Enamel thickness and density of primary teeth with and without early childhood caries: a micro-computer tomography assessment

Purpose: Differences in enamel density and thickness influence caries risk, emphasising their role in targeted early childhood caries (ECC) prevention. This study aims to compare the enamel thickness and density of unaffected enamel in primary teeth with ECC to that of caries-free (non-ECC) primary teeth using micro-computed tomography. Methods: A total of 128 primary teeth were analysed and divided into two groups: Group I (unaffected surface of the enamel of primary teeth with ECC) and Group II (healthy teeth). Enamel thickness and density of healthy surfaces of both groups were measured using a μCT 100 system, and differences between groups were statistically evaluated using the Mann–Whitney U test. Results: Enamel thickness was significantly higher in Group I (0.973 mg HA/ccm) compared to Group II (0.553 mg HA/ccm), with a statistically significant difference (p = 0.001). The mean enamel density in Group I was 2255.75 µm compared to 2294.71 µm in Group II (p = 0.001). In both the maxilla and mandible, Group II (healthy teeth) surfaces had higher enamel density (p = 0.001), whilst enamel thickness showed no significant difference. Amongst anterior teeth, Group II teeth surfaces exhibited significantly higher enamel density (p = 0.003). Conclusion: Enamel density, more than enamel thickness, emerges as a key indicator of ECC risk, enabling paediatric dentists to more accurately predict and identify vulnerable tooth surfaces before the onset of visible caries.