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What's an Enamel Pearl? Causes, Diagnosis, and Treatment

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Medically Reviewed By Colgate Global Scientific Communications

An enamel pearl is a hard lump of enamel that develops on the root of a tooth where it doesn't usually belong. Enamel pearls can affect the affected tooth's health and provide space for bacteria to collect in the gumline. Learn more about what causes enamel pearls and how they can be treated.

What Causes Enamel Pearls?

According to an article in the Journal of Dental Sciences, enamel pearls form when enamel cells — called ameloblasts — travel below the gumline to the root and start producing enamel. This prevents the normal root covering from developing, leaving a nodule of enamel at the root instead of at the crown where it belongs.

Enamel Pearl Diagnosis

According to a report in Biomedical Research, enamel pearls most commonly appear on the upper molars but can be found on other teeth. Their size can vary from 0.3 to 4 millimeters, and they may affect 1.1% to 9.7% of the population. Routine X-rays can detect enamel pearls early. It's critical to treat the enamel pearl early.

Enamel Pearl Complications

If left untreated, an enamel pearl may cause gum and bone tissue destruction. It may cause inflammation and periodontal pockets—gaps between the tooth and gums where bacteria can collect—which jeopardize the health and longevity of the tooth involved. The enamel's nodule can allow plaque to collect under the gumline and lead to losing the critical tissue structure that holds the tooth in place. If a patient has severe bone and tissue damage, tooth extraction may be the only option.


Once detected, the enamel pearl needs to be removed so plaque buildup can be removed, and the periodontal pockets can be healed. Your dentist can remove it with dental burs and files. After treatment is completed, the enamel pearl will not reappear.

Enamel pearls cannot be prevented since they begin as rare anomalies at the cellular level. But they can be treated quickly. Visit your dental professional for regular checkups, X-rays, and cleanings so they can detect enamel pearls as soon as possible. If you notice chronic inflammation, bleeding, or discomfort despite good oral hygiene habits, contact your dentist's office right away. Proper evaluation and treatment by your dentist and dental hygienist can prevent this tooth anomaly from affecting your smile.

Oral Care Center articles are reviewed by an oral health medical professional. This information is for educational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your dentist, physician or other qualified healthcare provider. 

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