Tooth enamel is the body’s hardest substance, forming a protective outer layer for each tooth that defends sensitive inner tissues from chewing and temperature changes. When this defense weakens through mineral loss, the first stage of tooth decay can emerge. This initial phase is an enamel lesion, which often appears as a subtle white spot on the tooth’s surface.
Causes of Enamel Demineralization
Enamel lesions result from demineralization, the loss of minerals like calcium and phosphate from the enamel. This process is driven by acids, primarily from bacteria in dental plaque, a sticky film that forms on teeth. When these bacteria consume sugars, they produce acid that lowers the pH in the mouth.
When the oral pH drops below 5.5, the enamel’s crystals begin to dissolve. In addition to bacterial acids, dietary acids from sodas, fruit juices, and citrus fruits also contribute to this process. Repeated acid attacks can overwhelm the protective mechanisms of saliva.
Certain conditions heighten the risk of demineralization. Orthodontic braces can make cleaning difficult, allowing plaque to accumulate. Dry mouth (xerostomia) is another risk factor, as reduced saliva production increases the risk of demineralization.
Appearance and Identification
The earliest sign of an enamel lesion is a “white spot” on the tooth. This spot looks different from healthy enamel because demineralization creates microscopic pores beneath the surface. These pores change how light reflects off the tooth, resulting in a chalky and opaque white appearance.
A dental professional often identifies these lesions during an exam, as they become more obvious when the tooth surface is dried. They may also be visible to an individual, particularly on the front teeth. If demineralization continues, the lesion can absorb stains from food and drinks, changing its color from white to a yellowish or brownish hue.
Treatment and Reversal Options
Treatment for an enamel lesion depends on its severity, with a focus on the least invasive methods first. In its early stages, a white spot lesion is reversible through remineralization. This repair process is enhanced by fluoride, which makes enamel more resistant to acid and helps attract minerals from saliva to rebuild weakened areas.
For deeper lesions that don’t resolve with fluoride, dental professionals have other options. One technique is resin infiltration, which involves applying an etching agent to open the lesion’s pores, followed by a liquid resin that seeps into the area. The resin hardens, filling the gaps, stabilizing the enamel, and restoring the tooth’s natural appearance.
Another treatment is microabrasion, which removes a thin layer of surface enamel with a mild abrasive compound to eliminate superficial white spots. If a lesion is not addressed, it can form a cavity. At that point, the damage is irreversible and requires a dental filling.
Preventing Enamel Lesions
Prevention revolves around consistent oral hygiene and dietary habits. The primary method is removing plaque by brushing at least twice a day with a fluoride toothpaste and flossing daily. Brushing removes the bacterial film that produces acid, while flossing targets plaque between teeth and along the gumline.
Dietary choices are important for controlling acid levels. Limit sugary foods and acidic drinks like sodas and fruit juices. Consume them with meals rather than throughout the day to reduce acid exposure, and rinse with water after eating to help neutralize acids.
Saliva is the body’s natural defense against demineralization, as it neutralizes acids and provides minerals for remineralization. Chewing sugar-free gum after meals can increase saliva production. Finally, regular dental check-ups and cleanings allow for the early identification and management of risks before lesions develop.