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Background
Amelogenesis is a genetically controlled mechanism but is prone to environmental insults. The enamel is prone to numerous insults which interact at different stages-formation, calcification and maturation either prenatally or postnatally. 1 Depending on type, timing and duration of insult, a variety of hypoplasias can occur. 2 Chronological hypoplasia (linear enamel hypoplasia) is a specific type of hypoplasia occurring due to environmental insult unlike amelogenesis imperfecta that has a genetic component. Even clinically they can be distinguished from other types of hypoplasias due to its multiple, symmetrical, chronological pattern, linear, ring-like pattern involving all surfaces of tooth. 2 Depending on severity, chronological hypoplasia can cause problems like aesthetic problems, tooth sensitivity, caries susceptibility, occlusal wear, loss of vertical dimension, early pulpal involvement. 3 Given that hypoplasias are present when teeth erupt, aesthetic problems arising from these hypoplasias are a big concern in children and adolescents. 4 5 Aesthetic problems in female children especially are associated with psychological crisis and will require early interception. Most of the cases mentioned in the literature have rarely been able to correlate aetiological factors and positive history. All environmental factors cannot be recollected by patients or their guardians. A uniqueness in the present case is that there was a positive correlation between malnutrition (specific) at a particular age (1-2 years) and the specific clinical presentation (area of tooth involvement that mineralises corresponding to 1-2 years). However, it would be difficult to pinpoint which particular deficiency caused hypoplasia because enamel formation requires several nutritional factors.
Case presentation
A 14-year-old girl presented with notched upper front teeth. Further history revealed that notches were present ever since the teeth erupted into the oral cavity. No history of positive trauma was present. Primary teeth did not have such abnormality. The parents accompanying the child were enquired regarding prenatal and postnatal history. Mother's obstetric history was unremarkable but child's postnatal history revealed that the child was hospitalised for a prolonged period around the age of 1-2 years. Parents recalled that the child suffered from severe malnutrition and required hospitalisation for 2 weeks until proper recovery.
General examination revealed a malnourished child. Child's height and weight showed severe deviation from standard general population height and weight charts for Indian population. Intraoral examination revealed dentition corresponding...