Local factors
As well as the possibility of damage to the forming teeth that may be caused by
dental injuries (843HFig. 13.36) (see 844HChapter 12), pressure on the premaxilla from the use
of an oro-tracheal tube may cause damage to the developing primary incisor teeth.
Children with a cleft lip and palate often have enamel defects of the maxillary
incisors. Sometimes this may be related to surgical treatment rather than the effect of
the cleft per se.
Treatment
The treatment of children with enamel defects requires more consideration than
simply mechanical treatment of the teeth. Children with amelogenesis imperfecta, in
particular, may be subject to teasing. This is a serious issue and requires the most
sensitive handling by professionals. Affected adult family members will often
describe their own childhood in lurid and painful terms. Many children will not admit
to this from the outset and need to be given 'permission' (with their parent's
knowledge) to contact the practitioner at a later date to revisit these issues.
Typically, as well as the aesthetics, there may be thermal, contact or osmotic
sensitivity of the teeth. Oral hygiene may be poor and irremediable as a result (845HFig.
13.22). The occlusion may be compromised by lack of vertical dimension as a result
of thinner enamel than normal, or there may be loss of enamel because of poorly
mineralized enamel matrix. Some practitioners advocate the early preventive use of
full coverage restorations in the primary dentition for these children.
Localized defects are much more amenable to simple measures.
846H
Fig. 13.21 Sporadic case; Amelogenesis
imperfecta; hypomineralized with anterior
open bite. Shows failure of eruption teeth
17, 15, 13, 27, 37, 47.847H
Fig. 13.22 Sporadic case; Amelogenesis
imperfecta; hypomineralized; anterior open
bite. The poor oral hygiene and staining are
typical when, as here, the teeth are
sensitive to thermal and mechanical
stimuli.