I receive many questions about the treatment required for molar hypoplasia and I can understand of parents when confronted with this problem. It is difficult to provide specific advice since there are multiple factors influencing the treatment. I will provide here some general guidelines that can influence the treatment for hypoplasia, but it does not replace a consultation with your dentist, since the treatment has to be tailored to each person.
When confronted with a tooth or teeth with hypomineralisation, the first decision that needs to be made, is if to treat or remove the tooth or teeth. The factors that can influence the decision are:
- The number of teeth affected, if it is more than one, is it a symmetrical condition? A symmetrical condition may allow for an extraction, while it is irrational to remove a perfectly good tooth.
- The position of the tooth or teeth, if the molars are affected, and extraction can be an option, but it will be not wise to remove any anterior teeth, like incisors. Even if the extraction is the way to go, the timing is important as well.
- The degree of destruction is a major consideration since if the tooth is severely deformed restoring it may be a challenge. At times the nerve inside the tooth may be damages as well. In severely affected cases removing the tooth and closing the gap with the other remaining teeth can be a good option.
- The condition of the other teeth, if other teeth are missing, there are no wisdom teeth, the relationship between the upper and lower jaws isn’t right or there is a spaced dentition, then removing the tooth is not a good option.
- The age of the child, in the developing dentition it is easier to influence the eruption sequence and position of the teeth.
- The number of teeth affected and their position are all factors which influence the treatment modality required.
This long list of factors to consider requires at times the treating dentist to consult an orthodontist that will monitor the eruption of the adjacent teeth and their position. The Orthodontist can decide if and when to intervene. The reason of remove the malformed tooth is that the teeth which will replace it will not need any treatment over the life of your child.
If the decision is made to retain the tooth it will need to be initially protected, so the irregular enamel does not allow bacteria to establish themselves and cause decay.
The degree of protection the tooth needs is dependent on the level of destruction, adjacent teeth and the general condition of the dentition.
Since the hypoplastic enamel, does not allow for good bonding of a composite restoration, the malformed enamel will either need to be removed and replaced with composite or porcelain restorations or covered with a stainless steel crown. Over the life of your child the restoration will need to be replaced, the replacement will depend on the condition of the tooth, the alternatives and the cost of treatment.
In summary there are multiple factors that influence the treatment needed for your child .
more information can be found in this article.
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