Are Tooth Gems and Grillz Bad for Your Enamel?
Clinically reviewed by Dr. Abinaash Kaur, DDS, RCDSO, on 2026-09-14. Dr. Kaur is a general dentist in Toronto (Bloor West Village) registered with the Royal College of Dental Surgeons of Ontario.
A tooth gem is stuck on with the same chemistry we use for a filling, and the enamel question sits mostly with taking it off, not putting it on. Done properly, the numbers involved are microns, not chips.
Here's the honest part up front. Nobody has measured what removing a tooth gem does to enamel. A review of tooth jewels and grillz put it plainly: "Owing to the lack of good quality studies, it is difficult to determine accurate effects on the dentition" (Dental Update via PubMed).
So how worried should you be? That depends on things nobody has measured yet, so I'll tell you what has been measured on the closest comparable thing, and flag where I'm reasoning rather than citing.
You should also know where my profession stands, because it's more definite than I am. The American Dental Association has a standing policy that "advises against the practices of cosmetic intraoral/perioral piercing, tooth gems/jewelry and tongue splitting, due to the increased risk of negative health outcomes" (American Dental Association). The American Academy of Pediatric Dentistry "opposes oral piercings and the use of oral jewelry and accessories" (AAPD).
I'm not going to pretend I hadn't read those. Where I'd put it differently: plenty of my patients already have a gem on, and telling them they shouldn't have doesn't help any of them. What helps is knowing how it went on, what it's doing at the gum edge, and who should take it off.
I've practised in Bloor West Village for about 25 years and my younger patients have been showing me gems for a while now. Nobody's getting a lecture here.
How does a tooth gem actually stick on?
Etch, rinse, composite, cure. It's the same sequence as a filling or composite bonding.
Dental etch is a solution, usually containing phosphoric acid, that we put on the tooth surface to clean off debris and create a microscopic roughness, so bonding materials grip properly. Then a tooth-coloured composite goes on, the gem sits in it, and a curing light hardens the whole thing in seconds.
So what is the gem actually made of? A Swiss review calls them tooth diamonds, made from composite and stuck on with an adhesive (Schweizer Monatsschrift für Zahnmedizin via PubMed). Same family of material as a white filling.
No drilling. Nothing is carved into the tooth. That surprises people who assume a gem gets set into enamel like a stone into a ring.
Does the etch damage your enamel?
Barely, when it's done the way a dentist would do it. One laboratory study measured the enamel at each stage and found that polishing plus etching cost a few microns, less than earlier work had suggested (American Journal of Orthodontics and Dentofacial Orthopedics via PubMed).
A micron is a thousandth of a millimetre. Enamel on a front tooth is roughly a millimetre thick.
The same study found something more useful. Most of the enamel that goes, goes during the clean-up afterwards, not during the etch (AJODO via PubMed). Not the acid. The removal.
That's the whole shape of this topic, and it's why the question that matters isn't whether to get one. It's who takes it off.
What does taking one off actually cost you?
Here's where I have to be careful, because nobody has measured gem removal on its own.
What has been measured is the nearest equivalent: taking bonded composite attachments off teeth after clear aligner treatment. Same composite, same bur, similar small pad of material. A 2026 review of that work found enamel loss running from roughly 15 to over 50 microns depending on how it was taken off, and leftover composite covering a fifth to two fifths of the surface (Clinics and Practice via PubMed).
A 2024 study using 3D surface scanning measured a mean enamel loss of 22.7 micrometres, across a range from zero to 132, and found composite remnants left on 34.4% of teeth (Journal of Adhesive Dentistry via PubMed).
That review is careful about its own limits, and says its findings shouldn't be stretched to everyday practice, because the evidence is thin and none of it comes from clinical trials (Clinics and Practice via PubMed).
I'm not alone in drawing that comparison. The American Academy of Pediatric Dentistry says tooth ornaments are bonded on much the way an orthodontic bracket is, in its 2025 policy (AAPD).
So does any of that apply to your gem? Pretty much. It's the same composite and the same bur, so I'd expect the same kind of enamel loss. The size of the loss depends on the instrument and the person holding it. Every study above had a dentist or a researcher doing the removal. Nobody has tested a salon, a gem tech, or you with a bathroom mirror, so I can't give you a number for those.
What if the gem falls off on its own?
The crystal goes, the composite pad usually stays.
That leftover pad is the thing to deal with. It's rougher than enamel, it sits there collecting plaque, and even after a careful professional removal a fifth to a third of the surface can still have composite on it (Clinics and Practice via PubMed).
Try this: don't pick at it with a fingernail or anything metal. Get it smoothed off properly at your next visit. It takes a couple of minutes with a polishing bur and no freezing.
One more thing worth knowing before anyone touches it. If the gem was bonded over a filling, a veneer or a crown rather than onto enamel, removal risks the restoration rather than the tooth. Mention that to whoever takes it off. It's the single most important thing they need to know before they start.
Will a gem give you a white spot or a cavity?
Not by itself. Plaque does that, and a gem gives plaque an edge to sit against.
The Swiss review says it straight about this category of thing. Tooth ornaments collect plaque, and they can get in the way of how you speak (Schweizer Monatsschrift für Zahnmedizin via PubMed).
The ADA agrees, and names the same mechanism. Gems, grills and other mouth jewellery give plaque somewhere to gather, which over time means more decay and more gum trouble, especially if the brushing around them is hurried (American Dental Association). Pretty much what you'd expect from anything stuck to a tooth.
One more risk worth naming, because patients rarely expect it. The AAPD lists tooth sensitivity alongside decalcification and decay as an associated risk of tooth ornaments (AAPD). If a tooth with a gem on it starts reacting to cold, that's worth mentioning rather than waiting out.
There's a useful signal from the aligner world. Among 203 teenagers in clear aligners, 35% developed white spots, and the more composite bumps they had on their front teeth, the likelier those spots were (Orthodontics and Craniofacial Research via PubMed). More bonded bumps, more white spots.
A gem is one composite bump. I can't give you your odds, because nobody has measured it for gems. I can tell you which way it points.
Keep that in proportion, though. White spots are common anyway. In a large review of orthodontic patients, around three in ten people who'd had no treatment at all still had them (Orthodontics and Craniofacial Research via PubMed).
So here's your job, and it's a small one. Angle your brush at the join between your gem and your gum. Floss past it the way you would anywhere else. Every so often, look for a chalky ring on the gum side of it. That edge is where I check first, and it's where your trouble would start if you were going to have any.
What about DIY gem kits?
Has anyone tested the kits against a dentist doing it? Not that I can find. So this next part is what I check for, rather than something a study settled.
A proper application controls four things. The tooth is dry, the etch goes on for a set time and gets rinsed off, the composite is the kind made for teeth, and the light cures it fully.
A kit can't examine the tooth first. I've seen gems sitting over a filling, where the bond isn't to enamel at all. Some kits ship an adhesive that isn't the composite we'd use, and I can't tell from the box which is which.
None of that means a kit wrecks your teeth. It means the variables nobody's controlling are the ones that decide how the removal goes later.
Are grillz a different problem?
Yes, because nothing gets bonded. A grill slips on and off, so the etch question doesn't arise at all. The hygiene question replaces it.
There's one published case worth knowing. A 16-year-old with no previous decay developed rapid decay on his front teeth after buying and regularly wearing a grill from a neighbourhood jewellery store (Pediatric Dentistry via PubMed).
One case isn't a rate. What it shows is the mechanism: metal held over teeth that aren't getting cleaned underneath keeps food and plaque pressed against enamel. The Swiss review makes the same point about tooth ornaments generally, and adds that they can get in the way of clear speech (Schweizer Monatsschrift für Zahnmedizin via PubMed).
One more thing, and no study sits behind this one. A grill made from an impression of your own teeth sits where it should. A one-size grill can hit first when you bite together, and that's the one I'd want to look at.
Does a gem change your other dental plans?
Two practical collisions worth knowing about, neither of them from a study.
Composite doesn't bleach, and that isn't just my observation. The ADA's position on whitening is blunt: only natural teeth lighten, not tooth-coloured materials (American Dental Association). Whiten with a gem on and you can end up with a shade mismatch where it was sitting, which our whitening guide is worth reading alongside.
Aligners are the other one. A tray is moulded to your tooth shape, and a gem isn't part of that shape.
If either is on your horizon, the sequence matters more than the decision.
Frequently Asked Questions
Q: Do tooth gems ruin your enamel? No clinical study has measured what a gem does to enamel, and a review of tooth decorations says exactly that, blaming a lack of good-quality research (Dental Update via PubMed). The nearest measured comparison is removing bonded composite attachments after aligner treatment, where enamel loss ran from about 15 to more than 50 micrometres (Clinics and Practice via PubMed). That's a fraction of enamel thickness, and it depends heavily on the instrument used.
Q: Does getting a tooth gem hurt? No. There's no drilling and no freezing. The tooth is cleaned, an etching gel goes on and gets rinsed off, composite holds the gem, and a light sets it. It's the same sequence as having a small filling bonded, minus the drill.
Q: How do I get a tooth gem removed safely? Any general dentist can take one off. It's a short appointment with a polishing bur, no freezing needed. Mention it if the gem was placed over a filling, a crown or a veneer, because that changes what's underneath. Ask for the surface to be polished smooth afterwards, since leftover composite is common even after professional removal (Clinics and Practice via PubMed).
Q: Can I whiten my teeth with a tooth gem on? Composite doesn't respond to whitening the way enamel does, so the covered patch can end up a different shade from the rest once the gem comes off. Whitening first, then placing a gem, avoids the mismatch. Our whitening guide covers what does and doesn't respond to bleaching.
Q: Are grillz bad for your teeth? The risk is hygiene rather than bonding, since nothing is attached to the tooth. One published case describes a previously cavity-free 16-year-old developing rapid decay on the front teeth after regular wear of a grill bought from a jewellery store (Pediatric Dentistry via PubMed). That's a single case, not a rate. Clean your teeth and the grill properly, don't sleep in it, and don't wear one that hits first when you bite together.
Q: My gem fell off. Is that an emergency? No. The crystal comes away and the composite pad usually stays behind. The pad is rougher than enamel and collects plaque, so it's worth having smoothed at a routine visit. Don't try to lever it off yourself.
Reviewed by Dr. Abinaash Kaur, B.Sc., DDS (University of Toronto Faculty of Dentistry), who has practised general and family dentistry in Bloor West Village for about 25 years. This article is general oral health information, not a diagnosis or a substitute for an examination.
Got a gem on and want to know how it's doing? We can take a look at it during a regular check-up and tell you honestly what we see at the gum edge. If you want it off, any general dentist can do that, so just ask when you book. We're at 750 Annette Street in Bloor West Village, serving the Junction, High Park, and Baby Point.
