Tooth enamel: causes, symptoms and what to do

What is tooth enamel?

Cleveland Clinic's fluoride page calls enamel the protective outer layer of each tooth, and its erosion page says enamel erosion is the gradual loss of this layer due to chemical or mechanical forces, making teeth more prone to stains, sensitivity and cavities. Colgate says the body cannot make new enamel, so the goal is to protect what you have.

What wears enamel down?

Cleveland Clinic lists sugary, starchy or acidic foods and drinks, brushing too hard especially near the gum line, teeth grinding, chronic acid reflux, dry mouth, long-term use of certain medicines such as antihistamines, genetic conditions like enamel hypoplasia, and bulimia, which exposes teeth to stomach acid. Our guides on white spots and tooth discoloration cover related changes.

What are the symptoms?

Cleveland Clinic says early signs are sensitivity, discoloration, chips and surface pitting, and that as erosion progresses pain and discomfort increase, especially near the pulp, where the nerves are. Untreated, it lists yellowing, decay, rough edges, cracks, heat, cold and sweet sensitivity, exposed dentin and eventual tooth loss. See our guides on sensitive teeth.

Can enamel grow back?

No. Cleveland Clinic says enamel cannot be replaced once it is gone, and that fluoride can strengthen enamel and slow erosion but cannot reverse the damage. Colgate says the body cannot make new enamel but existing enamel can be strengthened and partly repaired.

What is remineralization and can teeth remineralize?

Cleveland Clinic's fluoride page says enamel constantly loses minerals to acids (demineralization) and regains them from food and water, including fluoride, calcium and phosphate (remineralization), that decay occurs when loss outpaces regain, and that fluoride helps remineralize enamel and can reverse early decay. Colgate says remineralization is the natural process by which minerals return to weakened enamel, supported by fluoride toothpaste, cleaning between teeth, limiting sugary, starchy and acidic foods, drinking water and chewing sugar-free gum to keep saliva flowing. It says once enamel loss has progressed to a cavity and the dentin is exposed, remineralization will not restore it and a dentist must fill the cavity.

How is enamel loss treated?

Cleveland Clinic says topical fluoride is used for early-stage erosion, and dental bonding, veneers or crowns for more advanced erosion. Colgate lists the same three and describes bonding as tooth-colored resin protecting weakened areas, veneers as thin porcelain shells for damaged front surfaces, and crowns as covering the whole tooth when it is severely misshapen or discolored. See our guides on bonding, veneers and crowns.

What is enameloplasty and which dentist does it?

The sources we read do not mention enameloplasty, which is generally described as reshaping or smoothing enamel; we cannot say from our sources who performs it or when it is advised. Ask your dentist whether it is an option for you and what it would remove.

How to protect your enamel

Cleveland Clinic advises fluoride toothpaste, brushing at least twice daily, flossing daily, limiting sugary and acidic foods and drinks and alcohol, rinsing with water between meals and snacks, waiting at least 30 minutes after eating before brushing so saliva can neutralize acids, not eating within three hours of bedtime, chewing sugar-free gum after meals, and regular checkups. Our guide on how long to wait to brush after eating covers timing, and the sources disagree about the exact wait after acidic foods.

Does enamel loss always need treatment?

Cleveland Clinic says to see a dentist whenever you notice sensitivity or signs such as chips, pitting or discoloration, with routine visits about every six months and more often for people prone to erosion. Early loss may only need fluoride and protective habits, which is our reading of its advice, so ask your dentist whether yours needs more.

Questions to ask your dentist

Bring these to a check-up.

• Do I have enamel loss, and what is causing it?
• Would fluoride varnish or a prescription toothpaste help?
• Should I change how I brush or when I brush?
• Do I grind my teeth, or have acid reflux?
• Which repair would you advise if the damage progresses?

Frequently asked questions