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Pediatric Dental Health
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What You Need To Know About
Enamel Defects In Baby Teeth
Unsightly defects and discolorations of baby teeth are a
cause of concern for many parents. Nearly 40% of all baby front teeth have some
sort of enamel defect. These defects cause aesthetic problems and
predispose the affected teeth to dental caries. The two most common causes of
enamel defects are: developmental insults and minor facial trauma. These
problems can develop before, during, or after birth. The treatment options for
enamel defects in young children include: aesthetic veneering and microabrasion.
The process of enamel formation (amelogenesis) begins before birth, and
is sensitive to physiologic changes. The enamel of baby (primary) incisors
begins to harden (mineralize) at about 15 week after conception, and the process
of enamel maturation is finished two months after birth. The primary eye teeth
(canines) begin their mineralization at 19 weeks of intrauterine life, and
complete their enamel maturation process 9 months after birth. The cells that
produce the enamel are called ameloblasts, and they are very sensitive to any
developmental disturbances. Evidence of developmental insults, as well as
perinatal and postnatal trauma, can therefore be seen in the enamel of the
primary anterior teeth.
More than 75% of enamel defects in primary teeth are considered to be
developmental in nature. Most developmental enamel defects (DED) occur in
the middle third of the upper (maxillary) incisors. These location of these
defects coincide with the location of the so-called neonatal line. This faint
line, often visible on the facial surface of primary incisors, is thought to be
caused by physiologic, transient, neonatal hypocalcemia. DED of maxillary
incisors can be caused by: premature birth, systemic insults at birth, early
childhood infections, nutritional problems, maternal illness or drug intake
during pregnancy, or genetic problems associated with enamel formation.
Less than 25% of enamel defects in primary teeth are caused by minor facial trauma
or pressure. Such defects mostly appear as hypoplastic spots on the primary
canines. These hypoplastic defects result from perinatal or postnatal minor
facial trauma or pressure, including passage through the birth canal.
Hypoplastic defects in primary canines are quantitative defects, which means
that they are associated with a reduced thickness of enamel.
Treatment of dental defects should take into account the variability in
children's ability to cooperate during dental treatment. One option for treating
enamel defects is to cover up the unsightly areas with a tooth-colored cosmetic
material. This may be the best option for very young children. In this
technique, the surface of the tooth is covered by a bonded microfilled composite
resin. Another treatment option is microabrasion. Enamel microabrasion is the
process of removing dental stains and surface defects - using a combination of
acid and abrasives. Enamel microabrasion is useful for the removal of
superficial enamel dysmineralization defects and decalcification lesions. Enamel
microabrasion can be used in children as young as six years of age.
A dental journal article reviews a common type of defect in baby teeth:
Seow WK. Enamel hypoplasia in the primary dentition: a review. ASDC
Journal of Dentistry for Children. 58:441-452,1991
February Is National Children's Dental
National Children's Dental Health Month (NCDHM) is a
month-long nationwide program which promotes healthy smiles in children. The
American Dental Association has sponsored this annual event every February,
NCDHM originated in 1941 in Cleveland, Ohio as a one-day dental health program.
Since then, it has grown into a month-long observance, and every February it
reaches millions of people. Local observances often include: school programs,
dental society promotions, health fairs, and public service announcements.
In spite of the current national emphasis on preventive dental health, however,
many children are still affected by dental caries. Caries in the baby (primary)
teeth is one of the most common health problems affecting young children. In
1996, a national oral health survey found that 38% of children, ages 2 through
9, had dental caries. Caries prevalence in children attending Head Start
programs has reached 90% in some group samples. Early childhood caries (ECC) is
also a leading cause of operating room admissions for children requiring dental
restorations and extractions. Obtaining treatment for caries can be difficult,
since according to a 1997 study, almost 4.2 million children in the U.S. were
unable to obtain dental care.
In the past, children went to the dentist only after a problem was severe enough
to be noticed by a parent. Such an outdated, reactive, approach is no longer
appropriate in the age of preventive health, however. The infant oral health
visit is now the foundation upon which a lifetime of oral and dental health can
The American Dental Association, the American Academy of General Dentistry, and
the American Academy of Pediatric Dentistry all recommend that a child's first
oral health visit take place at 12 months of age, or shortly after the eruption
of the first baby teeth. This is the ideal time for a dentist to evaluate a
child's oral and dental health, as well as to diagnose any problems which may
Oral health is a vital component of a child's overall health. A partnership
between families, dental professionals, and other health professionals is
necessary for achieving oral health in children.
Children’s oral and dental health is achievable! By providing a healthy diet,
minimizing the consumption of sweets, cleaning a child's teeth twice a day, and
getting early dental examinations, a child can have a happy, healthy smile.
Teachers and parents can get dental coloring sheets, puzzles, activity sheets, and lesson plans at Resources
Problems With Over-retained Baby
Parents are often concerned when they see a "double
row" of teeth developing in their 6-year-old's mouth. This should not
be a cause for alarm, however. It occurs when the adult lower front teeth begin
to erupt into the mouth, but the baby teeth have not fallen out yet. It is
usually not necessary to have the over-retained primary incisors extracted in
this situation, however.
Lower permanent incisors normally develop and erupt behind the primary incisors.
Lower primary incisors can be over-retained when the adult teeth erupt
too far away from the baby teeth. In this situation, the normal process of
loosening (resorption) of the primary teeth may not occur.
When the lower (mandibular) permanent incisors erupt, some temporary crowding
will occur, amounting to 1.6 mm in boys, and 1.8 mm in girls. Only after the
full eruption of the lower lateral incisors is the growth and widening of the
supporting (alveolar) bone completed. In fact, the strongest stimulus for
widening of the anterior part of the jaw during childhood is the pressure
created by the eruption of the lower lateral incisors. The bottom line is: a
little bit of crowding during the eruption of the lower incisors can be
beneficial for dental arch development.
There are two rules of thumb used by dentists to determine whether or not
to remove an over-retained lower incisor.