Volume 8 • 2021 • Issue 6

Case Study: Managing a Hypomineralized First Permanent Molar Dr. Jennifer MacLellan, pediatric dentist from Halifax and president of the Canadian Academy of Pediatric Dentistry (CAPD). Definition of enamel hypomineralization It occurs when the mineralization process is not fully achieved during tooth formation. The clinical presentation is variable depending upon the degree of hypomineralization. The enamel may be mildly affected with intact areas of yellow or caramel discolouration or severely hypomineralized with a substantial lack of enamel and significant and rapid post- eruptive breakdown. Enamel hypomineralization is estimated to affect about 20% of children worldwide. Causes of hypomineralization Enamel hypomineralization can occur for many reasons, but it is commonly observed in children with chronic systemic medical conditions or those who have suffered an illness with a high fever during the period of enamel formation. “The Logan chart shows that the first permanent molars typically erupt around age six, start calcifying at or around birth and achieve complete enamel formation after 30 to 36 months,” says Dr. MacLellan. “A febrile illness during that window may lead to the condition.” A diagnosis of chronological enamel hypomineralization of permanent first molars often leads to challenging treatment planning discussions, especially when extraction of a permanent tooth in a young child is recommended as a treatment option. Case study: Hypomineralized First Permanent Molar A first molar erupts with discolored enamel. It has some exposed dentin. Even before it has fully erupted, there is carious breakdown. The child says that it hurts when eating cold, sweet and acidic foods and when brushing. The decay is progressing quickly. “As dentists, we love to save teeth,” says Dr. MacLellan. “And sometimes a hypomineralized tooth is restorable, though it may require a fair amount of treatment.” She says that a stainless steel crown, rather than intracoronal restoration, may be effective in 36 | 2021 | Issue 6