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:





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