White-spot lesions. - The earliest visible sign of tooth decay formation.

Why they form. / Where they occur- At the gum line, Around braces. / Pictures / What treatment is needed?

1) What are white-spot lesions?

White-spots are an early stage of tooth decay formation. They're the first one that can actually be visualized.

White-spot lesions on teeth.

a) What do they look like?

True to their name, these lesions have an opaque, chalky-white appearance. They're usually lighter in color than the unaffected enamel that surrounds them.

b) Where do they form?

Since they're caused by the decay process, you can expect to find them in those areas where dental plaque has been allowed to accumulate. As examples:

  • It's very common to see them form right at a tooth's gum line, a location people often miss when brushing. (See picture above.)
  • And since braces can be hard to clean, they sometimes form next to where a person's orthodontic brackets have been bonded to their teeth. (See picture below.)

c) What causes the white spots to form?

They're caused by tooth demineralization. (The process that causes cavities.)

The demineralization process results in the loss of mineral content from tooth enamel. And as a result, it undergoes a visible change in appearance. It looses its gloss and shine and takes on a lighter chalky-white, more opaque, coloration.

d) How do you prevent white spots from forming?

Better brushing.

Since these discolorations are an early stage of cavity formation, preventing them relies on practicing more effective brushing and flossing technique. (Of course, doing so may be easier said than done. The use of an electric toothbrush may help.)

Use fluoride.

Since the presence of fluoride in saliva assists the remineralization process (the action that helps to reverse the damage caused by tooth decay), making sure you have an appropriate exposure of it can help to reduce your risk for these lesions.

Consume xylitol.

Studies have shown that introducing xylitol (a natural table sugar substitute derived from birch trees) into your diet can create a substantial anti-cavity effect.

2) Treating white-spot lesions.

(Only an examination by your dentist can lead to a decision that any particular white-spot lesion should be treated or not.)

a) Some areas may not require any treatment.

White-spot lesions represent a very early stage of cavity formation. One where possibly only a minimal amount of tooth damage has occurred.

How your dentist checks.

One gauge of how much damage has taken place is to see if the tooth's surface is still hard and intact.

  • Your dentist will inspect the white spot with a metal tool. As they do, they will scrape and probe its surface to see if it's still hard and smooth.
  • If it is, tooth remineralization, on its own, may be able to repair the damage that's occurred.
  • However, even if it can, the appearance of the area will still remain chalky-white.
You'll need to change your habits.

Keep in mind that this type of natural repair can only take place if you change the conditions that allowed the white spot to form initially. (Remember: Cavities are usually caused by some combination of ineffective brushing and flossing, and inappropriate sugar consumption.)

Monitoring will be required.

Since they represent an area that at least historically has been difficult for you to keep clean, any and all untreated white-spot lesions should be monitored by your dentist during regular checkups.

b) Some lesions will need repair.

If the white spot's surface has lost its integrity (it's rough, pitted or possibly has even developed a hole), some type of repair is indicated. If so, a filling (dental amalgam or tooth bonding) is usually the type of restoration placed.

3) Concerns about white spot formation when dental braces are worn.

The formation of white-spot lesions can be especially troublesome for dental patients who wear conventional (bracket-and-wire) braces.

White spot lesions form around braces where dental plaque is allowed to accumulate.

White spot lesions that have formed around orthodontic brackets.

a) What's the basis of this concern?

Wearing dental braces can make it exceedingly difficult for a person to clean their teeth.

If the person allows dental plaque to accumulate around their brackets (the device that's bonded directly to their teeth), white-spot lesions may form.

However, the tooth enamel that lies underneath the bracket will remain unchanged. When the braces are taken off, the color difference between the damaged and undamaged enamel will be obvious.

White spot lesions resulting from dental braces.

White spot lesions resulting from poor home care while wearing braces.

b) The appearance of the teeth may be spoiled.

As bad as it is to have white spots form, this situation is complicated by the fact that the teeth involved occupy such a visible position in the mouth. The white outlines, showing the original positioning of the orthodontic brackets, will be obvious to all.

c) Treatment.

  • In those cases where the white spots require no attention (in the sense that a full-fledged cavity has not yet formed), it may be possible to use teeth-whitening treatments to mask their appearance.
  • If the cosmetic outcome of this solution is not satisfactory, or if tooth repair is required, white fillings (dental bonding) can be placed.


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