An enamel pearl is a condition of teeth where enamel is found in locations where enamel is not supposed to be, such as on a root surface. They are usually found in the area between roots, which is called a furcation, of molars. Enamel pearls are not common in teeth with a single root. The most common location of enamel pearls is the furcation areas of the maxillary (75%)and mandibular third molar roots.
Enamel pearls are formed from the Hertwig's Epithelial root sheath. After the initiation of the formation of dentin in the root area of the tooth, the root sheath disintegrates and moves away from the root surface so that the cells of the dental sac can come in contact with predentin to differentiate into cementoblasts and start deposition of cementum. However, if the cells of epithelial root sheath remain adherent to predentin, they may differentiate into fully functional ameloblasts and deposit enamel. Such droplets of enamel are called enamel pearls.