Can tooth gems damage enamel and can they be placed on every tooth?

When professionally and correctly applied, tooth gems do not have to cause permanent enamel damage. No drilling or grinding of the tooth is required. The enamel is, however, locally prepared to create a reliable bond between the tooth and the bonding material.

Why is correct application so important?

Retention does not depend on the adhesive alone. A successful tooth gem application depends on the entire bonding protocol: cleaning and preparing the tooth, correct etching, application of primer and bonding material, positioning of the jewelry, adequate curing and careful finishing.

Etching is an important part of this process. Dental etchant creates microscopic roughness and porosity in the enamel surface, allowing the bonding material to achieve better micromechanical retention.

Etchant must be used correctly and according to the instructions of the bonding system. More or longer etching does not automatically result in stronger bonding. Correct placement, amount, application time, rinsing and drying all contribute to a predictable result.

Finishing the bonding layer matters too

After placement, the bonding material around the tooth gem should be carefully finished. Sufficient material is required for secure attachment, but unnecessary thick edges, sharp transitions and excess bonding should be avoided.

A smooth finish also makes the area easier to keep clean. Irregular surfaces around oral jewelry may encourage plaque retention, making good oral hygiene particularly important.

Not every position is equally suitable

The most predictable bonding is generally achieved on healthy natural enamel. Tooth shape, bite and the position of the jewelry must also be considered.

Tooth gems are exposed to mechanical forces during eating and chewing. Biting into hard fruit, carrots, crusty bread or similar foods can place considerable load on the jewelry. If a gem frequently contacts food or opposing teeth, it may be more likely to loosen.

The size and shape of the tooth gem also matter. Larger or more prominent jewelry may be more easily contacted during biting or chewing, depending on its position.

In practice, tooth gems placed on the lower teeth often have a shorter retention time than those on the upper teeth, partly because space is more limited and contact with opposing teeth, the tongue, food and chewing forces can be greater.

A professional tooth gem artist should therefore assess the tooth, position, bite and size of the chosen jewelry before treatment. Crowns, veneers, composite restorations and damaged enamel require special consideration. If there is any doubt about the health of a tooth or surrounding gums, a dental assessment should be recommended first.