Q: I have two white spots on my upper front teeth that I’ve had my whole life. I’ve tried bleaching with teeth whitening products, but they’re still there. What can I do to get rid of them?
There are a number of circumstances or conditions than can result in areas on the enamel that appear markedly whiter than the rest of the enamel. The photo above clearly shows a distinct round dot that is typical of a condition know as Turner’s Hypoplasia. It is the result of a childhood trauma to the mouth that disturbed the enamel development of an adult tooth as it was forming in the jaws at the time of accident.
Injury to a child’s mouth can occur quite easily especially when they are beginning to crawl/walk and explore the world around them. Ten permanent (adult) teeth develop in the jaw bone immediately below the ten primary (baby) teeth that they will eventually replace. Even though you cannot see the adult teeth, injuries to the baby teeth can affect the health and development of these important replacement teeth.
If, during a fall, the child’s mouth is injured, one of the primary teeth may make contact with the facial (and sometimes the palatal) side of an upper front permanent (adult) tooth with enough force to interfere with the cells that are forming the adult enamel on that particular tooth. Injuries such as this usually occur before three years of age.
The disturbance can result is a round whitish, sometimes yellowish spot in a specific location which corresponds to where the baby tooth “banged into” the adult tooth and mineralization was impaired before it was completely finished forming. This spot is visible when the adult tooth comes into the mouth and usually affects only one tooth in the mouth.
Diagnosis and Treatment
There are other causes of Hypoplasia that can leave the enamel weak and more susceptible to the cavity process. If the size and depth of the spot is minimal, it can usually be fixed quite easily. The dentist will first identify and determine the cause of the white spot, ensure that more teeth aren’t affected and that it isn’t an indication of a more serious condition. If the area of concern is only cosmetic in nature there are two common remedies:
Microbrasion – If the affected area of the enamel is very superficial in depth then a conservative procedure called microbrasion can be done. A very minute layer on the affected enamel is removed using an acidic/abrasive mixture with some products having a bleaching agent added to their formula. The amount of enamel that is removed during microabrasion is minuscule and unnoticeable, however, there is a risk that the resulting thinner more translucent enamel may allow the darker coloured dentin to shine through causing the new surface colour to also appear darker. If your dentist is planning on adding a whitening procedure to this treatment in an attempt to better match the affected spot to the same colour as your natural tooth shade, they may decide to wait several weeks since it takes this long for surface remineralization to occur.
Filling – If the damaged enamel penetrates further into the tooth then the area can be fixed with a tooth-coloured resin filling material. Your dentist will choose a shade of enamel coloured dental filling material that most closely matches the white shade of your natural tooth. The white spot will be removed and replaced with this dental material then buffed to a high glossy finish for a natural-looking, glossy sheen.
Veneer – If the tooth is spotted with several larger areas of discolouration, yet the integrity of the tooth’s crown is still very sound, then a matching porcelain dental veneer can be place over the entire frontal portion of the tooth somewhat like a false nail is attached to finger nails.
It is important to understand that there are other, more serious reasons for white spotting on the teeth that are not just a matter of cosmetic concern, but a problem that can leave the enamel susceptible to further damage and deterioration.
Oftentimes, parents do not realize that their child has sustained a dental injury until obvious signs and symptoms appear such as an infectious gum boil, loose tooth or darkened enamel. Some dental injuries, if left untreated, can lead to damage of the developing adult teeth.
If your child has sustained an injury and you suspect that it may have affected one or more of their teeth it should be evaluated by your dentist as soon as possible. An examination will determine the severity of the injury, if immediate treatment is necessary or if it is a situation that should be monitored.
Our smiles are important to us which is why even small imperfections on our teeth can be bothersome. As the demand for perfect smiles continue to increase, so do the improvements in dental materials and techniques making it easier for us to restore Your Smile. In fact, it’s a simple as a call to (905) 5SMILES. 🙂
Yours in Better Health,
Dr. Sam Axelrod and Associates