raya:
Hi...
I have been searching for an answer as to what I can do about my teeth!!! Let me fill you in a bit..
This sounds really silly but when I let direct air onto my teeth white marks appear..this has been happening for years,I have been to the dentist and they have done nothing for me,one even chipped part of my tooth off!But that did nothing apart from leave me with a dent! It only happens to my two front teeth.Its a real problem for me as I am very self conscious of it,when I dive naturally the air Im breathing is going straight onto my teeth therefore,after each dive I come up with these white stains,its the same if at night I have my mouth open,in the morning I wake up with the marks.My parents told me that the problem stems from when I was a child I was given penicilon for something or other during the time when my milk teeth had fallen out...
I have even gone to the extent of buying a gum shield to wear whilst diving but that was a nightmare as the shield was too big and i couldn´t keep the regulator in my mouth.Can anyone please help me??? I am desperate so much so,Ide rather have them taken out just so I can enjoy the dives and not be constantly thinking about my teeth when I get out!
Thank you
Natalie xxx
Hi Natalie,
I don't believe I run across this question before but here goes...
It sounds like you're describing hypocalcification of the enamel on your front teeth. This condition is a result of something that either caused the enamel to form inproperly during the time your teeth were developing or something affected the enamel quality during or after the tooth eruption.
High fevers during early childhood affect the cells that form enamel. The result is a poor quality enamel. It may appear as white streaks or bands and may be chalky in appearance. When associated with childhood illness, the bands will form in the teeth that correspond to that point in time when those particular cells were forming enamel. Since it will be the same for similar teeth, i.e., the two upper central incisors, the bands will be in the same place. BUT...since ajacent teeth are forming enamel in a different part of the tooth, the banding will be in a different place within that tooth which corresponds to the same TIME as the bands formed in other, dyssimilar teeth. It is not uncommon to see bands in the six front teeth that appear at different levels of the affected teeth. It might create a curved band that is closest to the ends of the two front teeth and curving toward the gums as you go back to the canine teeth.
Another way to affect enamel formation is trauma to the unerupted permanent teeth by way of of some impact trauma to the overlying baby (deciduous) teeth. If the baby teeth are somehow jammed into the underlying permanent teeth while the enamel is forming, there will be a defect that corresponds to where the root of the baby tooth was forced into the surface of the permanent tooth or moved the permanet teeth and disrupted the enamel forming cells. The mark may appear as a white blotch or depression in the permanent tooth surface. Sometimes no normal enamel at all forms in the area of trauma and only dentin is visible. If the two front baby teeth were jammed at the same time and both affected the underlying permanent teeth, then a symmetrical injury will occur...similar to what you describe. Actually, this is a relatively common type of childhood injury. I would suspect that this is what happened to your teeth.
Slow eruption and/or poor dental hygiene during early childhood during normal eruption can result in the acids created by bacterial plaque to demineralize the otherwise normal enamel. The result is whitish streak or blotchs in a random pattern on the enamel of the permanent teeth.
OK...that is some of the ways enamel can become hypocalcified but why does it get lighter and darker?
The hypocalicfied enamel is more porous than normal enamel. When dry air is directed onto this porous surface, moisture normally found within the enamel is evaporatedleaving a dehydrated surface that is "whiter" than the rest. Scuba air is extremely dry and will definitely dehydrate the tooth surface. An analogous example is frosted glass...when wet, it is translucent and "darker" in color than when dry which makes it look more opaque and lighter.
I have seen this effect on normal enamel when doing a procedure that requires long periods of dryness such as bonding. The teeth change color and appear whiter. It is important for me to choose a restoration color before drying the teeth.
So what can you do to minimize or prevent the problem? First, unless you are willing to remove the defective enamel, the best you can hope to do is to minimize the dehydration. Your "gum shield" was one way. You might want to try applying cocoa butter to the surface of the affected teeth before diving and during your surface intervals. You can also do this before bedtime to minimize dehydration at night. It won't be 100% effective but it might be worth a try. Another thing you may want to try is to have the dentist apply topical fluoride at the office and have you use a fluoride rinse at home. The idea is to try to "remineralize" the affected toth surface. Results would be variable but would be permanent and might be worth trying before you consider some sort of restorative option.
If the hypocalcification is so bad as to be a real consmetic problem, you might have no other choice but to resurface the tooth with a restoration...be it a bonded filling in the white area only or a porcelain laminate veneer to entirely recreate the tooth surface with no visible defects or margins. If there is no decay in your affected teeth, then you have to decide whether you want to sacrifice the existing tooth surface for an artificial one. Your hypocalcification may go your entire life without any other problems other than cosmetic.
One more thing...if you are tempted to bleach or whiten your teeth, keep in mind that the white area of enamel will usually become whiter than the remainder of the tooth. In mild cases of hypocalcification, you might actually be able to whiten the normal enamel to almost the same level as the "white" areashiding the blotches. However, it is also possible that you will make you white areas permanently more visible so be careful.
Try the cocoa butter first. Let me know what happens...I'd be interested in how it works.
Laurence Stein, DDS
