Enamel Hypoplasia in Children with Down Syndrome: Developmental Pathways and Clinical Implications for Oral Health

Enamel hypoplasia is a developmental defect characterized by a quantitative reduction of enamel thickness resulting from disturbances during amelogenesis. Children with Down syndrome present a markedly higher prevalence of dental anomalies, including enamel hypoplasia, compared to the general population, potentially leading to functional, esthetic, and psychosocial complications. This review synthesizes current evidence regarding the association between enamel hypoplasia and Down syndrome in children, focusing on etiological mechanisms, prevalence, and clinical implications. A narrative literature review was conducted using PubMed, Scopus, ScienceDirect, and Google Scholar databases with relevant keywords related to Down syndrome and enamel developmental defects. The reviewed studies consistently report a higher occurrence of enamel hypoplasia in children with Down syndrome, with prevalence rates ranging from approximately 30% to over 45%. The condition is associated with genetic predisposition, impaired embryonic blood supply, and systemic developmental disturbances affecting neurological and odontogenic processes. Disruption of odontoblast activity may interfere with ameloblast differentiation, leading to reduced enamel matrix secretion. Clinically, enamel hypoplasia increases susceptibility to dental caries, tooth sensitivity, enamel wear, and compromised oral health–related quality of life. Current evidence indicates a significant association between Down syndrome and enamel hypoplasia; however, further comprehensive and methodologically robust studies are required to clarify causal pathways and optimize preventive and therapeutic strategies. Early diagnosis and tailored dental management are essential to improve oral health outcomes in this vulnerable population.