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Tooth Enamel: Functions, Problems & Proper Care | Hawaii Family Dental

The tooth enamel, which is considered the strongest substance in the body, is one of the four major tissues that comprises the tooth along with dentin, cementum, and the dental pulp.

It covers the visible part of the tooth called the crown. Unlike other parts of the mouth, it does not have blood vessels or nerves. Still, it is highly mineralized with 96 percent of its composition being water and the rest being organic materials. Hydroxyapatite, a naturally occurring mineral which is a crystalline calcium phosphate, is the primary mineral of the tooth enamel.

How Does Enamel Develop?

A part of the tooth development process, enamel begin to form in the crown stage through the process called amelogenesis or enamel formation. The process starts following the first establishment of the dentin through ameloblast cells.

The enamel formation is further divided into two stages called the secretory stage where proteins and an organic matrix  form a partially mineralized enamel, and the maturation stage which completes the mineralization of the enamel.

What Does Enamel Do?

As the outer layer of the tooth, enamel serves as a protective barrier against harmful bacteria and acids that can attack the teeth and cause dental problems. It also protects the teeth from the pressure and stress of the teeth's daily use including in chewing, biting, and grinding. Moreover, it works as an insulator of the teeth for temperatures and chemicals that may be potentially harmful to the teeth.

Enamel Wear

Your enamel is the outer layer of the teeth. It serves as the first defense against oral attackers and is responsible for shielding the teeth from everyday use, acid from oral bacteria, chemicals from a particular food, and the impact from your regular biting habits.

Enamel wear occurs when the enamel is damaged due to its exposure to different chemicals from food, fluids, and even smoking. Although the saliva works to neutralize the acids in the mouth and maintain its balance, too much exposure can lead to enamel erosion as the saliva cannot keep up with the acids.

Causes of Enamel Wear

Enamel wear or erosion can occur when acids corrode the enamel of the tooth which can be cause by the following:

  • Low salivary flow or dry mouth
  • Acid reflux
  • High amount of starch and sugar in the diet
  • Medications such as antihistamine and aspirin
  • Highly acidic drinks or food such as the excessive consumption of soda
  • Gastrointestinal problems
  • Genetics

Environmental Causes of Enamel Wear

Any combination of stress, wear and tear, corrosion and friction can cause the tooth surface to erode. These terms are also known as:

  • Abfraction. This takes place following stress fractures in the tooth like bending of the tooth or cracks from flexing of the tooth.
  • Attrition. This is described as a natural tooth to tooth friction which takes place when a person gnashes his or her teeth like bruxism. This usually happens involuntarily when a person is sleeping.
  • Corrosion. This takes place when the acidic content impairs the surface of the tooth. This can be because of excessive consumption of acidic foods, beverages, and medications. Likewise, this may be due to frequent gagging from bulimia, as a result of GORD, binge drinking, and other conditions.
  • Abrasion. This pertains to the erosion of the surface of the tooth which emerges because of improper flossing, brushing the teeth too hard, chewing tobacco or biting on hard or solid objects like pens, bottle caps, and fingernails.

In some instances, the lack of enamel arises from developmental problems that occur either during the critical developmental stages or inherited conditions. Currently, two general conditions cause a lack of enamel on one’s teeth:

Enamel hypoplasia: When someone has enamel hypoplasia, their teeth tend to have depressions in the form of pits and groves. They may also have white or yellowish spots on the teeth and be especially sensitive to the temperature. Factors that can increase the risk of this include congenital issues and hereditary factors.

Hypomineralization: Another factor that can contribute to a lack of enamel is hypomineralization. Much like enamel hypoplasia, risk factors include congenital issues, but one can also contract this from childhood illnesses. Those afflicted with enamel hypomineralization tend to have a chalky tooth surface. Their teeth may also appear translucent. 

While disease-associated factors partially cause a lack of enamel, it’s not the only thing that causes it. Most cases of enamel loss do not involve hereditary causes. Instead, enamel erosion is the most significant contributor to this reduction, be it in those who are predisposed and not. 

For the most part, two factors typically contribute to erosion:

Physical. When enamel erosion is physical, this means that it is physically taken off over time. The causes include sustained frictional or blunt damage your teeth get over time, due to external abrasive forces, or improper oral habits. Repeat occurrences usually take off more enamel. Intervention for this type of erosion often involves pinpointing practices that contribute to it and correcting them, either by oral appliances or lifestyle changes. 

Chemical. When enamel erosion is chemical, it usually comes from substances in the food you eat. One obvious offender is acid, which can be found in most carbonated or sour drinks. Other sources include chlorine from pools or certain medications. In this case, you can limit erosion by regulating your intake of abrasive substances in your diet or otherwise.

Signs of Enamel Wear

Tooth sensitivity is a sign of an early stage of enamel erosion wherein the teeth becomes sensitive to some foods and drinks especially sweets and those with high temperatures.

Tooth discoloration is a condition wherein the tooth appears yellow. The discoloration is caused by the exposure of the dentin due to enamel erosion.

Cracked and chipped tooth as it becomes more jagged, irregular, and rough due to the erosion.

Treatment

There are different types of treatments available for enamel wear. Depending on the degree or extent of the problem, the recommended treatment may include bonding, veneer, or crown. Talk to your dentist to know more of your options.

Additionally, you can also get treatments to reduce the effects of the symptoms of enamel wear such as tooth sensitivity, tooth discoloration, cracked or chipped tooth, and indentations on the tooth's surface.

Prevention

Enamel erosion, like most dental problems, is preventable with proper oral hygiene such as brushing, flossing, and rinsing with mouthwash. Fluoride treatments can also help strengthen the tooth's enamel.

Moreover, it is advisable to refrain from food and drinks that can potentially harm the enamel particularly those rich in sugar and acids. If you intend to drink acidic beverages, it is recommended to use straw to avoid contact with the teeth. Also, decrease the frequency of snacking as it subjects the teeth to more probability of tooth decay.

Additionally, accompany your food consumption with water to ensure the adequate amount of saliva and prevent the occurrence of dry mouth. Try chewing sugar-free gums to boost saliva production.

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