Ask the Dentist: What's the cause of soft, discoloured patches of tooth enamel?

Dentist Lucy Stock of Gentle Dental Care in Belfast outlines the reasons for and treatment of discoloured patches of enamel

Enamel Hypoplasia can be treated by applying strengthening remineralising gels or with veneers
Lucy Stock

ENAMEL is the armour of our teeth; it's the super-strong outer layer that protects the inner softer dentine and pulp layers. When we form as babies and all the processes work perfectly, the enamel ends up being one of the hardest substances in the body. However, like everything in life, sometimes things just don't go smoothly, leaving some children and adults with an imperfect coat of arms to defend their teeth.

Enamel Hypoplasia (EH), sometimes referred to as a 'Turner's tooth', is a condition of the enamel that can leave permanent discoloured patches of soft, crumbly enamel. They look like white, brown or creamy marks on the front and back teeth. EH mostly affects the 'six-year-old' first molars and the upper front teeth, with around one in five people in Britain and Northern Ireland affected. Some people may have a mild form and not even realise it. The affected teeth can be more sensitive, more difficult to numb and more prone to decay.

The cause of it is not fully understood, although severe childhood illnesses (high fever, pneumonia, middle-ear infection, viral infections etc) or a traumatic / premature birth have all been suggested as possible causes. First molars begin mineralising at birth and the top front incisor teeth shortly after at the two-to-four-month mark. So anything going on at this time will affect enamel formation.

Tooth development is sensitive to malnutrition or vitamin deficiencies, particularly vitamins A, C, and D. So it's super important to maintain a good diet during pregnancy, especially in the third trimester as this is the time milk-tooth enamel is forming. However, even perfectly healthy infants can suffer from EH; from, for example, if a baby tooth is knocked.

The type of treatment required will depend on how severely the tooth is affected. The key is to get to a dentist as early as possible to minimise problems. All that may be necessary is careful monitoring and the application of strengthening remineralising gels. If there is decay then fillings or crowns can be used to rebuild the teeth.

People with EH can help themselves by being extra careful to maintain a low-sugar diet and keep their teeth spit-spot clean. However, its not just the physical side; socially, people with EH teeth may feel embarrassed to smile due to the marks so if that's the case fillings or veneers can be placed to improve smiling confidence.

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