The spots indicate a local problem in the development of the tooth enamel. The spot may appear in different shapes, as one or more spots on the tooth, or in the form of stripes. Sometimes multiple teeth are involved. The different color of the spot (bright chalky white and sometimes yellow / brown) is due to a local disorder in enamel calcification. The depth and location of the spot varies.
To understand the factors that affect the appearance of white spot lesions, it is necessary to distinguish spots that have “always been there”, i.e. from the day of eruption, from spots that form at a later stage.
The causes of white spot lesions that appear on teeth since their eruption:
It is not always possible to know the cause of the spots that were “born” with the tooth, but as a rough estimate, one can know at what age the enamel’s development was impacted, according to the location of the spots (like geological layers in rocks).
The causes of late white spot lesions in teeth:
Incipient (early) caries – one of the most common causes of late white spot lesions. In incipient caries lesions, there is a decrease in the tooth enamel’s mineralization and the lesion initially appears chalky white. If we do not treat the caries on time, it will worsen.
Spots that appear after orthodontic treatment – braces and rings that are bonded to the teeth during orthodontic treatment prevent that area of the enamel from being exposed to saliva and from undergoing remineralization. Also, these areas become, if oral hygiene is not carefully maintained, a point for oral plaque accumulation. Therefore, after removing braces, white spot lesions may appear in those areas.
First, it is necessary to diagnose the spot and the reason for its formation. Late forming spots differ from pre-eruption spots, so they should be given different attention.
The best way of treating late spots is, of course, preventing their formation from the outset. Maintaining oral hygiene and regular visits to the dental hygienist and dental clinic will help prevent the spots that are sign of incipient caries. If a spot is identified as an incipient caries, it may be treated, first, using conservative measures such as local fluoride application, improving oral hygiene and use of a product called “Tooth Mousse” (GC Inc.).
Tooth Mousse is a paste containing bovine milk protein, casein, and minerals that are important to the tooth’s enamel. The casein bonds to the teeth, making minerals more available to the enamel for remineralization.
In orthodontic treatment, it is very important to maintain oral hygiene and regularly visit the hygienist. Tooth Mousse may also be used as a preventive treatment.
A spot that forms during the tooth eruption does not usually require treatment unless it appears in front areas and is a hindrance to esthetics. One of the ways of removing such a white spot lesion is by micro-abrasion. This method of removing white spot lesions from the teeth is relatively conservative, involving fine rubbing to remove them.
In certain cases, tooth bleaching will complete the process. It is important to emphasize that if tooth bleaching is done, when there are white spots that have not been treated previously, the result may highlight the spots, so it is important to establish the right manner of treatment.
In cases in which the treatment by micro-abrasion does not remove the spot completely and it poses an esthetic problem to the patient, the spot may be masked using a tooth-colored restoration or by coating the whole tooth with a laminate veneer.