Enamel hypomineralization of permanent first molars: a morphological study and survey of possible aetiological factors.

OBJECTIVES: The aim of this study was to investigate the morphological appearance of severe hypomineralized enamel of permanent first molars by means of polarized light microscopy, and to estimate the possible time, severity and longevity of the insult. Furthermore, the aim was to survey some commonly implicated aetiological factors in order to gain knowledge about possible pathogenesis of the enamel disturbances which could be compared with future epidemiological studies. SAMPLE AND METHODS: Seventy-three teeth, which had been extracted due to severe hypomineralizations of the enamel, were collected and serially cut longitudinally in a bucco-lingual direction. The sections were examined in polarized light, dry and embedded in water. The children were also examined with respect to the demarcated opacities of other permanent teeth than those that were extracted. The parents were asked about their health during the mother's pregnancy, the time of gestation, birth weight and any complications. They were also asked about the child's health during the first 2 years of its life, the length of time of breast-feeding and also about fluoride supplements.
RESULTS: The hypomineralized areas extended cervically from the cusps, comprising about half of the buccal and lingual sides. The cervical borders to normal enamel were well defined and mainly followed the lines of Hunter-Schreger. The hypomineralized zones were covered by thin well-mineralized enamel. The majority of the children had demarcated opacities of all their first molars and also of some permanent incisors. No obvious correlation to the anamnestic data could be found.
CONCLUSIONS: The hypomineralized enamel in the investigated teeth demonstrated areas of porosity of varying degrees. The yellow/brown defects were more porous than the white-cream and extended through the whole enamel layer, while the white-cream opacities were situated in the inner parts of the enamel. There had probably been an interacting disturbance of short duration of systemic origin of the activity of the ameloblast during the first 2 years of the child's life, resulting in chronological dispersed hypomineralized demarcated opacities in the developing teeth.