What is Enamel Hypocalcification & How to Treat It?

If you’ve noticed a white, brown or yellow spot or stain on your teeth, they could be showing signs of hypocalcification of enamel.

Enamel is the outermost mineralized layer of the tooth that protects the underlying tissues of the tooth.


Any damage to the enamel leads to eventual loss of strength of the tooth, increased sensitivity and in severe cases loss of tooth structure.

During hypocalcification, the chalky white spots appear on the surface of the teeth due to acidic conditions in the mouth that dissolve the calcium in the tooth enamel and cause it to leach out.

In some cases, hypocalcification may further lead to discoloration and can also trigger tooth decay. Several factors can cause this dental condition.

Some are hereditary by nature, whereas others can be due to any external factor and lack of oral health care.

In today’s post, we will discuss in detail about enamel hypocalcification, its causes, complications, and treatment.

What is enamel?

A tooth has several layers. The innermost layer called the tooth pulp consists of a nerve, vein, and artery encapsulated within the pulp chamber.

A layer of dentin that contains dentinal tubules covers the pulpal tissues. Enamel is the hard external mineralized layer which acts as a protective cover of the teeth and protects the tooth from bacterial damages.

What is enamel hypocalcification?

The layer of enamel is made up of minerals like calcium phosphate and hydroxylapatite. Low concentration of such minerals on the tooth surface leads to the formation of chalky white spots on the dental crown. This condition is known as enamel hypocalcification.

The common reason behind hypocalcification of the tooth enamel is the loss of calcium due to an excessive acidic condition in the oral cavity and defect in enamel formation during tooth development.

What causes enamel hypocalcification?

Calcium loss

Acidic foods and acids formed by bacteria around the teeth can wear out the calcium present in enamel.

This reaction changes the structure of the enamel, making the affected area of the tooth weaker and porous.

If this condition is left untreated, the calcium breaks down further causing permanent damage to the enamel and tooth cavity.

Poor oral care is often the reason to blame for demineralization of tooth enamel. Patients who have their braces removed might notice white spots where the brackets were attached to the tooth.

Similar spots also appear after teeth whitening procedures. In reality, a teeth whitening procedure only makes these white spots more visible.

Defective enamel formation

A hereditary dental condition can have adverse effects on both primary and permanent teeth. Ameloblasts are a type of cells that are responsible for the secretion of enamel proteins during tooth development.

These proteins mineralize to lay down the enamel. Presence of fewer ameloblasts impedes normal enamel formation. This condition is known as Amelogenesis imperfect.

This condition makes the enamel to form a fragile protective layer over the dentin instead of a hard covering, eventually leading to hypocalcification.

The National Organization for Rare Disorders reported that about one in 14,000 to 16,000 children in America have amelogenesis imperfecta. (1)

Treatment modalities

The best guide to correct the treatment is to find out the cause of hypocalcification. A proper oral care regime is the key to maintain the overall oral health.

In less severe cases, where the enamel is slightly affected, and the calcium is lost due to the acidic contents in the mouth, the enamel may respond to remineralization.

Here, remineralization is done through specially formulated toothpaste, creams or even fluoride treatments, preventing further calcium loss and cavity development.

In case of excessive tooth sensitivity, use of any toothpaste specially formulated to relieve sensitivity can be used.

If stains have affected only the cosmetic appearance of your teeth, the dentist may suggest tooth bleaching to improve its look.

If the discoloration is severe, your dentist may advise getting a restoration done in the affected areas.

In amelogenesis imperfecta patients, hypocalcification cannot be reversed. But a dentist can provide artificial replacements for the weak enamel.

Full crown restorations or specialized dentures for broken teeth are effective to cover and protect the dentin and to prevent decay relieving sensitivity of the tooth.

Take away message

Never lightly take dental problems and ignore them. Go for regular dental check-ups and professional cleanings.

Patients often take hypocalcification as decalcification of teeth as they have similar clinical symptoms.

A dentist will diagnose the correct dental condition and provide a treatment plan to restore your smile.


Nowadays a variety of cosmetic options are available that include orthodontics (braces), teeth whitening (both in-office and at-home), crowns and ceramic bonding for front teeth (veneers).

The layer of enamel protects the teeth, but weak enamel leads to severe dental problems.

Be aware and always check for any abnormality or changes in the appearance of your teeth. Consult a dentist and ask for advice to avoid damage to your oral health.


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