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Tooth Enamel Demineralization

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.

Enamel demineralization represents a superficial dissolving of the surface enamel—the glassy outer shell — of the tooth. It is the earliest stage of tooth decay (caries), 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 those produced within accumulations of bacterial plaque. White spot lesions can also be caused by direct exposure to acids found in food and drinks. Commonly, the white spots will darken as their roughened surface easily accumulates stains.

Common sources of acids

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.

  • Bacterial plaques
  • Frequent ingestion of acidic beverages (e.g. phosphoric acid is a common ingredient in soda, sports drinks and flavored water—it’s even found in diet soda!)
  • Frequent exposure of the teeth to citrus fruits, which contain citric acid (particularly lemons)
  • Stomach acids (as in the eating disorder, bulimia and patients with reflux disorders. Cells in the stomach produce hydrochloric acid to help digest food.)
  • Certain drugs such as methamphetamines (meth), 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 white spot lesions or 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 (known in such cases as Turner’s hypoplasia). Those white spots typically are not soft and chalky, however.

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Author: Thomas J. Greany, D.D.S. / Editor: Ken Lambrecht

This page was last updated on February 9, 2018.

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