The news coverage and social media we come into contact with often leads us to believe that everyone has the Hollywood smile, with super white and perfectly aligned teeth.
Sadly this is not the case and many people have conditions, such as white spots or marks on the teeth that can make us feel self-conscious about our smile.
The good news is for many there are things that can be done to treat this and give you the confidence to smile and show off your teeth.
What are white spots on teeth?
White spots or marks on teeth can be caused by a number of different factors, but are normally as a result of a condition called fluorosis or a process called demineralisation.
Fluorosis is the result of too much fluoride whilst the teeth are developing. This fluoride is a chemical substance found in water, toothpaste and foods.
Demineralisation on the other hand is when the enamel, the very hard outermost layer of the tooth, has been damaged and eroded, essentially taking away the natural protection and minerals found in the tooth.
A dental or medical professional may class these white spots under the term hypoplasia or hypocalcification.
Both fluorosis and deminseralisation can cause either, leaving a white stain, spot or mark on the tooth surface that is a different shade to the rest of the tooth.
What causes white spots on teeth?
As acknowledged above, there are a number of different reasons for white spots occuring on the teeth.
The common causes are as follows:
Terms used to describe the loss of minerals to the tooth enamel, these are quite common.
In these cases the natural layer of enamel on the tooth is thinner or less mineralised than usual. Pits are formed on the tooth surface and because they are porous, the tooth is more susceptible to staining and dental decay.
Hypoplasia /calcification/mineralisation is something that occurs whilst the teeth are developing, and is often as a result of infection, undiagnosed and untreated chickenpox and birth injury amongst others.
A condition whereby the adult teeth have these markings as a result of the individual getting too much fluoride in their system before these adult teeth finish developing under our gums. This typically occurs between 6 months and 5 years old.
Fluorosis does not damage the teeth, it just creates this often uneven, spotted look to the teeth.
Prevention comes from ensuring children are not smallowing too much toothpaste when they are a small child. This is why it is important to use only a smear of toothpaste for children, and is also why children’s toothpastes have a lower dose of fluoride.
You are also at risk of fluorosis if you live in an area with fluoridated water. It is worth noting that the fluoride content is water is generally not high enough to cause fluorosis, however it is more common in India, and some states in the USA.
Overall, the benefit of fluoride in preventing caries is not worth avoiding it to avoid fluorosis. You just need to be aware that too much fluoride can cause aesthetic damage.
- Brace demineralisation/decalcification
When wearing braces you are susceptible to decalcification as the fittings within the mouth offer up lots of crevices for food particles and bacteria to become trapped and allow plaque to build up.
In this case, the white patches are where the early stages of decay have been reversed.
This buildup of plaque around baraces eats away at the tooth surface and the spots and marks become more visible when the brace is removed.
This demineralisation process when wearing braces and undergoing orthodontic treatment is totally avoidable with a thorough oral hygiene routine.
If you are a braces wearer, see our guide on how to brush your teeth with braces for tips on keeping them clean and avoiding issues such as this.
- Poor oral hygiene/heavy plaque accumulation
Failing to brush twice a day for 2 minutes and floss regularly, goes against the advice that most leading dental bodies give out.
Failing to follow these guidelines leave the teeth and mouth vulnerable.
The reason we brush is to remove plaque, a sticky substance that is formed from bacteria.
As plaque grows, it builds up and slowly eats away at the nutrients and enamel on the tooth surface causing the demineralisation process.
What you eat and drink can have a significant bearing on the health of your teeth over time.
Consuming large amounts of sugar, be that in a fizzy drink or citrus fruit can all have an effect.
- Tetracycline staining
Tetracycline is an antibiotic that has been used to treat certain medical conditions. A known side effect is the staining of the teeth.
Tetracycline staining commonly affects children whose mothers may have taken tetracycline during pregnancy, or when the antibiotic was given at a very young age.
It is now less commonly used as a result.
Often caused without knowledge, it can be as a result of how the tooth formed or as a consequence of an illness or as a result of an injury that may have occurred.
An example of this might be in an adult front tooth. If the child fell over and knocked the child tooth when the adult tooth was still forming (say 3 years old), it could damage the adult tooth whilst it is still in the gum.
- Celiac disease
The disruption in what and how nutrients are absorbed the by the weakened immune system, diagnosed celiacs are more prone to white spots
If white spots run in the family, you are more susceptible to being affected too, due to your genetic makeup.
- Dry mouth/ Xerostomia
A condition often caused by medications that dry out the mouth.
Without adequate saliva production, acids that erode tooth enamel don’t neutralise and therefore begin wearing down.
As with braces causing deminseralisation, the white sports are areas where early decay has healed.
How to get rid of white spots on teeth
Many dentists would suggest that the best course of action to manage the appearance of white spots is to prevent them by having a good oral healthcare routine along with a balance and healthy diet.
Brush twice a day, for 2 minutes and clean between your teeth once a day too.
Regular dental appointments are important too, as your dentist will be looking for any signs of these when carrying out an examination.
If you are a parent, ensure your children don’t swallow too much toothpaste.
However, if you already have white spots, you might wish to take further action to reduce the appearance of these.
Best practice aside from the good oral hygiene is to consult your dentist before proceeding with any treatments, particularly if you think teeth whitening is the answer.
A dentist will assess your teeth and the cause of the white spots and consider the least invasive action required to deliver the results desired.
The severity of the white spots will likely impact the course of action. Generally, dentists will want to start with the option that does the least potential damage to the tooth (e.g. preventing white spots with toothpaste), but do have other special pastes they can use.
The techniques used for removing white spots on teeth depend on the cause of the white spot, and what treatment you are willing to go through. Some white spots may be improved with no need to drill, but some white spots may only be covered up with crowns. Every case is individual and get yourself booked in with a dentist to find out your options.
Dr Gemma Wheeler – In-house dentist – GDC Number: 259369
Possible ways of getting rid of or reducing white spots are:
- Home remedies
There are various home remedies documented on the internet and shared amongst people. From baking soda to strawberries, they may all have some merit. They also might have had and affect for some, but you are probably best avoiding them in preference for a professional dental opinion and directed course of action.
- Minimal Intervention (MI) paste/prescription paste
As we have discussed, most white spots are the very start of decay. To get rid of them we need to completely reverse this early decay by re-hardening the tooth surface.
Dentists can us special pastes. Consisting of natural molecules of calcium and phosphate to re-harden the surface. It works to restore the natural look and smooth out any white spots by strengthening the enamel.
Dentists may prescribe a high fluoride toothpaste to prevent you developing any more white spots on your teeth.
White spots could be removed by the dentist by using a mild abrasive on the tooth surfaces to remove a very thin layer of enamel. In some cases the high speed and mildly abrasive is just enough to buff away those surface level spots and give a more even and natural appearance.
- Resin infiltration
The pores of the teeth with the white marks are infiltrated by a tooth coloured resin similar to that used in white coloured fillings
A special gel is applied to the white spot to open up the pores, enabling a deep penetration of the resin. The resin is then light-cured, while the white spot infiltrated.
The resin takes on the appearance of the surrounding healthy enamel. The resin also blocks acid which works towards avoiding additional decay.
The advantage of resin infiltration is that it does not require any removal of any of the tooth surface.
Whitening treatments can lighten the entire tooth to match the brighter spots, but the results are not the same for all, depending on your white marks and the treatment for whitening used.
The advantage of whitening is that it does not require any removal of any of the tooth surface.
Where the spots are deeper a dental process called bonding can be undertaken, where the dentist removes the affected area and repairs it with a bonding agent to give the tooth a rejuvenated look.
A potentially more extreme approach, but one that might be better suited to those with multiple teeth with white marks or where the problem is deeper within the tooth.
The dentist attaches a thin porcelain veneer to the tooth surface and is can be used to conceal the marks on the teeth, to give them a natural, white appearance.
The teeth may be drilled before veneers are placed.
How to prevent white spots?
Whilst ultimately anyone is susceptible to white spots or marks on the teeth, there are a number of things that you can do to limit your chances and help manage the potential appearance of such.
- Brush regularly – Brush twice a day for 2 minutes.
- Floss regularly – Be sure to floss and clean interdental spaces once a day
- Drink water – Make sure to consume plenty of water to keep the body hydrated and healthy.
- Reduce sugars and acids – Try reducing the amount of sugar you eat or consumer via drinks. If you drink lots of squeezed fruit juices like Orange juice, reduce the amount consumed.
- Eat meals rather than snacks.
- If you have children, follow the professional advice on how much fluoride containing toothpaste should be used on your child.