Amelogenesis Imperfecta and Snap-On Smile®
Non-invasive solution offers AI patients a new alternative.
Dentists learn of amelogenesis imperfecta (AI) in dental school, but few are challenged with an entire family of AI patients. This author has treated three generations of patients all with the same disorder.
AI is genomic; it affects the structure and clinical appearance of enamel of all or nearly all the teeth. The pulp canal can be twice the normal size and the dentin can be thin enough to cause extreme sensitivity to thermal, chemical, and mechanical stimuli, and weak enough to allow prolific cavity formation.
The clinical challenges AI brings to the dentist are many, but the challenges faced by the patient can be overwhelming. Apart from making the simple procedure of filling a cavity an extremely painful experience, AI creates all manner of social problems. Patients find themselves shying away from normal social contact. Younger sufferers have been known to resort to covering their teeth when they speak in an attempt to make themselves look "normal."
One of this author's AI patients recounted that when she was a child, she was ridiculed at school for not brushing her teeth. They looked uncared for because of the discoloration caused by AI. Children can be very cruel and this taunting was an ongoing, everyday occurrence for this patient, and it had a huge impact on her self-esteem. In the 1960s and 1970s, virtually no one had even heard of this disease. The patient did not know why her teeth were discolored; she knew that she brushed them regularly but it made no difference. Finally, when she was 18 she had plastic caps put on the front teeth. She did not realize that, because of AI, they would not last or that they would stain with age and be very delicate.
This patient presented to the author at age 48 to have some of the cracked and discolored caps replaced. What she actually needed was a full-mouth restoration, but because of the dentition's condition, crowns and bridges were out of the question and bonding to enamel with hypocalcification and/or hypomaturation seemed futile. Extensive removal and fixed prosthetic reconstruction could have been considered, but such an irreversible conclusion was less than acceptable to her.
The author's approach to this case differed from the typical case. He knew he could not solve her AI and that, over time, any work short of extraction would be money wasted in a potentially never-ending chain of painful appointments. He decided to change tactics and explore how he could improve the patient's life, rather than her teeth. The goal became to relieve the pain and discomfort from the extreme sensitivity the AI caused, plus try to find a way to re-establish the patient's self-esteem.
An Esthetic Form of Protection
Snap-On Smile® is a flexible, removable appliance that snaps directly over the patient's natural teeth. It cannot cure AI, repair its damage, change the fragile dentition, or make the deterioration stop. What it can do is help provide excellent protection from the extreme sensitivity caused by AI, plus give the patient a natural, white, healthy-looking smile.
After the patient saw herself for the first time with her upper and lower Snap-On Smile arches in place, she was overwhelmed. It was such a dramatic transformation (Figure 1, Figure 2 and Figure 3). She actually smiled—in a way the author had never seen her smile before.
Of course there were a few days of adjustment to get used to the appliance, but she never looked back. She recently shared that now she has the confidence to walk into any room and talk to anyone, with her new smile and newfound confidence.
She was amazed that in the process of fitting Snap-On Smile, there was no grinding of tooth structure, no shots, and, because it is completely tooth borne, she does not have wire clasps or plates and does not need adhesives. She is excited to be able to eat steak, apples, and nuts without difficulty.
Only 1 person in 14,000 is likely to suffer from AI, but if an AI patient presents for treatment, consider treatment of the patient's self-esteem a top priority. There is no cure for AI but dentists can give the patient a whole new perspective on life with this treatment. Even patients who do not have AI could benefit from a rejuvenation of their self-esteem. Snap-On Smile can help them experience life with a beautiful, healthy-looking smile and give them the determination to go forward with a treatment plan that offers a permanent solution.
This article was written by Jim Hales, DDS. Dr. Hales is in private practice in Grants Pass, Oregon
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