Background: Amelogenesis imperfecta (AI) describes a group of hereditary conditions that affect the structure and appearance of enamel, often in association with changes in other intra-oral and/or extra-oral tissues. Without appropriate and timely intervention, oral health may deteriorate rapidly.
Presenting problem: A healthy 15 year old boy (IM) was referred for management of a “decayed dentition”. IM was dissatisfied with his dental appearance and reported generalised sensitivity. He appeared anxious and withdrawn in the clinical environment. Dental intervention had been sporadic for the preceding 5 years, and, before this, was predominantly provided under general anaesthesia. Clinical and radiographic examination demonstrated poor oral hygiene, gross calculus deposition, gingival inflammation, extensive coronal breakdown, failing restorations, increased overjet, incomplete overbite and maxillary crowding. IM was diagnosed with hypocalcified AI.
Clinical management: The treatment aims were to improve aesthetics, reduce sensitivity and protect the remaining tooth structure. Initial management involved prescription of a desensitising agent, oral hygiene instruction and calculus removal. Following multidisciplinary assessment, intermediate management entailed full mouth rehabilitation; composite restorations anteriorly and a combination of ceramic restorations and nickel-chromium onlays posteriorly. Long-term management to date has consisted of regular recall, periodontal and restorative maintenance, initiation of orthodontic therapy and transition to adult services.
Discussion: In the absence of regular dental care, the principles of management of AI had not been applied and IM’s dentition was in a state of neglect on presentation. In order to optimise oral health, the support of a multidisciplinary team involving Paediatric, Restorative and Orthodontic input proved invaluable.