Perhaps you’re sharing a meal with your kiddo, or you’re playing and joking around, when your child grins or open their mouth wide - and you notice a few white spots on their teeth! You think: is that white spot new, or has that always been there? And more importantly, is it a sign that something is wrong? The answer to both of those questions will depend on the cause.
One of the most common causes of white spots is demineralization, which is the beginning stage of decay. These white spots appear along the gumline, and usually are white with a chalky, dull, or dry appearance. White demineralization spots mean that the tooth has lost vital minerals, and the enamel (the hard outer coating of the tooth) has worn down. Wear on enamel can occur when bacteria and sugars combine, forming enamel-eroding acids. If left untreated, these spots may eventually turn yellow or even brown, which means that a cavity has formed.
There are a few main culprits of tooth demineralization and decay for young children, all of which are caused by not cleaning teeth and gums often enough. One cause is called “baby bottle tooth decay”. This can occur when a baby or toddler is allowed to sleep with a bottle or carry around a sippy cup filled with juice, milk, or other sugar-containing drink throughout the day. Because there is a constant intake of sugary fluids into the mouth, saliva can’t work as well to protect teeth and prevent cavities.
Similarly, frequent snacking can be harmful to tooth enamel because there is less time for saliva to get to work protecting teeth and washing away harmful acids, so there isn’t enough time to allow teeth to recover from acids. Another cause is not cleaning teeth properly, especially along the gumline, or not using the correct products with the right amount of fluoride for your child.
To prevent this type of white spot, you can encourage your little one to drink from a cup as soon as they’re able and to regularly take breaks between meals, rather than carrying around food or drinks all day. Another great option is to have your child sip water between meals, after breastfeeding, or after drinking any sort of fruity, fizzy, or acidic drink. Talking to our providers here at Jungle Roots about which products are best to use to care for your child’s teeth (and teaching proper brushing habits) will also go a long way in preventing decay!
However, if you do notice white spots and suspect decay, the good news is that the damage is very likely reversible. As soon as you notice a white spot, schedule an appointment with us. If the white spot is due to demineralization, we will clean the teeth, remove plaque off of the enamel, and may suggest a fluoride treatment, mouthwash, or toothpaste. Treating demineralization early on with fluoride can actually reverse the problem by replacing the missing minerals. This means that the enamel will be strengthened in the weak, soft, white spots, and prevent further effects of demineralization-causing acids on the teeth.
Another cause of white spots is enamel hypoplasia, which is similar to demineralization. These white spots are also areas of the teeth that are less mineralized than they should be, but these spots are caused by nutritional deficiencies, frequent illnesses, severe illness (especially high fever), side effects of some medications, or trauma to the mouth or primary teeth. They can show up on any part of the tooth, though normally you will notice it further away from the gumline. Enamel hypoplasia may show up as a few small dots, or in more severe cases, form streaks or lines.
If these white spots are on baby teeth, it isn’t much cause for concern long-term. However, it does still mean that these areas are more prone to decay and cavities. You can prevent further decay by following the measures listed above concerning how to treat demineralization. In terms of prevention, key measures to focus on include avoiding injuries to the mouth, ensuring your child has proper nutrition, and staying healthy to avoid illness as much as possible.
Calcium buildup, also known as tartar, can show up as white spots. These white spots can form when calcium-containing saliva interacts with bacteria on teeth, creating a calcium-heavy mixture (called plaque) that hardens on the surface of the tooth to become tartar. Tartar is often most noticeable near salivary ducts, which are near the inside of the lower incisors (the bottom four front teeth), and the outside of the molars (teeth farther back in the mouth).
Calcium buildup can only be removed by scaling the teeth, which is the process of a dental professional scraping tartar-heavy spots using specific instruments. The best prevention is proper dental hygiene, which includes visiting the dentist twice yearly to keep teeth clean and avoid tartar buildup.
Fluorosis is another cause of white spots on teeth. Quite the opposite of the causes listed above, fluorosis can occur when a child is ingesting far too much fluoride. These spots generally look blotchy or streaky, and may only be visible during a dental exam. If left untreated, fluorosis can cause white spots on any remaining baby or adult teeth that come in, as well as cause issues with bone growth and health.
However, it is worthwhile to note that most cases of fluorosis are often quite mild, and for most of the population, fluoride is harmless (and often beneficial!). Most children do not have enough fluoride-containing products in their daily routines to develop fluorosis. It normally only occurs if children are drinking from unregulated well water, or they are using multiple fluoride-containing products, including dental cleaning products and multivitamins. Additionally, babies who exclusively drink formula made with water with high levels of fluoride are at a slightly higher risk. Another important thing to note is that white spots caused by fluorosis won’t occur after teeth have come in. It is only those teeth that haven’t erupted from the gum line that may show these white spots.
Treatment may involve simply reducing the amount of fluoride available to your child. It can also be helpful to supervise your child when they are brushing their teeth, especially while children are younger, to make sure that they are spitting out toothpaste and not swallowing it. Other options, such as eliminating fluoride rinses, and using the recommended amount of toothpaste (rice-sized for teething babies and toddlers and pea-sized for older children), can go a long way. Cosmetic procedures such as whitening can be used in order to restore tooth appearance, but there is no “fix” needed, as these white spots are actually quite strong and won’t cause long-term harm. We are happy to discuss how much fluoride is best for your child and have put together this resource that goes into detail on scientific research into healthy levels for children.
Other White Spots
Older children may also encounter white spots after they get their braces removed. These white spots are caused by demineralization, and treatment involves repairing the weakened enamel.
If you have noticed white spots or any other changes in your child’s teeth, please reach out to us! We can talk through what is causing the spots, what the best treatment plan is, and how to prevent further changes. Additionally, if you have any further questions about fluoride, don’t hesitate to reach out - we would love to discuss what is best for your family. We look forward to hearing from you!
At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.
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