being crucial during these stages of life. Early detection is imperative to halt any further damage to the enamel. Environmental factors such as malnutrition and illness both contribute to the development of the enamel. Being that enamel damage is permanent, there is not a possibility for 'recurrence', but the condition can progress. Progression occurs due to the teeth being more prone to decay and structural damage. To mitigate these risk obtaining dental care is imperative. If the appropriate dental care is performed, affected individuals can maintain a good quality of life. To maintain this quality of life, regular dental check-ups are imperative. [12] [13]

Epidemiology

The occurrence of Plane-form enamel hypoplasia differs throughout various demographic groups. Regarding age, children are more affected by this condition due to the susceptibility of developing teeth to environmental factors. A study in Albania reported that 12.8% of children between 8-12 years experienced some form of enamel hypoplasia. [14] Sex difference have not been indicated for this disease. Plane-form enamel hypoplasia is prevalent in regions that have limited access to dental care and poor nutritional resources. This also includes populations located in lower socioeconomic areas. A study in Iowa found that 6% of well-nourish children have enamel hypoplasia on their primary teeth. [15]

Determinants of Plane-form enamel hypoplasia include both environmental and genetic factors. As stated previously, nutritional deficiencies, systematic illnesses, infections, and exposure to toxins during tooth development can disturb the formation of the enamel. Maternal smoking and certain medications can cause disruption during the pregnancy, leading to lack of enamel development in the fetus. Genetically, conditions such as amelogenesis imperfecta, are inherited conditions that can further cause plane-form enamel hypoplasia. [13]

Research directions

Recent studies have furthered knowledge on Plane-form enamel hypoplasia, focussing on genetic research, diagnostic advancements, and further treatments for the condition.

In 2022 research was conducted on 7,159 individuals within a multiethnic cohort, identifying genetic loci that is associated with Plane-form enamel hypoplasia. The BMP2K and SLC4AR gene was located suggesting its contribution within tooth development, these findings highlight the complexity of enamel hypoplasia. [16]

A 2023 study that was published in the Scientific Reports evaluated the effectiveness of different diagnostic tools when using the tools for enamel hypoplasia. In this study they compared tradition visual exams to advanced imaging techniques such as microscopes, and fluoresced-based devices. They found that using the microscope provided essential viewing that is needed to properly see enamel defects, suggesting that it would be valuable to use within routine dental practices. [17]

There are recent clinical trials that looked into restorative materials to manage plane-form enamel hypoplasia. A study was published in the Journal of Clinical Pediatric Dentistry this year (2024), comparing injectable giomer restorations to injectable composite resin when treating the enamel defect. They found that the injectable giomer was the better alternative providing better durability. Further research is currently being conducted to develop peptide-based gels, mimicking natural enamel formation. The peptide-based gels goal is to rebuild the enamel by replicating the mineralization process that occurs during enamel formation. [18]

Related Research Articles

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Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Tooth enamel</span> Major tissue that makes up part of the tooth in humans and many animals

Tooth enamel is one of the four major tissues that make up the tooth in humans and many animals, including some species of fish. It makes up the normally visible part of the tooth, covering the crown. The other major tissues are dentin, cementum, and dental pulp. It is a very hard, white to off-white, highly mineralised substance that acts as a barrier to protect the tooth but can become susceptible to degradation, especially by acids from food and drink. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as caries, is the breakdown of teeth due to acids produced by bacteria. The resulting cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation. Tooth regeneration is an ongoing stem cell–based field of study that aims to find methods to reverse the effects of decay; current methods are based on easing symptoms.

<span class="mw-page-title-main">Hyperdontia</span> Condition of having extra teeth beyond the regular number of teeth

Hyperdontia is the condition of having supernumerary teeth, or teeth that appear in addition to the regular number of teeth. They can appear in any area of the dental arch and can affect any dental organ. The opposite of hyperdontia is hypodontia, where there is a congenital lack of teeth, which is a condition seen more commonly than hyperdontia. The scientific definition of hyperdontia is "any tooth or odontogenic structure that is formed from tooth germ in excess of usual number for any given region of the dental arch." The additional teeth, which may be few or many, can occur on any place in the dental arch. Their arrangement may be symmetrical or non-symmetrical.

Tooth whitening or tooth bleaching is the process of lightening the colour of human teeth. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic colour of the tooth enamel. The chemical degradation of the chromogens within or on the tooth is termed as bleaching.

<span class="mw-page-title-main">Enamel organ</span> Aggregate of cells involved in tooth development

The enamel organ, also known as the dental organ, is a cellular aggregation seen in a developing tooth and it lies above the dental papilla. The enamel organ which is differentiated from the primitive oral epithelium lining the stomodeum. The enamel organ is responsible for the formation of enamel, initiation of dentine formation, establishment of the shape of a tooth's crown, and establishment of the dentoenamel junction.

<span class="mw-page-title-main">Dental fluorosis</span> Tooth enamel discoloration due to excessive fluoride ingestion

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Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.

<span class="mw-page-title-main">Dentinogenesis imperfecta</span> Genetic disorder impairing tooth development

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<span class="mw-page-title-main">Early childhood caries</span> Dental disease of young children

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<span class="mw-page-title-main">Enamel hypoplasia</span> Lack of tooth enamel

Enamel hypoplasia is a defect of the teeth in which the enamel is deficient in quantity, caused by defective enamel matrix formation during enamel development, as a result of inherited and acquired systemic condition(s). It can be identified as missing tooth structure and may manifest as pits or grooves in the crown of the affected teeth, and in extreme cases, some portions of the crown of the tooth may have no enamel, exposing the dentin. It may be generalized across the dentition or localized to a few teeth. Defects are categorized by shape or location. Common categories are pit-form, plane-form, linear-form, and localised enamel hypoplasia. Hypoplastic lesions are found in areas of the teeth where the enamel was being actively formed during a systemic or local disturbance. Since the formation of enamel extends over a long period of time, defects may be confined to one well-defined area of the affected teeth. Knowledge of chronological development of deciduous and permanent teeth makes it possible to determine the approximate time at which the developmental disturbance occurred. Enamel hypoplasia varies substantially among populations and can be used to infer health and behavioural impacts from the past. Defects have also been found in a variety of non-human animals.

<span class="mw-page-title-main">Amelogenesis imperfecta</span> Genetic disorder resulting in abnormal enamel

Amelogenesis imperfecta (AI) is a congenital disorder which presents with a rare abnormal formation of the enamel or external layer of the crown of teeth, unrelated to any systemic or generalized conditions. Enamel is composed mostly of mineral, that is formed and regulated by the proteins in it. Amelogenesis imperfecta is due to the malfunction of the proteins in the enamel as a result of abnormal enamel formation via amelogenesis.

<span class="mw-page-title-main">Tricho–dento–osseous syndrome</span> Medical condition

Tricho–dento–osseous syndrome (TDO) is a rare, systemic, autosomal dominant genetic disorder that causes defects in hair, teeth, and bones respectively. This disease is present at birth. TDO has been shown to occur in areas of close geographic proximity and within families; most recent documented cases are in Virginia, Tennessee, and North Carolina. The cause of this disease is a mutation in the DLX3 gene, which controls hair follicle differentiation and induction of bone formation. All patients with TDO have two co-existing conditions called enamel hypoplasia and taurodontism in which the abnormal growth patterns of the teeth result in severe external and internal defects. The hair defects are characterized as being rough, course, with profuse shedding. Hair is curly and kinky at infancy but later straightens. Dental defects are characterized by dark-yellow/brownish colored teeth, thin and/or possibly pitted enamel, that is malformed. The teeth can also look normal in color, but also have a physical impression of extreme fragility and thinness in appearance. Additionally, severe underbites where the top and bottom teeth fail to correctly align may be present; it is common for the affected individual to have a larger, more pronounced lower jaw and longer bones. The physical deformities that TDO causes become more noticeable with age, and emotional support for the family as well as the affected individual is frequently recommended. Adequate treatment for TDO is a team based approach, mostly involving physical therapists, dentists, and oromaxillofacial surgeons. Genetic counseling is also recommended.

<span class="mw-page-title-main">Tooth discoloration</span> Medical condition

Tooth discoloration is abnormal tooth color, hue or translucency. External discoloration is accumulation of stains on the tooth surface. Internal discoloration is due to absorption of pigment particles into tooth structure. Sometimes there are several different co-existent factors responsible for discoloration.

<span class="mw-page-title-main">Linear enamel hypoplasia</span> Presence of banded depressions in the enamel surface of teeth

Linear enamel hypoplasia (LEH) is a failure of the tooth enamel to develop correctly during growth, leaving bands of reduced enamel on a tooth surface. It is the most common type of enamel hypoplasia reported in clinical and archaeological samples, with other types including plane-form enamel hypoplasia and pitting enamel hypoplasia.

<span class="mw-page-title-main">Molar incisor hypomineralisation</span> Medical condition

Molar incisor hypomineralisation (MIH) is a type of enamel defect affecting, as the name suggests, the first molars and incisors in the permanent dentition. MIH is considered a worldwide problem with a global prevalence of 12.9% and is usually identified in children under 10 years old. This developmental condition is caused by the lack of mineralisation of enamel during its maturation phase, due to interruption to the function of ameloblasts. Peri- and post-natal factors including premature birth, certain medical conditions, fever and antibiotic use have been found to be associated with development of MIH. Recent studies have suggested the role of genetics and/or epigenetic changes to be contributors of MIH development. However, further studies on the aetiology of MIH are required because it is believed to be multifactorial.

Enamel microabrasion is a procedure in cosmetic dentistry used to improve the appearance of the teeth. Like tooth whitening it is used to remove discolorations of the tooth surface but microabrasion is both a mechanical and chemical procedure.

<span class="mw-page-title-main">Pitting enamel hypoplasia</span> Presence of rounded depressions in the surface enamel of teeth

Enamel hypoplasia can take a variety of forms, but all types are associated with a reduction of enamel formation due to disruption in ameloblast production. One of the most common types, pitting enamel hypoplasia (PEH), ranges from small circular pinpricks to larger irregular depressions. Pits also vary in how they occur on a tooth surface, some forming rows and others more randomly scattered. PEH can be associated with other types of hypoplasia, but it is often the only defect observed. Causes of PEH can range from genetic conditions to environmental factors, and the frequency of occurrence varies substantially between populations and species, likely due to environmental, genetic and health differences. The most striking example of this is in Paranthropus robustus, with half of all primary molars, and a quarter of permanent molars, displaying PEH defects, thought to be caused by a specific genetic condition, amelogenesis imperfecta.

References

  1. 1 2 3 Towle, Ian; Dove, Eleanor R.; Irish, Joel D.; Groote, Isabelle De (7 June 2018). "Severe Plane-Form Enamel Hypoplasia in a Dentition from Roman Britain". Dental Anthropology Journal. 30 (1): 16–24. doi:10.26575/daj.v30i1.23.
  2. ↑ Hillson, Simon; Bond, Sandra (September 1997). "Relationship of enamel hypoplasia to the pattern of tooth crown growth: A discussion". American Journal of Physical Anthropology. 104 (1): 89–103. doi:10.1002/(SICI)1096-8644(199709)104:1<89::AID-AJPA6>3.0.CO;2-8. PMID   9331455.
  3. ↑ King, T.; Hillson, S.; Humphrey, L.T. (January 2002). "A detailed study of enamel hypoplasia in a post-medieval adolescent of known age and sex". Archives of Oral Biology. 47 (1): 29–39. doi:10.1016/s0003-9969(01)00091-7. PMID   11743929.
  4. 1 2 3 4 DMD, Jin Lin (2021-03-09). "What Is Enamel Formation? | Enamel Developmental Defects". Hurst Pediatric Dentistry. Retrieved 2024-12-10.
  5. 1 2 3 4 5 "Enamel Hypoplasia, Hypomineralization And Teeth Effects". www.colgate.com. Retrieved 2024-12-10.
  6. 1 2 DMD, Jin Lin (2021-03-19). "Enamel Hypoplasia Treatment For Children". Hurst Pediatric Dentistry. Retrieved 2024-12-10.
  7. 1 2 "Enamel Hypoplasia: How to Spot the Symptoms (and Treat Them)". Better & Better. Retrieved 2024-12-10.
  8. 1 2 Lewis, Mary (2018). "Dental Disease, Defects, and Variations in Dental Morphology". Paleopathology of Children. pp. 67–89. doi:10.1016/B978-0-12-410402-0.00004-7. ISBN   978-0-12-410402-0.
  9. ↑ Kanchan, T.; Machado, M.; Rao, A.; Krishan, K.; Garg, A. K. (2015). "Indian Journal of Dentistry – Indian Dental Health Care Blog". Indian Journal of Dentistry. 6 (2): 99–102. doi: 10.4103/0975-962x.155887 . PMC   4455163 . PMID   26097340.
  10. 1 2 3 4 "Enamel Hypoplasia: Causes and Treatment". www.pronamel.us. Retrieved 2024-12-10.
  11. 1 2 Oliveira, Adriana; Felinto, Lázaro; Francisconi-dos-Rios, Luciana; Moi, Gisele; Nahsan, Flavia (January 2020). "Dental Bleaching, Microabrasion, and Resin Infiltration: Case Report of Minimally Invasive Treatment of Enamel Hypoplasia". The International Journal of Prosthodontics. 33 (1): 105–110. doi:10.11607/ijp.6232. PMID   31860920.
  12. ↑ Olczak-Kowalczyk, Dorota; Krämer, Norbert; Gozdowski, Dariusz; Turska-Szybka, Anna (2023-03-27). "Developmental enamel defects and their relationship with caries in adolescents aged 18 years". Scientific Reports. 13 (1): 4932. Bibcode:2023NatSR..13.4932O. doi:10.1038/s41598-023-31717-2. ISSN   2045-2322. PMC   10042880 . PMID   36973358.
  13. 1 2 Manton, David J.; Crombie, Felicity; Schwendicke, Falk (2021). "Enamel Defects". Oral Epidemiology. Textbooks in Contemporary Dentistry. pp. 169–191. doi:10.1007/978-3-030-50123-5_10. ISBN   978-3-030-50122-8.
  14. ↑ Disha, Valbona; Zaimi, Marin; Petrela, Elizana; Aliaj, Fatbardha (April 2024). "An Investigation into the Prevalence of Enamel Hypoplasia in an Urban Area Based on the Types and Affected Teeth". Children. 11 (4): 474. doi: 10.3390/children11040474 . ISSN   2227-9067. PMC   11049504 . PMID   38671691.
  15. ↑ Slayton, Rebecca L; Warren, John J; Kanellis, Michael J; Levy, Steven M; Islam, Mahbubul (January 2001). "Prevalence of enamel hypoplasia and isolated opacities in the primary dentition" (PDF). Pediatric Dentistry. 23 (1): 32–36. PMID   11242728.
  16. ↑ Alotaibi, Rasha N.; Howe, Brian J.; Moreno Uribe, Lina M.; Sanchez, Carla; Deleyiannis, Frederic W.B.; Padilla, Carmencita; Poletta, Fernando A.; Orioli, Ieda M.; Buxó, Carmen J.; Wehby, George L.; Vieira, Alexandre R.; Murray, Jeffrey; Valencia-Ramírez, Consuelo; Restrepo Muñeton, Claudia P.; Long, Ross E.; Shaffer, John R.; Reis, Steven E.; Weinberg, Seth M.; Neiswanger, Katherine; McNeil, Daniel W.; Marazita, Mary L. (2022). "Genetic Analyses of Enamel Hypoplasia in Multiethnic Cohorts". Human Heredity. 87 (2): 34–50. doi:10.1159/000522642. PMC   9378791 . PMID   35172313.
  17. ↑ Kobayashi, Tatiana Yuriko; Vitor, Luciana Lourenço Ribeiro; Carrara, Cleide Felício Carvalho; Silva, Thiago Cruvinel; Rios, Daniela; Machado, Maria Aparecida Andrade Moreira; Oliveira, Thais Marchini (June 2018). "Dental enamel defect diagnosis through different technology-based devices". International Dental Journal. 68 (3): 138–143. doi:10.1111/idj.12350. PMC   9378886 . PMID   29168574.
  18. ↑ Yup, Kayla (October 1, 2024). "Teeth-Cleaning Robots, Red-Light Therapy: What's Ahead for Dental Health". The Wall Street Journal . Retrieved October 8, 2024.
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