New developments in understanding development defects of enamel: optimizing clinical outcomes

Abstract

Developmental defects of enamel appear to be presenting with increasing frequency and with this comes significant clinical challenges. Affected teeth, in particular first permanent molars, are susceptible to dental caries as they are not only more porous but also very sensitive making effective oral hygiene difficult. Affected children require more dental treatment than their unaffected peers while also suffering greater pain and anxiety. Current clinical approaches focus on the placement of contemporary adhesive restorative materials onto the compromised tooth which in turn, fail, leading to premature loss of permanent molars with associated repercussions. Incomplete understanding of the structure, composition and behaviour of affected enamel means that clinical protocols are, as yet, empiric rather than evidence based. This review summarises contemporary evidence regarding this condition and identifies potential areas for future research which would assist in improving clinical outcomes.

Keywords:

• Developmental enamel defects
• molar-incisor-hypomineralization
• paediatric dentistry

Acknowledgments

This review is based upon a paper presented at the British Orthodontic Society Annual meeting in Harrogate in 2007. The author wishes to acknowledge the contribution of her collaborators; Professor Mike Swain, Dr Erin Mahoney, Dr Felicity Crombie and Dr John Winters in providing data, feedback and images for Figures 1 and 4 during the preparation of this manuscript.