What Happens If Your Teeth Lack Cementum?

Cementum is a thin mineralised tissue covering the roots of your teeth. It forms an important interface between the tooth and the periodontal ligament, allowing fibres from the ligament to attach the root to the surrounding jawbone.

Although cementum is sometimes described as the “enamel of the root”, this is misleading. Cementum is structurally and biologically different from enamel. It is less heavily mineralised, has no blood vessels or nerves of its own, and plays an important role in tooth attachment, adaptation and repair.

In most people, problems are not caused by simply “losing cementum”. Instead, conditions such as periodontal disease, gum recession, exposed root dentine, root caries or root resorption can affect the root surface and the tissues that support the tooth.

What Is Dental Cementum?

Cementum is one of the four mineralised tissues associated with the teeth, alongside enamel, dentine and alveolar bone. It covers the dentine forming the root of the tooth, beginning around the cemento-enamel junction near the gumline and extending towards the root tip.

Its most important function is providing a surface into which fibres of the periodontal ligament can attach. These fibres connect the root to the surrounding alveolar bone and form part of the tooth-supporting system known as the periodontium.

Cementum is unusual because it is:

• Mineralised but less heavily mineralised than enamel
• Avascular, meaning it does not contain blood vessels
• Not directly innervated, meaning it does not contain its own sensory nerves
• Deposited gradually throughout life
• Capable of limited repair following some forms of root injury

What Does Cementum Do?

1. Helps Attach the Tooth to the Jaw

The most important role of cementum is providing an attachment surface for periodontal ligament fibres.

Some of these collagen fibres, commonly called Sharpey’s fibres, become embedded in the cementum at one end and the alveolar bone at the other. This arrangement allows the tooth to remain securely supported while still permitting tiny physiological movements during chewing.

2. Covers Root Dentine

Cementum covers the dentine forming the tooth root. However, it should not be thought of as a thick protective shell like enamel. Cementum is relatively thin, particularly near the neck of the tooth.

If the root becomes exposed because the gum has receded, the cementum can itself become exposed to the oral environment and may gradually be lost or altered, leaving the underlying dentine exposed.

3. Helps the Root Adapt and Repair

Cementum continues to be deposited slowly during life, particularly towards the root tip. This allows the root surface to undergo a degree of adaptation and limited repair.

New cementum can also form as part of periodontal healing, although completely regenerating the original periodontal attachment after significant disease remains biologically challenging.

What Are the Different Types of Cementum?

Cementum is more complicated than simply being divided into one “acellular” and one “cellular” layer, but two broad types are particularly important.

Acellular Cementum

Acellular extrinsic fibre cementum is found mainly over the cervical and middle portions of the root. It does not contain cementocytes and contains large numbers of embedded periodontal ligament fibres.

This makes it particularly important for attaching the periodontal ligament to the tooth.

Cellular Cementum

Cellular forms of cementum are found more commonly towards the root tip and between the roots of multi-rooted teeth.

They contain cells called cementocytes and are involved more prominently in adaptation and repair of the root surface.

In reality, several histological varieties of cementum exist, and different types can occur in different areas of the same tooth.

What Is the Difference Between Cementum and Enamel?

Enamel covers the crown of the tooth above the gumline, while cementum covers the root.

Feature	Enamel	Cementum
Location	Covers the tooth crown	Covers the tooth root
Main function	Protects the crown and provides a hard chewing surface	Provides attachment for periodontal ligament fibres
Mineralisation	Very highly mineralised	Less mineralised
Cells within mature tissue	None	Present in some types of cementum
Repair capacity	Cannot regenerate biologically once lost	Has limited capacity for additional deposition and repair

What Is the Difference Between Cementum and Dentine?

Dentine forms most of the structure of the tooth underneath both enamel and cementum.

Cementum forms a relatively thin outer layer over the root dentine. Dentine contains microscopic tubules that communicate towards the dental pulp, which is why exposed dentine can sometimes become sensitive.

This distinction is important because the sharp sensitivity associated with an exposed tooth root usually comes from exposed dentine rather than cementum itself.

What Happens If a Tooth Has No Cementum?

A true developmental absence or severe deficiency of cementum is uncommon.

If functionally important cementum does not develop properly, periodontal ligament fibres cannot attach normally to the root. This can compromise the attachment between the tooth and the surrounding bone and potentially result in premature tooth mobility or tooth loss.

One rare example is hypophosphatasia, an inherited metabolic disorder in which dental cementum—particularly acellular cementum—can be poorly formed or absent.

Children affected by hypophosphatasia may lose primary teeth unusually early while much of the tooth root is still present. In some forms of the condition, premature tooth loss may be one of the earliest or most noticeable features.

This is very different from the much more common situation where an adult develops an exposed tooth root because of gum recession.

Can Cementum Be Lost?

Yes, areas of cementum can be lost, damaged or resorbed, but this does not necessarily mean the tooth loses its attachment or becomes loose.

Possible circumstances include:

• Exposure of the root following gum recession
• Periodontal disease and periodontal treatment
• Mechanical wear of an exposed root surface
• Acid erosion affecting exposed root surfaces
• External root resorption
• Dental trauma
• Rare developmental or metabolic disorders

Because cementum is very thin in some areas of the root, exposed cementum can sometimes be removed relatively quickly, leaving underlying dentine exposed.

Does Gum Recession Mean You Have Lost Cementum?

No. Gum recession and cementum loss are not the same thing.

Gum recession means the gingival margin has moved further down the root, exposing a root surface that was previously covered by gum tissue.

Initially, that exposed root may still be covered by cementum. Over time, parts of the exposed cementum may be altered or lost through a combination of mechanical wear, acids and other environmental factors.

If you have gum recession, a periodontal assessment can help determine whether the recession is associated with periodontitis, tooth position, brushing trauma or other factors.

Does Cementum Loss Cause Sensitive Teeth?

Cementum itself does not contain sensory nerves, so losing a microscopic layer of cementum does not directly produce pain.

Sensitivity develops when the underlying dentine becomes exposed and its microscopic tubules remain open.

This can produce a short, sharp pain in response to:

• Cold drinks or food
• Cold air
• Sweet foods
• Acidic foods or drinks
• Touch or toothbrushing

The most widely accepted explanation is the hydrodynamic theory, in which external stimuli cause movement of fluid inside exposed dentinal tubules, triggering a response from nerves within the dental pulp.

However, not every exposed root is sensitive. Some exposed dentinal tubules naturally become blocked over time and produce little or no discomfort.

If sensitivity persists, your dentist should exclude other causes such as decay, a cracked tooth, a defective filling or pulpal inflammation. Our guide to choosing the right toothpaste also explains the role of desensitising products.

Can Exposed Cementum Develop Tooth Decay?

Yes. Once the root surface is exposed, it can become susceptible to root caries.

Root surfaces are more vulnerable to demineralisation than intact enamel. Root caries therefore becomes particularly important in people with gum recession, reduced saliva flow, difficulty cleaning effectively or a high frequency of dietary sugars.

Early root-surface lesions may sometimes be managed with preventive measures such as fluoride and improved plaque control. Established cavities may require a tooth-coloured filling or another appropriate restoration.

Does Periodontitis Destroy Cementum?

Periodontitis affects the entire tooth-supporting apparatus, including the gingiva, periodontal ligament, cementum and alveolar bone.

However, it is misleading to describe periodontitis simply as bacteria “eating away the cementum”. The disease involves a complex inflammatory response to the subgingival plaque biofilm, resulting in loss of periodontal attachment and supporting bone.

The goal of periodontal treatment is to control the disease, disrupt the pathogenic biofilm and preserve as much healthy periodontal tissue as possible.

Does Dental Scaling Remove Cementum?

Professional periodontal instruments inevitably interact with the root surface, and overly aggressive instrumentation can remove small amounts of cementum and dentine.

Historically, periodontal “root planing” sometimes involved intentionally removing substantial amounts of cementum because it was believed that bacterial toxins penetrated deeply into the root surface.

Modern periodontal treatment is more conservative. The aim is primarily to remove calculus and disrupt bacterial biofilm while preserving healthy root structure wherever possible.

Having appropriate professional treatment from a dental hygienist or periodontal team should therefore not be avoided because of concern that normal cleaning will “strip the cementum” from your teeth.

Can Brushing Too Hard Damage Cementum?

Once a root surface is exposed, aggressive brushing can contribute to wear of the cervical tooth surface, particularly when combined with abrasive toothpaste or acidic conditions.

However, toothbrushes should not be blamed for all gum recession or root-surface wear. These conditions are usually multifactorial.

Use an appropriate toothbrush with gentle pressure and avoid scrubbing aggressively across exposed roots. A dentist or hygienist can demonstrate a cleaning technique that removes plaque effectively without unnecessary trauma.

Can Cementum Grow Back?

Cementum has a greater capacity for deposition and repair than enamel, but that does not mean a large area of lost cementum simply grows back to its original condition.

Cementoblasts can deposit new cementum, particularly during normal ageing and following certain minor root injuries.

Small areas of root resorption can sometimes undergo cemental repair. More substantial periodontal destruction is much harder to regenerate because successful regeneration requires coordinated formation of new cementum, periodontal ligament and alveolar bone.

Can Periodontal Treatment Regenerate Cementum?

Selected periodontal defects can sometimes be treated using regenerative periodontal procedures.

The aim of true periodontal regeneration is not simply to grow bone. Ideally, treatment produces a new functional attachment consisting of new cementum with periodontal ligament fibres connecting it to newly formed supporting bone.

Techniques may involve regenerative membranes, bone-grafting materials or biologically active agents depending on the type of periodontal defect.

However, regeneration is not possible or predictable for every tooth or every pattern of bone loss. A specialist periodontist can assess whether regenerative treatment is appropriate.

How Do Dentists Diagnose Cementum Problems?

There is usually no routine test that simply tells your dentist “how much cementum you have lost”.

Cementum and root dentine are similar in their mineral density and lie immediately next to one another, so they are difficult to distinguish as separate layers on ordinary dental X-rays.

Instead, your dentist assesses the clinical problem affecting the root and surrounding tissues. This may include:

• Looking for gum recession and exposed root surfaces
• Testing areas of sensitivity
• Checking for root caries
• Measuring periodontal pocket depths and attachment levels
• Assessing tooth mobility
• Taking X-rays to assess supporting bone and root anatomy when indicated
• Investigating suspected root resorption or other unusual root conditions

A routine dental examination is often the best starting point if you have noticed sensitivity, recession or changes around the gumline.

Can Cementum Problems Make a Tooth Loose?

Simply exposing a small area of cementum does not usually make a tooth loose.

Tooth stability depends on the whole periodontium, particularly the periodontal ligament and alveolar bone surrounding the root.

Mobility becomes more concerning when significant periodontal attachment or bone has been lost, when there has been trauma, or in rare disorders where cementum has failed to form normally.

If a tooth suddenly becomes mobile, arrange a dental assessment rather than assuming the problem is simply damaged cementum.

What Is External Root Resorption?

External root resorption is a different process in which cells begin removing mineralised tissue from the outside of the root, potentially involving cementum and dentine.

Possible associations include trauma, inflammation, impacted teeth and some orthodontic situations, although many cases are complex and require individual diagnosis.

Minor cemental resorption can sometimes repair naturally, while deeper resorption involving dentine may require monitoring or dental treatment depending on its location and cause.

How Are Exposed Root Surfaces Treated?

Treatment depends on what is actually causing the problem rather than trying to “replace cementum” directly.

Dentine Sensitivity

Initial management may include desensitising toothpaste or professionally applied products designed to reduce the movement of fluid through exposed dentinal tubules.

Root Caries

Early disease may sometimes be managed preventively, while established cavities may require restorative treatment.

Gum Recession

The cause should first be identified. Some recession can simply be monitored, while selected cases may benefit from soft-tissue grafting or other periodontal procedures.

Periodontitis

Treatment focuses on controlling plaque biofilm, improving home cleaning, managing risk factors and professionally cleaning affected root surfaces. More complex cases may require specialist periodontal care.

How Can You Protect Your Tooth Roots?

• Brush twice daily with fluoride toothpaste
• Use gentle pressure rather than aggressively scrubbing the gumline
• Clean between your teeth every day
• Avoid frequently exposing teeth to acidic foods and drinks
• Attend dental examinations at the interval recommended for you
• Attend hygiene appointments when advised
• Seek treatment for persistent gum inflammation or recession
• Avoid smoking, which significantly increases the risk of periodontitis

If you smoke, Glow Dental also provides information and support relating to smoking cessation and oral health.

Frequently Asked Questions About Cementum

Can you feel cementum wearing away?

No. Cementum itself does not contain nerves. You may notice sensitivity if underlying dentine becomes exposed, but it is not possible to feel microscopic cementum loss directly.

Does gum recession mean the cementum has gone?

No. Gum recession exposes the root surface, which may initially still be covered by cementum. Exposed cementum can subsequently be lost or altered, potentially exposing dentine underneath.

Can cementum repair itself?

Cementum has a limited ability to undergo additional deposition and repair, particularly following small areas of root resorption. Significant lost periodontal attachment, however, does not simply regenerate by itself.

Is cementum harder than enamel?

No. Enamel is considerably more highly mineralised. Cementum is more similar in some respects to bone and dentine and is much more vulnerable when exposed directly to the oral environment.

Can damaged cementum cause sensitivity?

The sensitivity itself generally originates from exposed dentine rather than the cementum. Loss or disruption of the thin cemental covering can contribute to dentine becoming exposed.

Does cementum contain nerves?

No. Cementum is not innervated and does not contain its own blood vessels. Sensations from an exposed root arise from structures such as the dentine and dental pulp.

Can cementum develop a cavity?

Decay can affect exposed root surfaces and progress through cementum into dentine. This is generally described as root caries rather than a “cementum cavity”.

Can a tooth survive if some cementum is lost?

Yes. Localised loss of cementum does not automatically make a tooth unstable. Tooth survival depends on the overall condition of the periodontal ligament, supporting bone, root, pulp and remaining tooth structure.

What happens if a tooth develops without enough cementum?

Severe developmental cementum defects are rare but can impair periodontal ligament attachment and lead to premature tooth mobility or loss. Hypophosphatasia is one recognised condition associated with defective or absent acellular cementum.

Cementum, Gum Health and Periodontal Care at Glow Dental

Most patients do not need treatment specifically aimed at cementum. Instead, treatment focuses on the condition affecting the exposed root or periodontal tissues.

If you have gum recession, bleeding gums, exposed roots or loose teeth, Glow Dental provides specialist periodontics in Battersea. Routine preventive care is also available through our dental hygienists.

If you have new tooth sensitivity or are unsure whether an exposed root is affected by wear, decay or gum recession, arrange a dental examination. New patients can also find out more about joining Glow Dental.

Summary: What Happens If Teeth Do Not Have Cementum?

Cementum is the mineralised tissue covering the tooth roots and provides an essential attachment surface for periodontal ligament fibres. A severe developmental deficiency of cementum can compromise this attachment and, in rare conditions such as hypophosphatasia, contribute to premature tooth loss.

For most people, however, concerns around cementum are actually related to gum recession, exposed root dentine, sensitivity, root caries or periodontal disease rather than complete cementum deficiency.

Cementum has some limited capacity for continued deposition and repair, but maintaining healthy gums and periodontal support remains the best way to protect the root surfaces and preserve natural teeth.