Treating white discolouration on upper front teeth

Richard Field discusses a minimally invasive treatment option for white spot lesions.

27-year-old female presented requesting an improvement to her smile with reference to the white discolouration to her upper front teeth (Figures 1-2).

She had an unremarkable medical history.

On extraoral examination, there was:

• No apparent decay
• Temporomandibular joint non-clicking
• No pain on loading or palpitation.
  Oral examination showed:
• Good general dental health
• Moderate fluorosis affecting the upper incisors
• The fluorosis was markedly worse on the upper centrals, where there was a marked white opacity
• Molar-incisal hypoplasia was ruled out due to absence of lesions on the first permanent molars (Denis et al, 2013).

Treatment options for white spot lesions discussed

Enamel is the most highly mineralised tissue in the body, 96% hydroxyapatite and 4% organic fluids. In white lesions, part of the mineral phase is replaced by organic fluids, however, the surface layer is constantly being re-mineralised by the saliva. This means that, histologically, white spots are also characterised by hypo-mineralised subsurface enamel with a relatively intact surface layer.

As the structure of the white lesions is less mineralised and less organised than healthy enamel, this causes a change in the lesions’ optical properties (refractive index).

Light entering the lesions is reflected back to the eye much brighter than light entering healthy enamel, giving the lesions a bright white appearance. Historically, treating white lesions in a minimally invasive way has been particularly difficult, with some practitioners advocating the extended use of minimal intervention paste, with varying success rates.

Often, if the lesions were…