This month Manrina Rhode explores white spots, what causes them, possible treatments and the pros and cons to each.
White spots can vary in degree of visibility. Some are barely visible, others only become apparent in the morning or after dental visits. Others glaringly obvious, potentially cause insecurity when smiling.
For patients who are not aware of the white spots on their teeth, there is often no reason to treat them. Apart from in the case of demineralisation, where leaving the area could potentially cause a cavity.
For those who feel their white spots are worsened by sleeping, whitening or dental visits, we can inform them that this is because typically these white spots become more apparent when dehydrated. For example sleeping with your mouth open.
Typical causes and types of white spots
Fluorosis is caused if you ingest large quantities of fluoride while your teeth are developing, up to the age of six years old. This can be from drinking fluoridated water, taking fluoride supplements or eating toothpaste.
The benefits of fluoride are undeniable. But too much when teeth are developing can cause white or brown patches on the teeth. Usually fluorosis patches are not well defined.
Enamel hypoplasia is a developmental defect where there is thinner enamel than normal. This causes pits and grooves that can appear white in colour.
It results from hereditary factors, vitamin deficiencies, medications given to a mother before the birth, trauma to teeth, and premature births.
Hypomineralisation are opacities visible on the labial surface of the tooth. These are due to injury or infection of the deciduous tooth, affecting mineralisation of the permanent tooth.
Demineralisation creates white areas of decalcification of the enamel on teeth. It results from the accumulation of bacterial plaque. This is caused by insufficient oral hygiene.
It’s often seen interproximally in people who don’t floss or around brackets in people who wear braces. The white spots are early cavities that can then be reversed if treated quickly.
Depending on the depth, size and cause of the white spot there are several options.
Microabrasion can help improve your teeth’s appearance by gently removing a thin layer of surface enamel. This works well on superficial white spots. Clinicians can combine this with other treatments.
Teeth whitening will make the whole tooth whiter. It doesn’t even the tooth surface but makes the white spots whiter and the rest of the tooth lighter.
There is a saturation point after which the tooth can lighten no further so this may reduce the difference between the rest of the tooth and the white spot. However, you must warn the patient that initially the white spot will look more apparent as it will dehydrate immediately after treatment.
Treat demineralised white spots with a topical fluoride application to re-calcify the area and reverse the early cavity.
Icon is great treatment for white spots. Icon smooth surface can treat white spots on the visible surface of the tooth.
The principle is – air and water entrapments in the tooth have a lower refractive index than intact tooth structure. This leads to unaesthetic discolourations. Icon balances out this difference and the appearance blends in with the healthy enamel.
Icon caries infiltrant is for demineralised areas, usually interproximally or after braces removal.
Use bonding over enamel hypoplasia and sometimes over fluorosis, depending on how white the mark is. Sometimes the thickness of composite required to mask the white patch makes for a bulky restoration. So it may be necessary to prep the white spot by drilling into it to allow space for composite build up without bulkiness.
Porcelain veneers will, of course, cover the labial surface of the tooth giving it an even surface. But will also most likely require some preparation to avoid the tooth looking bulky in appearance.
Preventing white spot lesions
White spot lesions can occur in all ages and for many reasons. Here are some things to consider.
Ask patients to check what the fluoride levels are in their tap water.
Inform patients that bottled water, milk formulas, drinks, and also many processed foods contain fluoride.
Educate parents with children under the age of six in child toothbrushing. For example, using pea-sized amount of fluoride toothpaste.
Inform patients with braces to brush and floss around wires and brackets conscientiously to reduce the risk of white marks.
Fluorosis, enamel hypoplasia, hypomineralistion and demineralisation of the enamel on teeth can all lead to white spot lesions.
We should also be able to recognise them and recommend a host of solutions which will vary from patient to patient.
To book Manrina’s courses, see courses tab on her website www.drmanrinarhode.com.
Catch up with previous Aesthetic dentistry expert columns:
- Aesthetic treatment options for closing a midline diastema
- Treatment of a gummy smile
- Dental photography.
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