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Diagnoses

Enamel demineralization

About this diagnosis

Diagnoses are associated with common findings which are used to prescribe appropriate treatment.

Alternate terms: White spot lesions.

Enamel demineralization represents a dissolution of the surface enamel—the glassy outer shell of the tooth. It is the earliest form of tooth decay, and is most commonly seen on the visible "facial" surfaces of teeth as frosty white areas (so-called "white spot" lesions). It is caused by a regular exposure of the tooth enamel to acids, such as may be present in persistent accumulations of plaque.

Severe enamel demineralization from methamphetamine abuse

Figure 1a: Severe enamel demineralization secondary to chronic use of methamphetamine ("meth mouth"). These teeth exhibit generalized enamel demineralization that ranges from early to advanced. Areas where it has completely eroded through the enamel into the underlying dentin appear as brown spots.

Softened tooth enamel removed after severe demineralization from meth abuse

Figure 1b: The extent of damaged tooth structure became evident after the softened enamel was removed.

Common sources of acids

  • Bacterial plaques
  • Frequent ingestion of acidic beverages (e.g. phosphoric acid is a common ingredient in soda—even diet soda)
  • Frequent exposure of the teeth to citrus fruits, which contain citric acid (particularly lemons)
  • Stomach acids (as in bulimia and patients with reflux disorders)
  • Certain drugs (such as "meth", or methamphetamine), whether from the drug itself, poor nutrition, chronic dry mouth caused by the drug, or poor dental hygiene common in drug abusers.
  • Poor dental hygiene while undergoing orthodontic treatment frequently results in enamel demineralization.
  • Infection/inflammation. This is the cause of the isolated white spot demineralized areas which are commonly seen on permanent incisor teeth, after a primary (baby) incisor is injured. The primary tooth root is positioned very close to the developing crown of the permanent incisor. If the primary tooth is injured and becomes inflamed at its root tip, the inflammation can demineralize the permanent incisor crown. Those white spots typically are not soft and chalky, however.