Soft Teeth and Enamel disorders ( Amelogenesis Impecfecta, Dentinogenesis Imperfecta )

Soft teeth is an occurance that usually occurs as the result of a disorder of the the enamel which is the hard outer layer of the tooth that makes it resistant to wear and decay. This can occur due to dietary insufficiencies (Calcium and Flouride), trauma (physical or chemical) to the tooth bud during developement of the tooth or from hereditary or systemic diseases such as Amelogenesis Impecfecta or Dentinogenesis imperfecta. The following images describe characteristics of enamel disorders.

Typical appearance of teeth with poor enamel on a 15 year old boy with excellent hygiene.

Soft teeth are typically darker in color than normal teeth because the enamel of the tooth is what gives it it's whitish color. When the enamel is missing, thin or poor in quality, the darker dentin shows through. Sometimes the teeth have a banded effect and often they also are smaller than normal teeth. If the teeth are banded or only some teeth are affected the cause is usually trauma, dietary or induced by antibiotics while that particular tooth was forming. A generallized enamel problem is usually hereditary or sytemic in nature. If the pateint practices excellent hygiene the teeth can stay relatively healthy as in the picture above.

Typical appearance of teeth with poor enamel on a 15 year old boy with average hygiene.

Since soft teeth have no or poor enamel, they are prone to decay as soon as they erupt into the mouth and typically the teeth are heavily restored with fillings (red arrows) or severely decayed (green arrows) by the time the patient is in their teens. Sometimes temporary crowns (blue arrows) are placed to cover the teeth and give them some protection until the patient is old enough for permanent crowns. Normally patients cannot have permanent crowns done until the late teens because the pulps (nerves) of the teeth are too large to allow preparation of the teeth without the need for root canals.

Teeth of first patient above prepared for crowns.

When the enamel is poor or not present the best treatment is to place crowns on the teeth. Bonding of plastic or porcelain to the teeeth is usually not an effective long term solution becausethe poor enamel yields a weak bond and the filling leak aroud the edges or break off. Crowns are porcelain or porcelain and metal coverings for the teeth which mimic the enamel in both appearance and function. The picture above shows the upper teeth of the first patient on the screen prepared for crowns and the lower teeth have already been prepared and have temporary plastic crowns placed on them.

Same patient with temporary crowns on all of the teeth.

Same patient with permanent crowns on all of the teeth.

Second patient with permanent crowns on all of the teeth.

First patient before and after treatment.

Second patient before and after treatment.

Key words: Soft teeth, amelogenesis imperfecta, enamel disorders, soft enamel, dentinogenesis imperfecta, severe decay

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