White spots, white lines, and rough spots
It’s easy enough to see a brown spot on a tooth and know something is wrong. Teeth should not have brown spots; people know and recognize brown is an unnatural, unhealthy color on a tooth. But what happens when the spots are not brown? What if you suddenly see white spots or white lines near your gums? Are white spots on the teeth a cause for concern?
The short answer is yes.
Whiter and Weaker
White spots on the tooth surface are properly called white spot lesions. The white, rough looking surface is a demineralized, weakened spot on the tooth enamel. Close examination shows the white spot is dull, lacking the natural luster of healthy teeth. Under high magnification (or a microscope) the enamel has its underlying, ladder-like structure exposed where the crystalline minerals that normally make up the surface of the tooth enamel have been stripped away. This naked structure is far weaker than healthy enamel.
Too Much of a Good Thing
There are several reasons that white spot lesions develop. Fluorosis is one common cause in small children, particularly children who live in areas where fluoride is added to the water supply and who tend to swallow toothpaste. Fluorosis only develops while enamel is developing; the risk for developing dental fluorosis ends when tooth development ends, usually around 8 years of age. Mild fluorosis, the most common type in the United States, is not considered serious and is mainly a cosmetic defect. Parents should be vigilant while teaching small children to brush their teeth. While fluoride can help make and keep teeth strong, too much of anything can be dangerous, and fluoride is no exception. Talk to your dentist to help evaluate all the sources of fluoride your child encounters and develop an appropriate plan for getting just the right amount.
Braces, mouth guards, retainers, and whitening trays can all be important tools in gaining and maintaining dental health. They also, unfortunately, can cause hard to clean spots on the teeth. The accumulation of plaques from inadequate brushing let acids build up on the tooth surface. This acid then strips minerals from the tooth enamel, causing unhealthy and unappealing white spots. Someone having braces removed wants the best smile of their life, so extra vigilance in an oral care routine is warranted while using dental appliances. Patients should use proper brushing technique, avail themselves of specialty tools to aid in cleaning the teeth, and consider adding a rinse the keep the mouth pH in balance.
Plaque is Back
Of course, the accumulation of plaque is never healthy for the teeth. Skipping dental visits, spotty hygiene habits, or poor brushing technique can lead to white spots near the gum line where plaques were heaviest. Any time plaque acids build up on teeth, it will strip away vital minerals from tooth enamel. While removing the plaque is important to stop the damage from progressing, removing the plaque does not, by itself, cause the teeth to regain lost minerals. Unfortunately, plaques are likely to recur for the same reasons they occurred in the first place, making it even more important to treat white spot lesions before they progress to full caries (cavities).
So What Can Be Done?
The most important treatment goal with white spot lesions is to arrest the damage process and remineralize the tooth surface before the lesion progresses to full cavitation. CariFree professional products are an excellent tool to consider when attempting to remineralize the tooth surface. The fluoride and biomimetic nano-hydroxyapatite are excellent for remineralizing enamel.
A white spot lesion that has been properly treated will regain luster and lose its odd matte appearance when dry. Preventing further damage or a recurrence of the lesion is vital to continued tooth health. Maintaining a healthy pH in the mouth and ensuring enough salivary flow to protect the tooth should be top priorities for long term management.
Once the white spot has been properly treated, it remains visible. Aesthetic concerns can be managed by careful tooth whitening to blend the color with the rest of the tooth. Whitening should be done under the supervision of a dentist. For some deeper spots or for patients who prefer to have the spots completely disappear, additional treatments with microabrasion, where an abrasive paste is rubbed into the teeth and resurfaces the enamel, or resin infiltration, where tooth-colored resin fills in deeper lesions to improve the look and the strength of the tooth, may be able to help achieve the desired appearance.
With proper care, a white spot lesion need not progress to a full cavity and can be successfully brought back to strong and aesthetically pleasing natural teeth.