Main treatment objectives for dental anomalies:
- to alleviate symptoms;
- to maintain/restore occlusal height; and
- to improve aesthetics.
Prevention
Prevention is an essential part of the management of children with enamel and dentine
anomalies. Oral hygiene in these children is often poor, due in part to the rough
enamel surface which promotes plaque retention and to the sensitivity of the tooth to
brushing. As a result there may be marked gingival inflammation and bleeding. The
combination of gingival swelling and enamel hypoplasia can result in areas of food
stagnation and a generally low level of oral health. Oral hygiene instruction must be
given sympathetically, with plenty of encouragement, and should be continually
reinforced. In some cases it may be necessary to carry out some restorative/cosmetic
treatment before good oral hygiene measures can be practised. For example, the
placement of anterior composite veneers may reduce dentine sensitivity and improve
the enamel surface so that the patient can brush their teeth more effectively.
Conventional caries prevention with diet advice, fluoride supplements, and topical
fluoride applications is mandatory. In this group of children it is particularly
important to preserve tooth tissue and not allow caries to compromise further the
dental hard tissues.
Restoration
Restorative treatment varies considerably depending on the age of the child and extent
of the problem. The basic principle of treatment is that of minimal intervention. If
there is sensitivity or signs of enamel chipping, techniques to cover and protect the
teeth should be considered. In the very young child it is often impossible to carry out
extensive operative treatment, but the placement of glass ionomer cement over areas
of enamel hypoplasia is simple and effective. In older/more co-operative children
stainless-steel (or nickel/chrome) preformed crowns should be placed on the second
primary molars to minimize further wear due to tooth on tooth contact (587HChapter 8). It
is advisable (and usually possible) to place such restorations with minimum tooth
preparation because of the pre-existing tooth tissue loss.
Young children with dentinogenesis imperfecta often pose the greatest problems. The
teeth undergo such excessive wear that they become worn down to gingival level and
are unrestorable. Teeth affected by dentinogenesis imperfecta are also prone to
spontaneous abscesses due to the progressive obliteration of the pulp chambers. In
these cases pulp therapy is unsuccessful and extraction of the affected teeth is
necessary.
As the permanent dentition develops close monitoring of the rate of tooth wear will
guide the decision about what intervention is needed. Cast occlusal onlays on the first
permanent molars not only protect the underlying tooth structure but also maintain
function and control symptoms. The resulting increase in the vertical dimension is
associated with a decrease in the vertical overlap of the incisors. Within a few weeks
full occlusion is usually re-established, the whole procedure being well tolerated by
young patients. As the premolars erupt similar castings may be placed if wear is