White spots on teeth: causes and possible treatments

Where do white spots on teeth come from?

A white spot is an area where the enamel is less mineralised or more porous than the rest of the tooth. It reflects light differently, which gives it a chalky look. The three most common causes are demineralisation (early decay, often after braces), fluorosis (too much fluoride during childhood) and molar incisor hypomineralisation (MIH), a defect in how the enamel formed.

Treatment depends on the cause, how deep the spot is and how far it extends. Depending on the case, the enamel can be remineralised, infiltrated with resin, have a very thin surface layer removed (micro-abrasion), the whole tooth can be lightened or, for deep defects, the tooth can be covered.

First of all, the dentist needs to distinguish an active spot, which is progressing and can turn into a cavity, from a stable one, which is mainly a cosmetic concern.

The main causes, and how to recognise them

A few clues guide the diagnosis, which still has to be confirmed at the examination:

• Demineralisation (early decay). Chalky spots near the gum or around where the brackets sat after orthodontic treatment, in areas where plaque built up. The surface may be dull and rough if the lesion is active.
• Fluorosis. White spots or streaks, often symmetrical on teeth that formed at the same age, sometimes with brown areas in more severe forms. It results from excessive fluoride intake while the teeth were forming. In Morocco, some areas where the water or environment is naturally rich in fluoride are known for this condition, sometimes called "darmous" locally.
• MIH. Creamy-white, yellow or brown patches that are asymmetrical, mainly affecting the first permanent molars and the incisors. The enamel can be fragile, sensitive and may crumble under chewing.
• After-effect of a baby tooth. An infection or knock on a baby tooth can leave an isolated spot on the permanent tooth that replaces it.
• Temporary spots after whitening. These are caused by short-lived dehydration of the enamel and usually fade within a few days.

Remineralisation: for active and early spots

When a spot is due to recent demineralisation, the priority is to stop the process. Enamel can partly regain minerals if the conditions in the mouth become favourable again.

The usual measures:

• careful brushing with a fluoride toothpaste, paying attention to the gum line;
• professional application of fluoride varnish, at intervals set by the dentist;
• sometimes calcium phosphate based remineralising products, where indicated;
• cutting down on sugary snacks and acidic drinks between meals.

This approach often halts progression and can soften some spots, but it does not always erase them. After braces come off, it is often advisable to allow a few months of natural remineralisation before considering cosmetic treatment, as some of the spots improve on their own. Our article on clear aligners or metal braces also covers hygiene during orthodontic treatment.

Resin infiltration: erasing spots without drilling

Resin infiltration is a micro-invasive technique that has changed how white spots are managed. It fills the pores of the enamel with a very fluid resin whose refractive index is close to that of healthy enamel: light then passes through the area as it does through the rest of the tooth, and the spot fades.

How it is done:

• the tooth is isolated and the gum protected;
• an acid gel is applied to open the surface layer of the spot;
• the area is dried, often with alcohol, to preview the likely result;
• the resin is infiltrated, light-cured and then polished.

The advantages are clear: no anaesthetic in most cases, no drilling, and usually one session per area. Infiltration works well on non-cavitated demineralisation and on many mild to moderate cases of fluorosis. It is less predictable for MIH and deep spots, where the defective enamel is thicker. Your dentist will tell you whether your spot is suitable.

Micro-abrasion and whitening: other gentle options

Micro-abrasion removes a very thin layer of surface enamel using a paste that combines a mild acid with an abrasive, applied with a slow rotary instrument. It suits superficial spots, including some cases of fluorosis and surface brown marks. It is often combined with other techniques and followed by a fluoride application.

Teeth whitening does not remove a white spot, but it lightens the tooth around it, which reduces the contrast. Be aware that spots can look more noticeable during treatment, before blending in better once the shade has settled. For brown areas of fluorosis or MIH, whitening can also tone down the coloured component.

These techniques are frequently combined: whitening then infiltration, or micro-abrasion then infiltration. The order and combination are decided case by case. If what bothers you is more of an overall yellow shade, see our article on yellow teeth.

Deep spots and severe MIH: composite and veneers

When the enamel defect is deep, the surface has already broken down or gentle techniques are not enough, the area needs to be rebuilt.

• Composite. The dentist removes the defective enamel selectively and restores it with a resin of matching shade. This is a common solution for one or a few teeth, particularly incisors affected by MIH.
• Veneers. For extensive spots on several front teeth, or when shape and colour also need correcting, composite or porcelain dental veneers may be suggested. They mask the defect durably but, in most cases, involve some enamel preparation.
• Molars affected by MIH. The priority is functional: protecting a sensitive, fragile tooth, sometimes with bonded restorations or crowns, depending on the patient's age and the state of the tooth.

These solutions are more invasive and are only considered after the more conservative options have been assessed.

Children, prevention and an assessment in Rabat

In children, white spots deserve particular attention. MIH is often noticed as soon as the first permanent molars appear, around the age of six: early follow-up with protective varnishes and fissure sealants helps limit sensitivity and breakage. As for fluoride, it protects against decay provided the amounts suit the child's age: a smear of toothpaste for toddlers, then a pea-sized amount, without swallowing it.

To prevent demineralisation spots, especially during orthodontic treatment: thorough brushing around the brackets, interdental brushes and regular check-ups.

At German Dental Clinic in Agdal, the assessment starts with an examination of clean, dry teeth, photographs and, if needed, an X-ray to make sure no decay is hiding under the spot. Children's dentistry is also part of the care offered, so affected children can be followed up. If you are in Rabat and would like white spots assessed, yours or your child's, you can book an appointment.