Decalcification

Decalcification (also demineralisation) in dentistry is a pathological process of losing inorganic minerals - primarily calcium and phosphate ions - from the crystalline lattice of hydroxyapatite, which forms the main component of tooth enamel. This process weakens the tooth structure, increases its porosity and is considered a precursor (early stage) of dental caries.

Mechanism of development

Decalcification occurs due to disruption of the dynamic balance between minerals in the tooth and the surrounding saliva. The main trigger is a drop in pH in the oral cavity below the critical threshold of 5.5.

• Bacterial metabolism: Bacteria in dental plaque (especially Streptococcus mutans) ferment dietary carbohydrates and produce organic acids (e.g. lactic acid).
• Acid attack: These acids penetrate the microscopic pores of enamel and dissolve mineral bonds.
• Ion diffusion: Minerals are washed out from the tooth surface into the external environment, causing enamel to lose its density and optical properties.

Clinical presentation (White spot)

In the early phase, decalcification manifests as a "White Spot Lesion".

• Appearance: A chalky white, matte spot on the tooth surface that differs from the surrounding healthy, translucent enamel.
• Location: Most commonly occurs in areas of high plaque retention - along the gum line, in interdental spaces or around orthodontic brackets (fixed braces).
• Symptoms: At this stage the process is usually painless, although increased sensitivity to cold or sweet stimuli may occur.

Reversibility and progression

Unlike advanced dental caries (cavity), decalcification in early stages is a reversible process.

• Remineralisation: If the acidity of the environment can be reduced and mineral supply ensured (especially through fluorides and calcium in saliva), the mineral lattice can be restored and the spot may disappear or stabilise.
• Cavitation: If demineralisation outweighs remineralisation, total collapse of the enamel structure occurs and a visible cavity forms - dental caries that requires invasive treatment (filling).

Prevention and management

The basis of prevention is mechanical removal of dental biofilm (plaque) and dietary adjustments (reducing frequency of sugar intake). Professional management includes:

• Fluoridation: Topical application of gels or varnishes with high fluoride content.
• CPP-ACP therapy: Use of products with casein phosphopeptide and amorphous calcium phosphate.
• Enamel infiltration: Method (e.g. ICON) where a special resin is applied into the pores of demineralised enamel.