White spots on the teeth can develop because of early cavities, excess fluoride during tooth development, increased acidity in the mouth or problems with enamel formation. They may affect baby teeth or permanent teeth and can sometimes signal that the enamel is losing minerals.
Braces, injuries or infections involving baby teeth, childhood illnesses and inherited enamel disorders can also cause white spots on the teeth. A dental evaluation is important because the location, appearance and number of spots can help identify the underlying cause.
Treatment may include fluoride or remineralizing products, resin infiltration, microabrasion, bonding, whitening, veneers or fillings, depending on the condition. Regular brushing with fluoride toothpaste, daily flossing and limiting sugary or acidic foods and drinks can help protect the enamel and prevent further damage.
Main causes
The most common causes of white spots on the teeth include:
1. High acidity in the mouth
Increased acidity in the mouth can cause minerals to be lost from the tooth enamel, leading to the appearance of white spots.
This can be caused by frequent consumption of acidic foods or drinks, reduced saliva production, frequent vomiting or acid reflux. Repeated exposure to acid can gradually weaken the enamel and increase the risk of tooth sensitivity and cavities.
What to do: It is important to identify and treat the cause of increased acidity. A dentist may recommend changes in diet and oral hygiene, while a doctor may need to evaluate conditions such as acid reflux or frequent vomiting.
Acidic foods and drinks should not be consumed frequently throughout the day. After consuming them, rinsing the mouth with water and waiting about 30 minutes before brushing can help prevent further enamel damage.
2. Braces
Fixed braces can make it more difficult to remove plaque from around the brackets and near the gums. When plaque remains on the teeth, acids produced by bacteria can remove minerals from the enamel and cause white spots.
These spots are not caused directly by the braces. They are early areas of enamel demineralization and may develop into cavities if the mineral loss continues.
What to do: Teeth should be brushed carefully around brackets and wires, and floss or another orthodontic cleaning device should be used every day.
A dentist or orthodontist may recommend fluoride products or other remineralizing treatments. After the braces are removed, persistent spots may be treated with resin infiltration, microabrasion, bonding or another cosmetic procedure.
3. Cavities
White spots can be an early sign of tooth decay. They develop when acids produced by bacteria in plaque remove minerals from the enamel.
These spots commonly appear in areas where plaque and food accumulate, such as near the gums, between the teeth and around orthodontic brackets. At this stage, the enamel surface may still be intact and the decay may be stopped or reversed before a hole develops.
What to do: A dentist should evaluate the spot to determine whether tooth decay is active and whether the enamel surface is intact.
Early, noncavitated lesions may be treated with improved oral hygiene, fluoride and other remineralizing treatments. If a hole has formed, a filling or another restorative procedure may be necessary.
It is also important to brush at least twice a day with fluoride toothpaste, floss daily and limit frequent consumption of sugary foods and drinks.
4. Fluorosis
Dental fluorosis occurs when a child consumes too much fluoride while the permanent teeth are still developing beneath the gums. It cannot develop after the teeth have finished forming and erupted into the mouth.
Mild fluorosis may cause faint white lines, streaks or cloudy areas on several teeth. More severe cases can cause brown discoloration or pitting, although these forms are less common.
Fluoride helps strengthen teeth and prevent cavities. Fluorosis may occur when young children repeatedly swallow fluoride toothpaste or are exposed to excessive amounts of fluoride from more than one source while their teeth are forming.
What to do: Mild fluorosis usually does not require treatment. When the appearance of the teeth causes concern, a dentist may recommend microabrasion, whitening, resin infiltration, bonding or veneers, depending on the severity.
Children should use an age-appropriate amount of fluoride toothpaste and be supervised while brushing to reduce the likelihood of swallowing it.
5. Illness or nutritional problems during tooth development
Certain illnesses, premature birth and nutritional or metabolic problems during childhood may interfere with enamel formation while the teeth are developing.
The appearance and number of affected teeth depend on when the disturbance occurred. The teeth may have white, cream, yellow or brown areas, grooves, pits or thinner enamel.
What to do: A dentist should assess the affected teeth and determine the extent of the enamel defect. Treatment may include fluoride or remineralizing products, sealants, resin infiltration, bonding, veneers or crowns.
Any underlying nutritional or health condition should also be evaluated and treated by an appropriate healthcare professional.
6. Injury to a baby tooth
An injury to a baby tooth can affect the permanent tooth developing beneath it. When the permanent tooth erupts, it may have a localized white, cream or yellow spot, an irregular surface or an area of missing enamel.
The risk and severity of the defect depend on the child’s age, the type of injury and the stage of development of the permanent tooth.
What to do: A child who injures a baby tooth should be evaluated by a dentist, even when the tooth does not appear badly damaged. Follow-up appointments may be necessary to monitor both the injured tooth and the developing permanent tooth.
After the permanent tooth erupts, treatment may include fluoride products, microabrasion, resin infiltration, bonding, veneers or a crown, depending on the damage.
7. Infection in a baby tooth
A deep cavity or infection around the root of a baby tooth can interfere with the formation of the permanent tooth underneath it.
When the permanent tooth erupts, it may have a white, yellow or brown patch, an irregular shape or an area where the enamel is thin or missing. This usually affects one tooth or a small number of teeth near the infected baby tooth.
What to do: Cavities and infections in baby teeth should be treated promptly by a pediatric dentist to reduce pain, control infection and protect the developing permanent teeth.
Treatment of the permanent tooth depends on the severity of the defect and may include remineralizing products, bonding, veneers or a crown.
8. Enamel hypoplasia
Enamel hypoplasia is a developmental condition in which the body does not produce enough enamel in certain areas of a tooth.
It can cause white, cream, yellow or brown spots, as well as grooves, pits, thin enamel or areas where enamel is missing. Affected teeth may be more sensitive and more likely to develop cavities or wear down.
What to do: Treatment depends on the severity of the enamel defect. Mild cases may be managed with fluoride, remineralizing products, sealants, resin infiltration or dental bonding.
More extensive defects may require veneers, crowns or another restorative procedure. Dental implants are generally considered only when a tooth is absent or so severely damaged that it cannot be preserved.
9. Inherited enamel disorders
Inherited conditions such as amelogenesis imperfecta can interfere with the formation, mineralization or maturation of enamel.
Unlike a single isolated white spot, inherited enamel disorders commonly affect many or all baby and permanent teeth. The teeth may appear white, cream, yellow or brown and may have enamel that is thin, soft, pitted or easily damaged.
These conditions can cause sensitivity, rapid tooth wear, cavities and difficulty chewing, although severity varies considerably.
What to do: Treatment should be planned by a dentist and may involve fluoride products, treatments for sensitivity, sealants, bonding, veneers or crowns.
Children may require ongoing care from a pediatric dentist, and more extensive restorative treatment may be needed as the permanent teeth erupt.
