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Perhaps you’ve just visited your dentist and have questions. Maybe you’re just starting to explore the world of dental health (in which case I’m glad you’re here)! Either way, you’ve got foundational questions about the structure of teeth — like tooth enamel.

What is tooth enamel? Tooth enamel is the outermost layer of the tooth surface. Enamel is a hard shell made up of minerals that covers and protects more sensitive tooth tissue. It does not contain living cells. The color of healthy enamel ranges from gray- or blue-white to light yellow.

What is the role of tooth enamel? The role of tooth enamel is to guard your teeth against decay, bacteria, plaque, acids, and any daily wear or tear that threatens your tooth’s health. It is the hardest substance in the human body and has a Mohs hardness scale similar to steel.

While the definition of tooth enamel is widely agreed upon, how to care for it is a different story. Integrative dentistry believes in treating root causes of enamel issues and building stronger enamel to promote overall health. 

Tooth enamel loss can be prevented, and in some cases, even restored. Let’s dive into defining tooth enamel and how to avoid enamel erosion.

What causes tooth enamel loss?

Tooth enamel is a changeable substance within the body. It can be reinforced or reduced, depending on many environmental erosive factors. 

There are several causes of tooth enamel loss, AKA dental erosion:

  • Abrasion. This is physical wear and tear on the outer layer of the tooth, which can be caused by improper use of floss, toothpaste, or a toothbrush, chewing on hard objects like pens and nail biting, and chewing tobacco use.
  • Attrition. This is the deterioration of teeth due to friction with other teeth. The most likely culprit here is bruxism, or tooth grinding, which is related to stress. Bruxism often affects the molars, though it can occur on any tooth.
  • Abfraction. Flexing or bending the tooth beyond its capacity can crack the tooth and cause a form of erosion known as abfraction.
  • Corrosion. This is tooth decay caused by acid attacking the enamel surface. It may occur from very acidic food, GERD (gastroesophageal reflux), acid reflux, fruit juices, vomiting (especially due to bulimia or alcoholism), aspirin, excessive whitening, or vitamin C tablets. These culprits eat away at the surface of the tooth over time.

Signs of Enamel Erosion

How do I know if I have enamel erosion or not? You can quickly see if you have enamel loss by looking at two things: color and condition. A yellowish color or cracks and damage to the tooth structure may indicate thinning tooth enamel.

What are the main signs of enamel erosion? The main signs of enamel erosion include:

  • Mild sensitivity. When enamel begins to wear away, it can expose the more sensitive layer below, called dentin. Dentin quickly registers changes in heat, cold, and sweets (which feed the acids that cause tooth decay).
  • Intense sensitivity. Sharp, severe pain from the hot, cold, and sweet sensations in the mouth can occur in the later stages of enamel erosion.
  • Discoloration. The teeth can take on a yellowish color when more of the dentin layer is exposed.
  • Cracks and chips. The edges of teeth take on a more jagged appearance, feeling rougher and more irregular as the enamel wears down.
  • Indentations. Also known as cupping, small dents can appear in your teeth as enamel wears thin.

Tooth enamel can also begin to develop dental caries (tooth decay) more easily. If you’re experiencing frequent dental issues or cavities, eroded enamel may be to blame.

Can you rebuild tooth enamel?

You can restore demineralized tooth enamel, but you cannot rebuild tooth enamel entirely once it’s gone. When you notice weakening enamel, make necessary changes in your diet, lifestyle, and oral care.

The first step in losing tooth enamel is called demineralization. This occurs when the acid produced by bacteria eats away at the minerals that make up the enamel. These minerals include fluoride, hydroxyapatite, and the calcium and phosphate ions that help to restore teeth.

Teeth can also be remineralized. In this process, you can replenish the minerals that have worn away, weakening the enamel. Fluoride and hydroxyapatite treatments aim to remineralize tooth enamel.

Protecting Your Tooth Enamel

In functional dentistry, addressing root causes of demineralization is preferable to dealing with cavities down the road. Protecting your tooth enamel is undeniably a better option than trying to remineralize your teeth after the enamel has eroded away.

How do you stop enamel loss before it starts? Stopping enamel loss before it starts involves a combination of several preventative measures:

  • Get the best nutrients. Vitamins K2, D3, and essential minerals are all crucial dietary factors to build healthier teeth.
  • Avoid mouth breathing. Breathing through the mouth can dehydrate oral tissues, creating a friendlier environment for bacteria to demineralize the teeth. Mouth taping at night or retraining yourself or your child to breathe through the nose during the day can help!
  • Oral probiotics. Oral probiotics are a great option to balance the microbiome in the mouth and fend off an acid attack.
  • Limit phytic acid intake. Often found in whole grains, legumes, nuts, and plant-based oils, phytic acid reduces your ability to absorb certain minerals that help build tooth enamel. Try sprouting, fermenting, or soaking the phytates in your diet — particularly when kids are involved.
  • Practice oral hygiene. Both brushing and flossing are vital in preventing demineralized enamel for children and adults. I also recommend tongue scraping to keep the oral microbiome well-balanced.
  • Flossing. Flossing removes buildup of plaque from in between teeth. This prevents plaque bacteria from eating away at the tooth enamel that toothbrushes don’t reach.
  • Alkalizing mouthwash. An acidic oral environment can promote enamel loss. An alkalizing mouthwash neutralizes the harmful bacteria that break down tooth enamel.

For more on prevention, diet, and handy oral health tips, check out my Instagram!

Treatment of Enamel Loss

While prevention is the best possible outcome, it’s simply not possible in some cases where enamel loss has already begun. 

How do you fix tooth enamel? You can often fix tooth enamel by restoring the minerals it has lost. This process is called remineralization. The best ways to rebuild demineralized teeth are to change your lifestyle and diet and to practice holistic oral hygiene. 

Minerals to add back to tooth structure include calcium phosphate, magnesium, potassium, and hydroxyapatite.

Consider an oral probiotic to restore the good bacteria and other organic material within your oral microbiome.

Dietary Overhaul

Diet is the key to overall health, and changing what you eat can give your body the essential minerals it needs to remineralize enamel.

Ensure these vitamins are in your diet for optimal dental health:

  • Vitamin K2
  • Vitamin D3
  • Vitamin A
  • Vitamin E

Essential minerals for restoring teeth include:

  • Calcium
  • Magnesium
  • Phosphorus

I recommend eating the rainbow, with lots of whole fruits and vegetables, as well as grass-fed dairy and meats.

Oil Pulling

Oil pulling involves swishing organic oil around in the mouth for up to 20 minutes. This habit can moisturize the mouth, inhibit plaque, and support strong enamel.

Additionally, oil pulling doesn’t have the same drying effect as many traditional types of mouthwash. Conventional mouthwash kills positive bacteria in the mouth and promotes dry mouth. Please, don’t use alcohol-based mouthwash.

Personally, I prefer organic coconut oil for this healthy practice.

Hydroxyapatite Toothpaste

Hydroxyapatite toothpaste is one of the best options for your oral hygiene routine.

Hydroxyapatite makes up 97% of the tooth. A toothpaste containing hydroxyapatite crystals can help restore the minerals that build strong enamel.

My personal favorites are Risewell (use my code DOCTORSTACI for 10% off) and Boka (use my code DOCTORSTACI for 20% off).

Switch to Sugar-Free Gum 

Saliva contains calcium and phosphorus, agents that assist in remineralizing enamel. Chewing on sugar-free gum can help increase the saliva circulating through the mouth.

I recommend xylitol gum, which seems to promote oral health beyond just saliva production. Xylitol is almost 0-calorie but still sweet because it’s a sugar alcohol. (Definitely don’t let your dog eat any xylitol products.)

A Note On Toothpaste

Many traditional dental professionals suggest fluoride toothpaste. However, I do not recommend it to my patients for their overall health care. 

Hydroxyapatite toothpaste is proven to work as well as fluoride toothpaste, but without the potential side effects.

When to Visit the Dentist

In some more severe cases of enamel loss, remineralization is not possible. The enamel may be extremely damaged, or lifestyle changes may not be the right choice for that specific case.

What happens if tooth enamel is gone? If tooth enamel is gone, certain dental procedures like fillings, crowns, or veneers may be necessary. Make sure to use biocompatible materials, not heavy metals like mercury amalgam.

If you are experiencing painful tooth sensitivity, cracking and chipping in the teeth, or cupping in the teeth, it’s time to see a dentist and create a plan for treating enamel loss.

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