Tuesday, August 15, 2006

White Spots On Teeth-Enamel Hypoplasia

When new teeth erupt there may be small (or large) white spots on the teeth. These spots formed during development are called Enamel Hypoplasia or Hypocalcification. The defects in the teeth can be milky white, yellow or brown in color. Sometimes the Enamel, or outer layer of the tooth is even deformed or thin in places. These white or yellow spots are very common. In baby teeth, I tend to see it on the very back molars or the cuspids (the corner teeth). In permanant teeth the first permanent molars are quite commonly affected. Also, the front teeth can be involved leading to cosmetic concerns. You would be surprised how many children have some kind of discoloration. Again, very common.

Hypoplasia can be either a distinct spot on one tooth (sometimes called Turner's tooth, which might have been caused by a trauma or other unknown disturbance to the area during the mineralization of that tooth), or diffuse streaks or cloudy opacities on all the teeth which was some kind of systemic disturbance over a long period of time. Less often, spots are due to Fluorosis, or too much fluoride during development. Usually I cannot pinpoint what causes the hypoplasia, but I can sometimes tell when the disturbance occurred based on the position and appearance of the defect. In fact, sometimes it is in horizontal lines much like layers of brick are on a building. *If the spots were not there when the tooth erupted and have formed recently, they might be the beginning stages of decay.

Treatment: Well, most of the time you don't have to do anything. The areas will not usually decay and, if it isn't a cosmetic problem, we will just observe the area. If the area is more severely affected it might get a cavity or begin to crumble, as the enamel is weaker in those areas. If there is a good bit of breakdown on a back molar, a crown may be needed. If it is just a small spot that is decayed then a small white filling is all that may be needed. Now, for those areas that are on the front teeth with no decay, they just look funny, then there are a few options there too. It all depends on how severe or how deep the lesion is. A technique called Microabrasion, perhaps followed by a little bleaching, can be very useful to treat these cases and make it look at least a little better and it's very easy to do. More severe cases need a white filling or more extensive cosmetic dentistry like a porcelain veneer. With children and teens, I will try the less invasive techniques first. If they need any porcelain work, I usually refer to a cosmetic general dentist when they are finished with braces or around that age.

Mild Hypoplasia:














Moderate Generalized Hypoplasia:










Severe Localized Hypoplasia:





To return to the home page for more info click here: Pediatric Dentistry

82 comments:

Mrs. Stanley said...

I think our pediatric dentist said this is what my son has - although I can't recall the exact words (enamel hypoplasia) he said the enamel didn't form properly and the teeth are becoming brittle. He wants to cap all 4 back molars under general anesthesia at an outpatient center. My son is 3 and 1/2 years old. Does this sound like a common solution? Will he also have problems with his permanent molars? I'm a little nervous putting my son "under" for this procedure, but it sounds necessary. Any advice, insight? Have you done capping under general anesthesia before? Is it a realtively safe procedure? I know two other parents whose children needed caps for enamal problems, but they were able to do their caps "in the chair". I don't think our dentist thinks our son will sit for it.

Another question I had for you - is it common for pediatric dentists to not let parents go back? What is the reasoning behind this?

Thank you. Based on reading your blog I think you explain things better than our dentist, although I do like our dentist and am sure he is good.

Dr. Dean Brandon said...

--I see that kind of Hypoplasia more often than I would like. Sometimes it is milder and requires no treatment, other times there is that breakdown that does require crowns, so yes, I have seen that kind of thing before.

--I cannot advise on any treatment or anything like that for your child in particular, but most (not all) three year olds are unable to cooperate and general anesthesia is a valid method to accomplish treatment. I just treated two preschoolers last Friday in the OR. As they get a little older, they often can do that kind of procedure in the office. See my posts on behavior in the office and general anesthesia, etc.

--In the past it was very common to not allow parents back except for like examinations. There is a good bit of evidence and experience that tells us that the kids do much better when the parents are not there. Kids know how to wrap their parents around their little finger to get what they want. Dentists end up having to "manage" the patient and the parent. However, things are a little different now. Many do allow parents back. We do at our office, especially for the little ones. I might advise a parent to step around the corner if I think the child is paying more attention to the parent than me. I have seen whiney kids instantly become more cooperative when the parent is not present. I think there is more of a trend for parents to be present simply because they want to (and they do that at the pediatrician's office) and dentists are responding to that "demand". It all depends on the parent how much of a problem or not it would be. (That's a big subject I probably need to write up a whole post!).

DetroitMom said...

My son was diagnosed with hypoplaysia yesterday afternoon, and I am very concerned. First, his white patches are very large and have a strong contrast to the rest of his teeth. Also, the spots have appeared on every permanent tooth so far and he already has two cavities! The dentist tells me that this condition is probably due to a high fever as an infant and the subsequent antibiotic to treat the illness. He also tells me that there is nothing to worry about as the affected teeth are just as strong as 'normal' teeth. This concerns me because everything that I've read indicates otherwise. His suggestion is to wait until his teeth are fully developed and either cap them or fit them with porcelain veneers. My question is, will this affect his ability to wear braces? His dentist has already anticipated that he will need them. Also, is there any product that I can use to prevent furthur tooth decay? He flosses and brushes regularly, but is there anything specific for children affected by this disorder? Are my kid's teeth
going to be yellow? Any information would be very helpful.

Dr. Dean Brandon said...

I have never had a patient that has had any problem with hypolasia and braces.

Teeth in the front tend to have fewer problems than teeth in the back (there is a lot of chewing forces back there).

There really isn't any magic cure other than restoration (getting out the bad enamel (fillings/facings) and it is often best to wait on that, but I have seen microabrasion help cosmetically in the front. These defects are kind of like birth marks or blemishes, they got that way during formation of the teeth.

Cavities are caused by a bacteria and a hundred other factors, so just because there are "defects" there doesn't mean someone will get more caities. However, if they are prone anyways, then the likelyhood of cavities is at least as great as if the teeth were sound.--I don't know if this answered some of your questions--good luck.

Sam Roberts said...

My 11 month old daughter's top front tooth came through with a grey line all the way down the middle and as it comes through further it has started to crumble quite rapidly just down that grey middle line so she is now left with a downward 'v' shape in her tooth. My dentist has diagnosed enamel hypoplasia and basically said there is nothing that can be done at this stage.
Have you any suggestions...for preventing it crumbling further and stopping it decaying also can you give me any insight on what will become of the tooth will it have to be extracted eventually or can it be capped and if so what age? (the affected tooth it hasn't come through fully yet).
My dentist seemed fairly vague about the whole thing so am looking for some help as i am very concerned. Any more information would be much apprieciated.
Thank You very much.

Dr. Dean Brandon said...

You might search through the blog to find posts regarding treatment of young children. Also I have a post on Pediatric Partials for those kids that may loose a front tooth at an early age. Generally, if just hypoplasia, the defective area itself will crumble. If decay sets in or is present then it is much worse more rapidly.

I have seen kids who need removal of teeth even at a very young age which can be done, but if more elaborate treatment (like a crown or something) is needed, I consider general anesthesia or in-office sedation. Even then, I like to wait on that till the child is 2 if possible for medications like that. On one year olds, some things can be done without sedation. It can be easy or kind of a short wrestling match. Have I been vague enough? Good Luck!

Anonymous said...

My 8 yo daughter has the severe form randomly dispersed on a number of her teeth, including one of the very front ones. When do we consider cosmetic procedures for that front one? (the back molars have already been sealed and the middle teeth, the discloration is in the back so we are ignoring). And does the sanding and bleaching even work for a more severe discloration? Thanks for your help!

Dr. Dean Brandon said...

8 years old is a little young to do much of anything. However, if it is severe, I have done a white filling to replace the defective/missing enamel. In fact the "severe" photo you see in this post was restored with a large white filling due to the severe breakdown.

The more severe (or deep) it is into the enamel, the less likely just bleeching or even microabrasion will get you where you want. Restorative procedures are usually what is needed. Sometimes it's a matter of timing. At 8 the teeth are not even fully erupted. It is often the case that we do composites (fillings) on the front tooth areas that are not amenable to microabrasion. However, later on (when she is full grown), fancier things like porcelain veneers are possible.

Heidee Lail said...

My 10 month old son has white spots on all 4 of his top teeth. They have been there since they erupted. Do you think I should be concerned and take him to a dentist or just let it go and watch closely?

Dr. Dean Brandon said...

The American Academy of Pediatric Dentistry recommends seeing the Pediatric Dentist for the first visit by one year af age. So, yes I think it would be a good idea to get it looked at, but as you have described it may or may not be a problem. I've seen kids that age with decay, but most of the time it's just hypoplasia. Have a happy 4th of July!

Heidee Lail said...

Thanks for your response. I also wanted to mention that he is a breast-fed baby and has never taken a bottle or a pacifier. Does that change your opinion any? I am a "freak" about teeth and do not want any problems. Happy 4th to you!

Dr. Dean Brandon said...

No bottle, paci or thumb-good. However, I still see breast fed babies with cavities.

I you are as concerned as you seem, I think you would feel better getting a dentist to look (a Pediatric Dentist specifically). If there is no problem other than a minor cosmetic concern, than I think you will feel a lot better knowing that. In addition they usually go over a lot of stuff other than just a quick problem focused exam. If it is something of more concern, than you certainly want to get addressed before it becomes a much bigger problem. So, I still stand by my recommendation (and the Academy's)-let the Pediatric Dentist be the one to "keep an eye on it".--Good Luck!

Anonymous said...

my daughter is 2 years old and went to her first dentist appointment because she had some weird discoloration on her front 2 teeth. the dentist said that she had enamel hypoplasia. he said that she needs to have an outpatient procedure to fix this. he wants to do stainless steel crowns on 4 of her 2nd to last teeth. is the stainless steel neccesary? i hate to put those ugly metal crowns on the teeth that will be in her mouth for the next 10 years. isn't there a way to do it without the stainless steel?

Dr. Dean Brandon said...

You might want to read this post:

White Crowns for Baby Teeth

Although they look funny, Stainless Steel Crowns are a really good restoration. They make some with white stuff on them, but my experience is that the white part chips off after a while because of the biting forces back there. I have done very few of those, but you could ask. When I have done the few I have, I special order them and charge more. The post above describes crowns for front teeth where there are more options.

Isn't it funny, we put gold and silver all over ourselves (Jewelry), but a nice shiny crown seems not quite right somehow.

Anonymous said...

im 17 years old and i have a mild white spot on my front tooth, ive had it since i was like 8. it really bothers me and i feel like i cant smile as much as i want. sometimes its less noticable and other times you can really see it. i just want to know my options so it doesnt bother me anymore. and also the cost, would it be really expensive??

Dr. Dean Brandon said...

I don't think it would be that expensive.

Anonymous said...

im the 17 year old again...when i asked my dentist what i could do he said that i could just whiten my teeth and hope that it makes it less noticable. i did that, this was probably 3 years ago and it only made the spot brighter for some time. so what are the options to make it less noticable?? thank you for answering my question before

Dr. Dean Brandon said...

Bleaching usually does that at least at first. Microabrasion (you may have to ask about that) helps and sometimes a white filling is what is needed, but that's more invasive.

Anonymous said...

Ms. Lucas (07/19/2007)
My 8 1/2 year old has what looks to be a moderate level (middle picture) of hypoplasia. I would like to find a dentist that can confirm and then perhaps do the microabrasion procedure. Can you advise for a dentist type and what I should ask for/say in Washington, DC? Thanks in Advance. K (kylucascpm@aol.com)

Dr. Dean Brandon said...

All I can suggest is to contact someone who is practicing as a specialist in Pediatric Dentistry. That should be listed in the phone book under dentists/Pediatric or something like that. Most are familiar with microabrasion and other appropriate treatments. The American Academy of Pediatric Dentistry has a listing of Academy members on their web site- (linked in my sidebar).

Anonymous said...

My 2 1/2 year old daughter has moderate to severe hypoplasia on all of her teeth and is expected to have caps/crowns put on all of her teeth within the next 3 or 4 months. She also has Taurodontism. Is there anything I can do to prevent the hypoplasia from forming in her permanent teeth?

Dr. Dean Brandon said...

True hypoplasia is a developmental phenomenon whose cause is a little hard to pinpoint. Any systemic distrubance over a long period of time can effect developing tooth enamel. So, if the enamel is forming now (permanent teeth), then a healthy child with no prolonged illnesses or fevers will be more likely to avoid developmental disturbances.

Taurodontism is usually inhrereted.

Anonymous said...

Can someone tell me what are the effects putting braces on crowns and temporary crowns

christine said...

Is it possible to have enamel hypoplasia only on the top front teeth, and not the bottom? Our dentist diagnosed EH for my 14 month old son, who only has the first 8 teeth so far. The top four have a severe case of flaking EH, the bottom four have no EH. A pediatric dentist she consulted with says it can't be EH then since the top and bottom front teeth would have developed at the same time under the same conditions, and therefore it must be decay from breastfeeding at night! I can't find any information about this particular aspect of EH online. I'd appreciate any guidance you can give me.

Dr. Dean Brandon said...

Yes as to your question. It is possible. However, if it's decay, it doesn't really matter the original "condition", only that it may need treatment.

I have seen hypoplasia without decay, but what you discribe sounds like like classic baby bottle decay. If so, such a condition would be caused by a bacteria and could be aggrivated by the bottle. Hypoplasia might be a contributing factor, but I have no idea what your particular situation is.

Anonymous said...

My daughter is 17 months old. Last weekend I noticed a white spot at the base of her front left bottom tooth. She has been "brushing" her teeth since she was about a year old. Have we done someting wrong for the tooth to look like that?? I do have a white spot on one of my front teeth. I have always taken good care of my teeth. Did she get this from me. Will the spots continue on her permanent teeth?

Dr. Dean Brandon said...

If it's hypoplasia it's developmental not inherited--don't blame yourself!

There is something called Amelogenesis Imperfecta that is inherited, but that's when all the permanent teeth have very poor or no enamel--pretty rare.

johanne said...

I am 17 and have just been diagnosed with enamel hypolasia i would say my teeth are level pegging with the first picture.
I am so worried because i have noticed the change in colour and strength over the past year i also have th white marks and had 5 fillings in say a year and a half but my oral hygene is good i brush 3 times a day.I am having a brace soon im worried will it make things worse? what is the next step eg treatement? my dentist said not to worry but how can i not worry its teeth were talking about complexion here please help my dentist is no good do i need to see a pediatric dentist?hope u can shed some light would be most helpful thanks

Dr. Dean Brandon said...

Well, firstly, if things are changing there might be a problem. Hypoplasia does not change under normal circumstances.

Pediatric Dentists see "kids" up to age 21.

Anonymous said...

Hey Doctor. I am 14 years old and pretty unhappy with my teeth.
I have a huge white spot on my front tooth and then small little tiny ones all around that and on the other front tooth. I just got braces on..and was hoping it would cover it up, but it didn't. (Very disappointed.) But, what can I do to MAKE THEM GO AWAY? Kids these days are brutal and I can't stand being so self-conscious. It's just not me. So..give me some advice Doctor..pleasssee.

Thank you very much.
Anna

Dr. Dean Brandon said...

Best to get your dentist to give advice applicable to your particular circumstance. As you can read here, there are lots of different variations of this. If the enamel is really defective, we remove the bad enamel and place a filling (tooth colored), but usually not till less invasive things are tried. I have no idea if that is an option for your case, but usually there is something that can be done....however, it is usually after braces are finished. Still, let you dentist advise you properly.

Anonymous said...

Dr. Brandon,

Our dentist said that our son had Hypoplastic Enamel on one of his back teeth and a cavity also, that wasn't related to the Hypoplastic Enamel. The area she pointed out having Hypoplastic Enamel is not very big, but the doctor recommends a crown. I really don't feel like it's necessary. Is there any harm is watching it for 6 months to see if it worsens and then go from there?

Dr. Dean Brandon said...

A lot of times a crown is needed because of the location of the decay/hypo. Of course, I sometimes do a filling if possible. If there is lots of decay or too much breakdown in the wrong place, it is often best to do a crown. There have been times, we did a filling trying to avoid a crown, and the tooth broke down more later on or had new decay where I had to go back and do a crown anyways.

AL Fayard said...

We noticed two days ago white spots on my son's front teeth - basically the bottom part of his two front teeth. He's seven years old and these are his permanent teeth. Yet, his teeth has been out for a year or so and the spots have just appeared - in the last 2 or 3 weeks. I called up our dentist who suggested to go and see a pediatric dentist for a diagnosis as she was not sure whether the spots appear as the teeth came out of the gum or if they can appear later on. Can these spots appear after the teeth are out for a while?
thank you.

Dr. Dean Brandon said...

It could just be that, with time, the teeth erupted a little more and the hypoplastic defects then became visible. It could also be decay if it just "appeared". Most kids something like that just does not pop up all of a sudden--it is usually hypoplasia which formed when the tooth was growing. Get a pediatric dentist to take a look.

cynthia said...

Hello I just got my braces off a month ago and I noticed a white spot on my front tooth. It was really noticeable when I woke up for work. But then I brushed my teeth and it was still there. Then an hour later barely there. Is this because I sleep with my mouth open? Should I contact my ortho? I would like to know since my family will be taking xmas pictures and everyone wants to see my teeth

Dr. Dean Brandon said...

That kind of white spot might have been present before your braces, or it may have formed during treatment. Often when teeth dry out (like mouth breathing during sleep), the white spots seem whiter than normal till they get wet again.

momof3 said...

My daughter is 11 yrs old and probably has what I would call a moderate version of enamel hypoplasia. She absolutley hates it! I don't quite get how it happens, her other 2 sisters have beautiful teeth so that just makes it worse for her. It is on all her permanent teeth so far. What exactly is microabrasion? Does it usually work for moderate cases. She has never had a cavity(unlike her sisters)! We hate this! Just looking for help.

Dr. Dean Brandon said...

Microabrasion is when a mild acidic solution is placed on the teeth teeth and a pumice solution is used to "clean" off or abrade the outer layers of enamel. It is fairly non invasive and has improved the appearance every time I have done it. It does not always make it all go away, just improves the look.

Anonymous said...

I am 16 years old and i think i may have this problem. Ever since my front teeth grew in when i was about 6 years old i have had discoloration. it gets worse and then better at different times (i guess it depends on my routine). Its basically one decent sized spot on my tooth. Is there anything i can do non-prodecure wise to lessen this (such as a kind of toothpaste, whitening strips, etc.)?

Dr. Dean Brandon said...

Some people use whitening strips that might help in some cases, but they could also make it appear "worse" as it might lighten an already too white area. I really can't say because Every case is different. Good oral hygiene is always ok, as it keeps the yellowish plaque off there. Ask your dentist too.

Anonymous said...

Hi Dr. Brandon.

My daughter appears to have a 'moderate' form of teeth enamel hypoplasia and we've been really worried because, until I found your article (about 10 minutes ago), I had no idea what it was.
My wife and I thought it might be baby bottle tooth decay, but looking at the very clear pictures on your site, I'm thinking its this hypoplasia.

We will be taking her to a pediatric dentist in a couple weeks. Thing is, she's 18 months old! Do you have experience with this age group? I won't know for sure until we get to the office, but I'm a bit worried about what they may do with her - she's so young!

A Worried Dad in New Jersey

jjjvernet said...

my 8 month old has 2 white spots on her the only two teeth she has on the bottom. We give her flouride water (nursery) and we let her sleep with a pacifier. We just resently stopped night feedings. Could it be decay this early or flourosis?

Worried first-time mom!

Dr. Dean Brandon said...

Not likely decay at that age, but get it looked at.

aparna said...

hello doc..... is it possible to have this hypoplasia only on the incisors and molars wid others bein normal... if so can u put up a clinical picture of it....

Dr. Dean Brandon said...

Incisors and back molars form around the same time while the bicuspids (in between) form later on, so yes it is possible.

aparna said...

thanku.... but is hypoplasia and hypomineralisation d same.... i heard somethin called molar incisor hypomineralisation.... is it different from d usual white spots in hypoplasia....

Dr. Dean Brandon said...

There is a slight difference in terminology. The words are often used interchangeably.

Hypoplasia usually referes to a morphological defect. Hypominerilization or hypocalcification indicates improper calcification and may be either hypoplasia or just the "white spots" color change only.

Anonymous said...

Hi, I just turned 21 years I noticed a white spot on my tooth, so of course I came and looked it up, and I got here, it looks like the picture of mild Hypoplasia just a bit smaller. Anything I can do to make it go away? I brush everyday at least twice a day.

Anonymous said...

I am 25 years old and have had Moderate Generalized Hypoplasia since my teens. It has increased over time. It it predominantly at the bottom of my teeth (the "oldest" part). I find it interesting that both you and my dentist state the most usual cause as having too much fluoride. I grew up on well water. I had fantastically healthy teeth until about age 20 when I suddenly began to get many cavities. I brush and floss at least twice a day and always have. I just recently was told to start using a fluoride rinse since there has never been any in my water (something I wonder why no dentist ever asked me about before). Is the fluoride rinse going to make the white spots worse? I also have large areas on my molars that are white, brown and yellow. One dentist said they were cavities, another dentist (my current one) says they're just stains. That worries me too.

Dr. Dean Brandon said...

If the areas weren't there before, and formed later on, they are likely decalcified areas which are the beginning stages of cavities. Fluoride and good brushing can help strengthen the areas although the white color will not likely change.

blogger said...

My daughter is 2 yr & 3months old.she has white and slight yellow patches on almost all her upper teeth and on 1 lower tooth.i tried scratching them and felt it hard there.one one tooth a small hole as if poked by a pin can be seen.i am very much worried about this.please could you tell me what can be done on this.

Dr. Dean Brandon said...

I don't know, but could be the beginnings of decay. Only way to find out is visit your Pediatric Dentist.

Progression of decay: white chalky area-weaker and weaker-breakdown (small or large cavity)-deeper and larger---etc.

Hypoplasia is a defect, that is not likely to progress like this, although I see often the cuspids (corner teeth) have hypo that my crumble a bit. If it's small it's easy to fix. If it's extensive you want to get on it fairly soon. Good Luck.

blogger said...

Hi doc,thanks a lot for ur reply.i will take her to a dentist as soon as possible.i am still worried about it..hope her tooth becomes ok soon.

Anonymous said...

hi doc i am a general dentist in egypt and i have a paitant with total loss of enamil in perment teeth she is 8 year old female and she can not go to a spialist would you kindly tell me what is the line of treatmet for such case thank you dr| amira salem

Dr. Dean Brandon said...

If it is enamel loss on ALL teeth, I suspect Amelogenesis Imperfecta, a genetic disorder that affects the developing enamel. In other words, it just grew that way with pits, thin enamel or no real enamel at all.

I have treated a few cases of this. Usually, I place composite on the front teeth to help with esthetics. the back teeth I leave alone or place composites or crowns if needed to protect the teeth and occlusion form the biting forces. Still, it is a difficult thing to treat. I think as they get older, crowns and porcelain work of some kind would look pretty good.

Anonymous said...

Can you tell me if the white spots on my sons teeth have been caused by a lack of fluoride? I was concerned about the hreath implications of fluoride and sodium laurel sulphate & I alternated fluoride toothpastes with a "green" variety. Now I am wondering if I have done more harm than good.

Dr. Dean Brandon said...

Fluoride is a whole subject unto itself. Too much and you can get fluorosis. Too little and you get cavities. You also can get hypoplasia that looks like fluorosis, but is not. Hard to tell.

Dr. Dean Brandon said...

Oh, it is a good idea to not use too much toothpaste on the brush with children (especially preschoolers). Just a small smear or dab--if they swallow that, it's no big deal.

Anonymous said...

My twin sons (age 8) both have Hypoplasia of several of their front teeth. Is there a correlation b/w this and toothpaste usage? We've always used small amounts twice a day, and my older child does not seem to have this problem.

Thank you.

Dr. Dean Brandon said...

there can be problems (fluorosis) with too much fluoride, but you'd have to ingest a lot over a long period of time. As you can see other factors often come into play

bparkerson said...

I notice you don't mention the impact of nutrition on this condition. My 8 year old has recently gotten white spots on her teeth. Since I have had success with calcium supplementation (no more brittle sensitive teeth) I have just started to give my daughter extra calcium.
What are your thoughts on this?
Many thanks,
Brenda

Dr. Dean Brandon said...

Good nutrition is important for proper development of teeth. It is most important while they are forming before they erupt. Afterwards they are pretty much the way they are going to be. Proper nutrition after they erupt has more to do with periodontal health. Fluoride content of the water and dietary considerations ar,e of course, important in caries formation. As far as supplimentation, I don't usually reccomend this and I would advise consulting her pediatrician before such a thing,

Anonymous said...

Dr. Dean
My daughter is almost 12 years old and since her permanent teeth were coming out I noticed they were streaked white in many areas, vertical, from top to bottom of teeth. Seems the yellow is a little darker than what should be normal and of course the white stands out even more. We just came from our Pedatric dentist and she has good teeth with no problems and has never had a cavity. Our dentist wanted to see the report on our flouride because he thought about the flouride problem. It is not our flouride because I have the reports to show the flouride and we have lived in the same house since she was born. I have talked with him on these spots because she is starting to get teased and is self conscious about them. He mentioned trying the Crest White strips first but if it made it worse to stop because it is probably something inside and will have to be gotten out. After doing research on the net I see that those spots are early signs of decay, the teeth are decalcified in those white spots? She has 8 permanent teeth and all have spots/streaks, is her teeth going to like fall apart??? I also would hate to do the white strips if it is only going to make it worse. If I know they were there when they were coming out do you think the strips might work or make it worse? Will microabrasion help, our dentist didn't mention that? Since her teeth are still growing he would like to wait on anything else. I am in south Alabama and he did say he sees it more in the south than up north, who knows? To top all that off my 8 year old son has his 3 1/2 permanent teeth and his 2 front has the mild white marks, here we go again. Any advice will be helpful. Thanks in advance.

Dr. Dean Brandon said...

Hypoplasia (fluorosis too) would be areas have always been there (they came in that way). Incipient cavities form much later.

Sounds like your dentist is correct in that it is likely hypo not cavities. If so, it is more of a cosmetic problem only--albeit hard to correct. As you can read we often try microabrasion and bleaching. Even with those things it is can still be present to some degree.

Anonymous said...

My daughter is 12 months old and I believe she has Enamel Hypoplasia on her two fornt top teeth. I have a lot of dental (veterinary) experience, and am concerned becuase she is so young.
What is the cause of this? Her pediatrician said it could be from antibiotics I used while pregnant (Augmentin), or from a high fever I had while oregnant (no high fevers or that that baby had (no high fevers until recently).

What are the treatment options and approximate cost for something like this to be fixed (under anesthesia of course)??? I am concerned she will get cavities, as she will not loose these teeth till she is 7 or 8 years old. Her other 6 teeth are fine.

Thank you

Dr. Dean Brandon said...

I can't say, but most hypo areas need no treatment in very young children. Sometimes on a young child a small white filling might be needed.

Anonymous said...

Our 8 1/2 yr old daughter has Enamel Hypoplasia on her top two permanent teeth - I would say it is between the mid & high level. I am told whitening should wait until she is finished with puberty. What are your thoughts on the age of whitening (along with safe products) and the microbrasion technique for this age. Also, are these temporary solutions that will need to be repeated later?
Florida Mom

Anonymous said...

I have the white spots on my 4 front teeth. It is not splotchy, just gathered all at the bottom, about half and half. I have tried bleaching to blend it in but it doesn't work. My dentist recommended microabrasion but I dont want to do anything that severe to my teeth, shaving off a layer and replacing it with a fake one just does not sound healthy to me. I know my teeth are healthy and I want to keep them in the same condition they are, just without the discoloration. I am 20 years old and have had the white spots ever since I can remember. When I was about 17 I used invisaline to straighten my teeth. When i wore the invisalign, the white spots disappeared COMPLETELY. When I removed the invisalign out of my mouth, after a about an hour, the white spots slowly came back. After discovering this I know that there must be another way to remove the white spots with out a dramatic expensive procedure. I dont know what the invisalign does to my teeth whether it traps in moisture or what but I think it is worth doing some investigating. I mentioned this to my dentist and she didn't even bother to look into it. She just said that is was weird and went on to tell me about the microabrasion. Very ignorant. I am wondering if there is any procedure that just covers up the tooth with a clear coat of some sort... not permanently altering the teeth that I have.
I no longer wear the invisalign, my teeth are straight as can be. I would wear the invisalign just to get rid of the discoloration but it is like caring for a second set of teeth... and still doesn't even look normal. Whatever suggestions you might have im sure will be helpful. And hopefully my discovery will spark another solution to the problem. Thanks for reading.

Dr. Dean Brandon said...

Moisture content of teeth will affect the appearance. Makes sense to me that there was a change depending on wearing something or not, etc.

Anonymous said...

What exactly do you mean "depending on wearing something or not, etc."? The white spots have not disappeared permanently, only when I wear the invisalign... which is no longer possible because I don't have them/am not required to wear them. Are there any solutions associated with this? Can you please elaborate?

Dr. Dean Brandon said...

Wearing something like that changes the moisture content,but only when you wear it for a while. --not a permanent solution.

krking20 said...

My daughter is 5 yrs old and her first permanent tooth has started to come through. It is the lower front incisor. I noticed that it appears to have a missing piece centrally and you can see a yellow color beneath it-I thought it was food. It appears to be embedded in the gum line. The tooth is only 1/2 through and I am unsure if it is hypoplasia or something else? it does not look like any pics that are shown for hyploplasia. She is a healthy girl and has received routine dental care since age 1 and never had any caries. Thanks,

Dr. Dean Brandon said...

Good idea to get it checked out by your pediatric dentist.

Anonymous said...

I just noticed a light brown spot near the middle of one of my front teeth. I tried brushing but it wouldn't go away. I am seriously concerned about it although it does not seem sensitive or like a cavity. I am a fifteen year old girl and i weat retainers every night and have had my braces off for over a year. I really need to know what this is. Please help me.

Dr. Dean Brandon said...

If you noticed any kind of spot recently, it could be that it was always there, but you just noticed it. Sometimes I see the retainer wire make a little gray mark where it rubs--can be cleaned off. If it is something you are concerned about, let your dentist take a look.

Anonymous said...

My 4 year old daughter has developed white lines across the bottom of her two upper front teeth. We have well water, so there is no fluoride in the water and she takes a fluoride vitamin from the doctor. Is there a concern?

Dr. Dean Brandon said...

Sometimes it is difficult to determine the cause. Let your dentist take a look. Either way he might be able to tell you what might be done or if he has a concern.

Jan said...

My son was on an oscillator at birth for 2 weeks and had very low blood oxygen levels, at one point as low as 54%, he was also give 8 doses of surfactant, he was critically ill for 3 weeks and started to recover well after his lung collapsed. He is now 20 months old and due to have 5 teeth repaired under general anesthetic in 3 weeks, can you confirm to me whether there is a link between what he went through and this tooth decay, he is a breast fed baby, as were my other 3 children who have no cavities, the eldest being 16. The only difference being they did not go through the trauma at birth that my little guy did, he trauma started with Meconium Aspiration that was NOT suctioned below the vocal cords. I believe there is a link between the lack of oxygen and /or surfactant and his decay, what do you think, thanks in anticipation.

Dr. Dean Brandon said...

I cannot say in particular about your child, but I can say I see (every day) children, sometimes very young, with lots of decay and they have no history of medical complications or illness. I think it's more due to the type bacteria they have, immune response and other things. I have families where only one child has all the decay problems and the others do not....

Binni said...

I am 24 years old and I got some white spot on my one tooth then it appeared in 2 other teeth next to that tooth in week or so. I have no idea what is that. How can I stop spreading this thing and how can I get rid of it? Is there something I can do in eating and drinking to stop spreading them first. I wish that you would help me out with this. Thank you

Jan said...

thanks for your reply but is there a link between lack of oxygen, surfactant and tooth decay?