A number of factors can lead to the development of white spots on teeth. Sometimes these spots are caused by inadequate nutrition during the formation of the tooth, or a genetic upset in development. Occasionally white spots are due to fluorosis, an excess of fluoride during tooth development that disrupts the homogeneous formation of enamel.

Most often, white spots or patches on teeth are due to demineralisation, i.e. the loss of some essential minerals such as calcium that are part of the tooth enamel. The demineralisation is caused by acid attack and the acids are either formed in the mouth by bacteria acting on sugars, or by acidic drinks or mouthwashes used in excess. Many people fail to brush adequately at the gum margin, leaving a layer of plaque on the tooth just above the gum line. It is in this plaque that bacteria multiply forming organic acids that are in close association with the tooth surface within the plaque and hence start to dissolve enamel. The removal of certain mineral elements from the enamel causes it to lose its slightly translucent property and it becomes an opaque white. If the decay process carries on unchecked the enamel will eventually be breached allowing bacteria into the underlying softer dentine which can then become brown and discoloured. White patches of demineralisation can often be seen unfortunately on children’s teeth on removal of orthodontic appliances following treatment. This is because the brace has made it too difficult for the child to adequately clean all the surfaces of the teeth and some demineralisation has occurred.

In view of the explanations of how white spots occur it can be appreciated that they are not simply stains on teeth but due to a change in the actual structure of the teeth and cannot therefore be easily removed. They cannot be wiped away or cleaned off.
If the white patches are due to demineralisation some improvement can occur quite often by repeated application of topical fluorides which become incorporated into the enamel. This can help to strengthen the weakened enamel and can sometimes also help to dull down the whiteness. It is unlikely however to enable the original natural color of the enamel to be recovered.

The main concern of many is the appearance of white spots on the teeth which they find unattractive and they want something done to improve the aesthetics. The only options are to remove the affected area and restore with a bonded composite type of filling that matches the tooth’s color, or, if the area is extensive, to reduce the outer enamel and then overlay the whole outer aspect of the tooth with a bonded porcelain veneer or laminate. This is a very thin piece of porcelain, looking rather like a false finger nail, made from an impression of the tooth, and bonded into place with light-cured low viscosity composite dental cement. These restorations can look amazingly lifelike and, if well done, can restore a tooth to its former glory. A good veneer is indistinguishable from a normal tooth in most circumstances. If white patches are extremely extensive it may be decided by your dentist that a full crown or cap is your best option, and this can also be made to match in with your other teeth.

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