Diagnoses

Enamel demineralization

Establishing this diagnosis

Tooth enamel is extremely durable, and is glassy smooth when healthy. Early demineralization usually appears as frosty white spots on the enamel. Demineralized enamel has a chalky surface, which may scrape off in a fine powder with relative ease, and readily picks up brown stains from coffee, tea, smoking, and food / drink colorings.

Clues about the origin of the demineralized enamel can be obtained by studying the pattern of demineralization on the teeth (i.e. which teeth are involved, which surfaces of the teeth, the amount of surface area involved, and the location of the demineralization).

For example, bulimic patients typically show acid erosion of the palatal surfaces of the upper front teeth. Patients who maintain poor oral hygiene (especially while in braces) often have demineralization in the gingival one third of the teeth.

Enamel demineralization may be difficult to discern from enamel hypoplasia (a condition in which the enamel shell is thin, and may be pitted or otherwise irregular; or from enamel hypocalcification, a condition in which the enamel never mineralizes completely to begin with. Generally, however, if it is possible to establish that the enamel was once regular, and that chalky demineralized spots occurred since that time, the diagnosis of enamel demineralization is correct.

Many times, early enamel demineralization won't be apparent on X-ray images of the teeth, because enough hard tissue remains to stop the penetration of X-rays. However the remaining hard tissue may no longer be durable.