White and brown spot discoloration of teeth
A common question from concerned patients is about the speckled appearance of their teeth enamel. The teeth are not uniform in shade but have chalky white and/ or yellow to brown specks, giving the teeth a mottled appearance. The specks can vary in size and several front teeth are sometimes affected. This can also be accompanied by irregularities in the surface of the enamel such as pits and striations.
What causes white and brown spot lesions on teeth?
White or brown spots are caused by a mineralisation defect in the enamel and arise during the development of the teeth before they erupt into the mouth during childhood.
The most common causes of these mineralisation defects are:
Fluorosis occurs when fluoride is ingested during the period of tooth formation, leading to hypomineralised enamel. This only happens if the level of fluoride ingested exceeds one part per million. Drinking fluoridated water which contains less than one part per million of fluoride will therefore not lead to hypomineralised enamel. At such a low dose, the fluoride in drinking water actually has a protective effect on teeth, making the enamel more resistant to decay when the teeth are in contact with fluoridated water on a daily basis.
The most common source of ingested fluoride is usually fluoridated toothpaste by children who swallow instead of spitting out the toothpaste. It is therefore advisable to provide low-fluoride toothpaste to young children who are likely to swallow the toothpaste during toothbrushing.
- Genetically inherited developmental abnormality of enamel
This rare condition is known as amelogenesis imperfecta and leads to abnormal enamel calcification during tooth development. The severity of enamel hypomineralisation can vary. In some cases, the teeth can be of normal shape with the enamel being chalky and brittle. In other cases, the teeth can be abnormally shaped as well and the enamel pitted and irregular.
How can white and brown enamel spots be treated?
Treatment for white and brown spots will depend on the extent of the lesions. The following options are recommended
- Acid etch treatment
Acid-etch treatment involves the application of an acidic gel to the affected teeth. The acid etch can be combined with gentle microabrasion with a polishing cup that removes the outer microlayer of affected enamel, exposing the smooth glassy, unaffected enamel underneath without harming the tooth. If the white/brown spots are not too deep, this can be enough for elimination of the spots. However, if the lesions are deep, acid etch treatment can be insufficient for complete erasure of the spots. In such cases, the next treatment modalities are recommended.
- Acid etch treatment and Remineralisation
The acid etch treatment is used in combination with a remineralising treatment Remineralisation involves treating the affected surfaces with a remineralising agent such as casein phosphopetide-amorphous calcium phosphate (CPP-ACP) which is obtained from milk and is the active ingredient in toothmousse®.
The affected teeth surfaces are first treated with an acidic gel. The remineralising agent is then applied to the teeth to penetrate into the enamel and restore the affected area. More than one application is often necessary to obtain a significant reduction or elimination of the enamel spots. The remineralisation technique is minimally invasive but it can take a number of treatments for elimination of more extensive lesions.
If the white/brown spot lesions in the enamel are too deep or extensive, the acid etch treatment alone or in combination with remineralisation might not be sufficient. The tooth surface must then be covered up with a tooth- coloured filling material known as composite resin. The affected areas might need to be polished down first or can be treated with the acid-etch and/or remineralisation methods beforehand. Ceramic veneers for greater coverage of the tooth surface can also be used. The restorative method is move invasive as it involves more extensive removal of affected tooth structure and the restorative material might need to be replaced over time.
White and brown spots can give teeth an unsightly, mottled appearance. There are however different treatment modalities that are minimally invasive and effective for the reduction or elimination of the lesions.
To know which treatment is the best option for you , the Melbourne Smile Clinic is your dentist in Northcote. Contact us for an assessment.