tooth enamel erosion and treatment options - Savina dental clinics malta and gozo

The topmost layer of the tooth is known as the enamel. It is the part that protects the tooth from chemical and physical damage. For this reason, it is very tough and deemed the hardest tissue in the body.

Being the first line of defence against physical and chemical damage, the enamel experiences a great deal of wear and tear. This is what we call enamel wear and it occurs in three ways – erosion, abrasion and attrition. As we shall see in this piece, enamel wear causes some symptoms such as tooth sensitivity and stains. Here’s the most unfortunate bit- enamel cannot be regrown.

But on the bright side, you can protect it from wear or stop the damage already done from getting worse with proper dental care and treatment. We will look at everything you need to know about tooth wear and how you can prevent it.

If you are looking for a dentist Malta or dentist Gozo, you can book a dental appointment online at one of Savina Dental Clinics, or contact us directly on (+356) 2125 7253 (Skyparks Business Centre, Malta International Airport), or (+356) 2155 7323 (Dingli Street, Victoria, Gozo). For international patients, it is recommended to request a free e-consultation where we can discuss your individual case and treatment options.

What is tooth enamel, and how is it grown?

What is tooth enamel - savina dental clinics malta

As mentioned above, the enamel is the hardest tissue in the body. But in addition to this, it’s also the most mineralised tissue and provides impeccable durability, which allows teeth to function as both tools for breaking down foods and weapons in animals (1).

The process of developing the enamel and mineralisation is intricate and is handled by the enamel cells called ameloblasts. The process of forming the enamel is known as amelogenesis. Just before a tooth erupts from the gums, the ameloblasts die. This removes the ability of the enamel to repair and regenerate itself. It is because of this that once the enamel is damaged through decay or injury, it cannot self-restore. Also, when the tooth erupts from the gum, it’s partially mineralised (usually 30%).

The mineralisation is completed above the gum using phosphorous, fluoride, and calcium ions, which are present in saliva. These ions are used to thicken the enamel by between 10 micrometres and 100 micrometres over time.

What causes enamel damage?

There are three ways in which the enamel can get damaged.


This is caused by an object rubbing against the tooth. It could be an exercise as simple as brushing your teeth with a toothbrush with hard bristles, brushing horizontally instead of in circular movements, poking your teeth with a toothpick or scraping your teeth when removing partial dentures and retainers.


As opposed to abrasion, enamel erosion occurs when the enamel is exposed for prolonged periods to acids in foods and drinks or stomach acids that are regurgitated from time to time.  Erosion can also be caused by toxins released by plaque bacteria that build upon the gum line.


This is the wear of enamel caused by the teeth rubbing against themselves. It is normally more noticeable in people who grind their teeth, especially a night.

Does plaque cause enamel erosion?

Plaque is a sticky film made up of food particles, saliva, and bacteria. It is formed on the surfaces of the teeth and can get stuck in the pits on the molars. It also forms on the gum line and around cavity fillings.

From time to time, the bacteria in the plaque produce acids from the starch that you ingest. With time, these acids start to eat away at the enamel by eroding the mineral deposits.

So, yes, plaque does cause enamel erosion.

What are the signs of enamel erosion?

The signs tend to vary from person to person and also depend on the stage of erosion. However, the most common signs that we come across include;

  • Sensitivity – some foods and their temperatures can cause some pain during the early stages of erosion. This pain is usually mild.
  • Discolouration – as the enamel is eroded and the dentin (the layer beneath the enamel) is exposed, the teeth start changing colour to yellow.
  • Chips and cracks – as the enamel erodes, it gets weaker and weaker. This causes the edges of the teeth to become rough, jagged and irregular. In some instances, the enamel may chip off or crack.
  • Painful sensitivity – in the late stages of the erosion, the teeth become severely sensitive to sweets and temperatures. You may even experience pain when you breathe in cold air.
  • Cupping – the teeth may become indented as the cusps are worn away
  • When enamel erosion occurs, the teeth become susceptible to tooth decay and cavities.

How to stop enamel erosion

how to stop enamel erosion - savina dental clinics malta and gozo

To prevent the loss of the enamel, you need to keep your teeth healthy by flossing and brushing your teeth twice a day and using antiseptic mouthwash on a daily basis. You should also schedule a checkup with your dentist regularly. In addition to this, you can try;

  • Using a straw when drinking acidic foods. This will push the liquid to the back of your mouth and avoid bathing your teeth with the liquid
  • Monitor the snacks that you have as these increase tooth decay and acidity in the mouth
  • Avoid carbonated drinks and foods
  • Drink water frequently throughout the day
  • Only use fluoride toothpaste as the fluoride strengthens teeth and allows demineralised enamel to repair itself

How to protect tooth enamel from acid erosion

Proper dental care will do the trick. In addition to this, you can;

  • Rinse your mouth with plain water after having acidic foods and drinks
  • Finish your meal with a piece of cheese or a glass of milk to neutralise the acid
  • Chew sugar-free gum as this stimulates saliva production to combat the acids in food or produced by bacteria

How is tooth enamel loss treated?

The treatment of enamel erosion depends on the level of loss that has occurred. At times, tooth bonding is used to protect your teeth and to improve the overall appearance of the teeth. However, if the enamel loss is extreme, then we recommend that you cover the tooth with a veneer or a crown. A crown may protect the tooth from further decay.

Can tooth enamel grow back?

While the body has some powerful self-regeneration abilities, for example, the skin heals and the hair and nails grow when they’re cut, bone also knits together with time after a fracture (2), unfortunately, enamel doesn’t regrow. This is because the cells responsible for its formation are destroyed when the tooth breaks through the gum.

Restorative Dentistry for Tooth Enamel

Restorative dentistry is simply the management of health problems and restoring the mouth to its previous aesthetic state and function. Some of the processes involved in this include veneers, crowns, partial or full dentures, dental implants, bridges, and fillings (3).

And with that, you are equipped with everything you need to know to keep your teeth healthy and safe from enamel erosion. If it has already started, you also know what to do to stop it from spreading.

Have You Tried Our Free e-Consultation Service?

If you are worried about a dental related issue, interested in travelling to Malta for a dental holiday or have questions about any of the treatments we offer, please contact us using our new free e-Consultation service. One of our highly-qualified team will respond to your query as soon as possible. Our e-Consultation service is live 9 am – 6 pm Monday to Friday.

If you would like to schedule an in-person consultation at Savina Dental, please book your appointment using this form.

Savina Clinic – Dental & Implantology Centres are friendly, state-of-the-art practices in Malta and Gozo dedicated to comprehensive quality dental care. Savina Dental is an innovative dental practice in Malta and prides itself on the high-quality customer service, low waiting room times, attention to detail and the advanced dental technology at its disposal.

Joseph Xuereb
Principal Dental Surgeon & Owner of Savina Dental Clinics, Dr Joseph Xuereb BChD (Hons), MFGDP(UK), MGDS RCS(Eng), FFGDP RCS(UK), FICD is a general dental practitioner with a special interest in Implant and Restorative Dentistry. Dr Joseph & the teams' full biographical information can be found here.