Tooth decay: White-spot lesions.

What are they?

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

Cavity Prevention 

What do they look like?

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

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.

Gum line white spot lesions on teeth.

For example, it's very common to see them form right at a tooth's gum line.

What causes them?

They're caused by tooth demineralization. (This is the process that causes cavities.)

This loss of mineral content results in a visible change in the appearance of tooth enamel. It starts to lose its gloss and shine and starts to take on a lighter chalky-white coloration.

How do you prevent white spots from forming?

Since these discolorations are an early stage of cavity formation, a big part of preventing them has to do with practicing effective brushing and flossing technique. Of course, this may be easier said than done. The use of an electric toothbrush may help.

Since the presence of fluoride aids the remineralization process (the action that helps to reverse the damage caused by tooth decay), its use can help to prevent the formation of white spots.

Treating white-spot lesions.

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.

One gauge of this is if the tooth's surface is still hard and intact. If it is, tooth remineralization, on its own, may be able to repair the damage that's occurred. Even if it can, however, the appearance of the area will still remain chalky-white.

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.)

Any and all untreated white-spot lesions should be monitored by your dentist for change during regular checkups.

b) Some lesions will need repair.

If the tooth's surface in the area of the white spot has lost its integrity (is rough, pitted or possibly even has a hole), a repair is generally considered necessary. If so, some type of filling (dental amalgam, tooth bonding) is usually placed.

(Of course, any decision to treat or not to treat a white-spot lesion can only be determined by a dentist's examination.)

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 traditional bracket-and-wire braces.

What's the basis of this concern?

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

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

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

The appearance of the teeth may be spoiled.

As bad as that is, this situation is complicated by the fact that the portion of each tooth that lies directly underneath its bonded bracket will be protected from the plaque. And as a result, no lesion will form on it.

This disparity will be apparent once treatment has been finished and the patient's braces are taken off. White outlines, showing the original positioning of the orthodontic brackets, will be obvious to all.


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 presence.

If the cosmetic outcome of this solution is not satisfactory, or if tooth repair is required, white fillings (dental bonding) can be placed.

Dental Caries
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