What is Enamel?
Enamel is the hard, outer layer of the teeth. It is made up of hydroxyapatite crystals that provide strength and protection for the teeth. Enamel is naturally transparent and ranges in color from light yellow to grayish white. It covers the entire tooth and works to protect the sensitive dentin layer underneath.
Once fully formed, enamel cannot be regenerated by the body. This is because enamel-forming cells called ameloblasts are lost after tooth development. While enamel is durable, it can become damaged and worn down over time from factors like diet, oral hygiene, grinding, and age. Loss of enamel is irreversible and can lead to increased sensitivity and decay.
What Causes Enamel Loss?
There are several factors that contribute to the breakdown and demineralization of enamel:
– Acidic foods and drinks – Frequent consumption of acidic foods and beverages can erode and dissolve enamel over time. This includes items like citrus, carbonated drinks, vinegar, and sour candy. The enamel slowly wears away through a process called demineralization.
– Poor oral hygiene – Not properly brushing and flossing allows plaque bacteria to build up along the gumline. The bacteria metabolize sugar and release acid that eats away at enamel.
– Teeth grinding – Grinding or clenching puts excessive force on teeth and slowly thins and fractures the enamel layer. This abrasion causes the enamel to wear down.
– Genetics and developmental issues – Some people may be born with thinner or weaker enamel that is more prone to breakdown. Developmental defects can also leave areas of enamel missing or underdeveloped.
– Acid reflux or bulimia – Frequent vomiting introduces stomach acids into the mouth which can dissolve tooth enamel. Acid reflux at night has a similar effect.
– Medications – Certain medications like antihistamines reduce saliva flow. Saliva naturally helps to neutralize acids and protect enamel. Dry mouth leaves teeth more susceptible to decay.
– Whitening treatments – The peroxide gels used in whitening strips and treatments weaken enamel over time, making it more porous.
– Tooth injury – Chipping or cracking teeth from an accident can damage the enamel layer. Clenching and grinding may then further wear down compromised areas.
Is it Possible to Regrow Lost Enamel?
Once enamel is lost, it is gone for good. Enamel cannot regenerate or grow back on its own because the cells responsible for forming it are lost after teeth erupt. There are no living cells left in mature enamel.
While we do not yet have the ability to regenerate true enamel, there are ways to repair and replenish minerals lost from enamel through a process called remineralization. The goal is to prevent further enamel breakdown and improve the strength and appearance of existing enamel.
– Fluoride – Fluoride is the most commonly used substance to remineralize enamel and reverse early decay. It attracts calcium and phosphate ions present in saliva to rebuild and mineralize eroded areas. Fluoride toothpaste, treatment gels, and municipal water sources help strengthen enamel.
– Calcium and phosphate – Minerals like calcium, phosphate, and hydroxyapatite can be replenished through special rinses, gels, and pastes. This helps enamel recover some mineral content and become less porous. Food sources high in calcium like milk and cheese also support remineralization.
– Xylitol – Xylitol is a natural sweetener that has been found to prevent bacteria from producing acids that demineralize enamel. It reduces caries and helps bolster enamel. Xylitol gum is an easy way to obtain benefits.
– Casein phosphopeptide-amorphous calcium phosphate – CPP-ACP is a special milk-derived protein applied via mousse or toothpaste that delivers bioavailable calcium and phosphate. It attracts minerals into the enamel to fill microscopic gaps.
– Argon laser – Low-level argon laser therapy at dental appointments can stimulate mineral uptake in enamel crystals. The light energy encourages calcium and phosphate from saliva to rebuild enamel.
– Silver diamine fluoride – Topical silver diamine fluoride helps halt the progression of caries (cavities). It kills bacteria and primes compromised areas for remineralization with elements like fluoride.
– Bonding and sealants – Placing resin composites and dental sealants over areas of enamel breakdown can physically protect against further damage. By sealing off enamel from bacteria and acids, bonding prevents caries.
There are a few things you can do at home on a daily basis to help reverse enamel loss and prevent further demineralization:
– Use fluoride toothpaste and rinse daily – Brushing twice daily with a fluoride toothpaste and rinsing at night with a fluoride mouthwash will strengthen your enamel and fight demineralization.
– Limit acidic foods and drinks – Avoid frequent exposure to acids by limiting intake of carbonated soft drinks, sports drinks, citrus fruits and juices, pickles, and other acidic items. Rinse with water after consuming.
– Chew xylitol gum – Chewing gum with xylitol has been shown to stimulate saliva flow and remineralization. Xylitol gum also inhibits the bacteria that cause caries.
– Eat remineralizing foods – Consume foods high in bioavailable calcium and phosphate like milk, yogurt, cheese, fish with edible bones, leafy greens, and nuts. This helps replenish lost minerals.
– Use remineralizing toothpaste – Seek out specialty toothpastes containing compounds like CPP-ACP or nano-hydroxyapatite to rebuild lost enamel minerals.
– Avoid teeth grinding and clenching – Use a nightguard and stress management techniques to stop putting excess force on your teeth that wears down enamel.
– Stimulate saliva flow – Chew sugar-free gum or hard foods like carrots and apples to promote more saliva production. Saliva provides minerals that strengthen enamel.
– Get regular dental cleanings – Regular professional cleanings and checkups will monitor for early enamel breakdown and allow for remineralizing treatments.
Professional Enamel Remineralization Options
More intensive remineralization therapies are available from your dentist to help recover enamel integrity:
– Varnish – A resin-based varnish is painted onto teeth to deliver a high dose of fluoride. It adheres to enamel and slowly releases fluoride over several hours to boost remineralization.
– Gel – A stronger gel containing a high concentration of fluoride is applied to teeth using trays. This intensive treatment remineralizes enamel and reverses white spot lesions.
– Foam – Foam containing 1.23% acidulated phosphate fluoride is brushed onto teeth. It adheres well to enamel and provides calcium and phosphate minerals.
– Silver Diamine Fluoride – Painting on this medicated solution not only halts active decay but also remineralizes enamel crystals.
Sealants and Resin Infiltration
– Resin sealants – Flowable composite resins can seal over areas of enamel breakdown to protect against bacteria and acid penetration into pores.
– Resin infiltration – Special resins are applied to smooth and reinforce weakened enamel and halt subsurface lesion progression.
– Bonding – Composite resins can also be bonded to chipped or cracked areas of enamel to shield it from additional damage and provide a polished finish.
– Carbon dioxide lasers – A dentist can use a carbon dioxide laser to irradiate enamel and convert calcium and phosphate into more stable compounds inside enamel crystals.
– argon lasers – This blue light interacts with pigments inside bacteria and promotes the release of free radicals that accelerate mineral recrystallization in enamel.
– Biomimetic mineralization – Synthetic self-assembling peptides are applied that attract free calcium and phosphate ions and rebuild hydroxyapatite crystals in enamel.
– Calcium phosphate rinses – Rinsing with calcium phosphate before bed helps replenish critical minerals lost throughout the day.
– CPP-ACP paste – This casein phosphopeptide-stabilized calcium phosphate paste delivers bioavailable minerals to remineralize enamel.
Can You Permanently Replace Lost Enamel?
The truth is, we do not currently have the ability to regenerate true natural enamel once it has broken down. No treatment can permanently recreate enamel’s complex structure, physical properties, and appearance. Remineralization aims to salvage and fortify remaining enamel rather than recreate it.
However, permanent restorations are available to replicate the look and function of natural enamel in areas where it has been significantly lost. These include:
Dental crowns cap the entire visible portion of a tooth. A crown is made from porcelain fused to metal, ceramic, or resin composite. It fully envelops the tooth to provide strength and a natural appearance. Crowns protect what enamel is left and prevent fractures. They are a long-lasting solution for extensive enamel loss.
Veneers and Facings
Veneers and facings are semi-permanent shells made from porcelain or composite resin that adhere to the front surface of teeth. These thin coverings mask enamel imperfections and mimic enamel’s translucency. While not as strong as crowns, they preserve remaining enamel.
Resin composites can be bonded directly to teeth to fill in gaps or chips in enamel. Dentists sculpt and polish resin to match the tooth’s natural color, shape, and texture. Bonding creates a protective barrier over areas of enamel loss.
Outlook for Enamel Regrowth in the Future
The complex structure of enamel continues to elude efforts to regenerate it fully. Enamel forms from proteins and minerals deposited in a highly organized manner that cannot be replicated once mature. But emerging research brings hope for enamel regrowth down the road:
– Stem cell therapy shows promise to one day generate new enamel-producing cells. Stem cells from sources like urine or adipose fat might be coaxed with growth factors to become functional ameloblast cells.
– Gene therapy may enable correcting genetic defects causing enamel malformation and hypomineralization. Introducing normal genes into ameloblasts could improve enamel quantity and quality.
– Peptide-induced biomimetic mineralization may eventually organize synthetic enamel formation in vitro. Self-assembling peptides applied to etched enamel direct calcium and phosphate into ordered hydroxyapatite crystals.
– Scaffolds made from materials like chitosan and synthetic collagen aim to facilitate enamel regrowth in vivo by providing a template for ameloblast adhesion and structured deposition of minerals.
– Drug therapies that target cellular ion channels may stimulate transport of minerals needed for organized enamel formation. Manipulating ion concentrations can enhance enamel mineral content.
– Amelogenin proteins are being investigated for their role in modulating enamel mineralization. Reintroducing these proteins to adult teeth may provide the right signals for enamel regrowth.
While still in early stages, these approaches represent possible routes to clinical enamel regeneration in the years ahead. But currently, remineralization and permanent restoration remain the best ways to salvage and recreate lost enamel structure and function. Proper preventive dental care is key to maintaining the enamel you have.
Enamel does not regenerate on its own once it is lost. The cells responsible for forming enamel are only present before teeth erupt. However, it may be possible to regrow enamel in the future with emerging technologies like stem cell therapy, biomimetic mineralization, and gene therapy. For now, remineralization treatments can help strengthen and protect remaining enamel by replacing lost minerals. Permanent restorations like dental crowns, veneers, fillings, and bonding are able to mimic the appearance, function, and feel of natural enamel in areas where it has broken down extensively. While enamel cannot yet be regenerated, researchers are working to make this a reality in the coming years through enamel regrowth and regeneration techniques.