White Spots (raise your dental IQ Part II)

In reponse to my patient Stephanie’s great question…

What’s the cause of white spots in people’s teeth?  I don’t have any but just a question.

Best Wishes,

UCLA School of Law
J.D. Candidate, c/o 2012

Great Q… I think I’ll make my response my next blog!  (so excuse my lengthy response)
White spots can be the result of a variety of factors. I’ve come up with this short list to describe the most common ones…
#1 Everyone who has had braces was lectured about keeping their teeth clean. Bacteria are constantly in our mouths & are in a constant fight trying to attack our teeth. They like places where they can hide from our toothbrush. Braces give them a home that is more difficult for us to clean, as a result they attack just above the brackets. Anytime they attack their job is to try and decalcify the enamel in order to break it down. White spots can be the result of this ongoing war like scars on an old European building. The war is won when the braces come off and you can clean the teeth easier, but unfortunately for some the damage is permanent.
#2 Believe it or not, a white spot (alson known as enamel decalcification) on the front of a permanent tooth is often caused by trauma from a baby tooth! Many years prior to getting our permanent anterior teeth we all need to learn to walk. During these stages as a toddler falls are frequent & as a result can result in tiny traumas to our front teeth. When a child bumps her chin on the floor (or the back of their brother’s head in my family’s case) that ‘baby’ tooth will sometimes bump into the permanent tooth that is forming underneath. The white spot left behind is the disrupted (decalcified) enamel like a scratch on the tooth. Its not until many years after the trauma that we notice the white spot, but it can be diagnosed based on its shape and location. Unlike white spots due to braces this kind is usually only on one or two teeth.
#3 Now that you understand a little about decalcified enamel (white spots) we can discuss some of the its more complex manifestations. As the teeth are formed the enamel is layered like rings of a tree in an orderly manner forming crystals known as hydroxyapatite. This process can be disrupted by systemic disease that may be effecting other parts of your body. The most common is a viral infection which causes a high fever common in infants. When you are little, your permanent teeth are forming. At this time the enamel is susceptible to irregularities (white or brown spots) at the time the “bricks” of enamel crystals are being laid down. We know this happens during formation because it will usually affect more than one tooth and in different places in the mouth (unlike tooth trauma). The most common occur as white and brown spots around the four first permanent molars (form most that is the second tooth from the back).
#4 If you search fluoride or fluorosis on the internet you will hear a lot of things that may scare off the advantages of fluoride. This is correct off Wikipedia: “Dental fluorosis is a health condition caused by a person receiving too much fluoride during tooth development.” The key note is the difference between topical and systemic fluoride. You can only cause fluorosis by ingesting the fluoride, which in some cases will cause white spots because it affects the development of the enamel. We highly recommend fluoride because it is one of the top 3 health discoveries to prevent disease. ( Penicillin & Polio Vaccine being #1&2 respectively)

Now that we have discussed some of the causes… lets look at our possible solutions. Depending on the severity of the white spots the first option is always no treatment. These can be minor and hardly noticable to the untrained eye, so if its not bothering you – chances are its not bothering anyone else. Obviously, some white spots can be part of ongoing dental disease (i.e. the beginning of a cavity). If this is the case a ‘filling’ needs to be done. Today we use tooth colored materials that look identical to the natural enamel, so even if its on a front tooth we can simply ‘fill’ the damage by ‘bonding’ our tooth colored composite in place. Take a look at this patient that I just treated… Be sure to click on the photos so you can zoom in and see the fix up close….

in her case we were able to smooth off the white spots on one tooth without doing anything else. On the other front tooth we had more significant damage so the tooth was rebuilt (by me) with layers and multiple colors of composite resin bonding to give a natural look. In cases that are more extensive or severe (commonly on multiple teeth caused by poor dental hygiene during braces) we can talk about porcelain veneers.  This is reserved for those who are unhappy with the shape and color of their teeth & would like to “hit 2 birds with one stone” by eliminating white spots and changing their tooth form and coloration. There are also some other techniques that have inconsisent results… Muriatic Acid is one, but most commonly we can first try to simply whiten your teeth; See my blog about “Getting your smile ready for summer (raising your dental IQ Part I)” .

A comment by the great Dr. James Drake on our Facebook page that “ICON works well for some. Not a big fan of trying it interproximal but on facials it seems great” brought up a great discussion. There is a product from DMG America which takes some previously known techniques and nicely “packages” them into a system they call ICON:

“Icon, a caries infiltrant that works by capillary action, is an entirely new, revolutionary approach to treating white spot lesions as well as incipient (or early) dental caries. Previously, dental professionals had only more invasive options for treating anterior tooth discoloration that could not be eliminated by tooth whitening, including microabrasion, veneers, and bonding. Caries infiltration is a major breakthrough in micro-invasive technology that fills, reinforces, and stabilizes demineralized dental enamel without drilling or sacrificing healthy tooth structure. ”

At the end of the day, you need to have someone you trust who is open-minded to all the potential techniques available. That person, your dentist, will explain the options & should give you their professional opinion. Each case is distinct & (if your dentist keeps up to date with the latest technology) you’ll be in good hands.


12 Responses to “White Spots (raise your dental IQ Part II)”

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  1. Melissa Cornish says:

    Hi, I'm Stephanie's friend. Thanks for asking for me, Steph! My two year old has a white spot on her front top tooth. I was just wondering if too much fluoride or fluoride that was never washed off on a baby tooth can cause white spots?

  2. Dr. Vanek says:

    White spots at her age ( 2 years old) will most likely be due to something that happened to you (Mom) during your pregnancy. Unless its a surface stain, that we would remove during a routine cleaning, it has something to do with the formation of that tooth (during the second trimester of your pregnancy).  Hope that helps! Sincerely, Dr-V

  3. Wanita says:

    Wow, your post makes mine look fbelee. More power to you!

  4. Great blog. Love the Q and A section for your patients.
    From one Orange County dentist to another.
    Brian Toorani

  5. Wow that was strange. I just wrote an really long comment but after I clicked submit my comment didn’t appear. Grrrr… well I’m not writing all that
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  7. soifa young says:

    Hi im sofia and im 14 years old i just got braces put on a week ago, and i have a whie spot on my top right tooth and im starting to get more little white spots why??? i brush twice a day with this fluride tooth paste my orthadontest gave me and i use fluride mouth wash and floss everyother day, why is this happening?

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