Seeing White? It Could be Hypomineralization?

If you or your children have little white spots on your teeth, you may be wondering what they are and if they’re dangerous. Those little spots are called hypomineralization, and while they all appear in the same form, they don’t all come from the same place or pose the same risk. But don’t panic! They’re usually not dangerous and are often correctable with proper care.


According to Dr. Gary Lederman of Bellmore, New York, one of the most common causes of hypomineralization is fluorosis. Fluorosis begins long before your adult teeth even erupt. It is caused by excessive exposure to fluoride while the adult teeth are still forming.

"Fluorosis can come from swallowing lots of fluoridated toothpaste, from drinking well-water, and from certain medications," Lederman said.

In cases of fluorosis, the spots appear on the child’s new adult teeth as they emerge, but unlike with other cases of hypomineralization, the white spots from fluorosis are actually harder than the rest of the tooth.

"In fluorosis, those spots are the hardest part of the tooth’s enamel," said Lederman "But despite their strength, they do appear uneven in tone, and unfortunately, this type of hypomineralization is permanent."

Other causes of hypomineralization spots include enamel hypoplasia, which can be caused by a high fever, premature birth, prenatal smoking, nutritional deficiencies and as a side effect of certain medications. Enamel hypoplasia may appear as spots but can appear more linear in nature, and unlike fluorosis the hypomineralization spots from enamel hypoplasia are weaker than the rest of the tooth’s enamel, thus carrying an elevated risk of cavities.

Hypomineralization can also be caused by demineralization, which occurs when plaque builds up on the teeth due to inadequate brushing. Demineralization often appears in children and adults who wear braces, because they cannot reach certain areas of the teeth due to the braces being attached to their teeth. Demineralization spots are permanent and also carry a high risk of cavities, but this can be prevented with proper care.

Thankfully, while spots from enamel hypoplasia and demineralization may not as strong as those left behind from fluorosis, they are treatable. In fact, a new procedure called resin infiltration is being tested at the University of Alabama at Birmingham, and may soon be able to treat hypomineralization spots without using a drill. The process is said to use a solution made from either phosphoric acid or hydrochloric acid to prep the surface of the tooth, allowing the dentist to carve away the spots and rebuild the face of the tooth with the resin used in fillings.

Until resin infiltration is widely available, Lederman says patients with hypomineralization should pay extra attention to those discolored spots and make sure they don’t change size or color, as this could be the sign of a cavity forming.

"Often, these spots are harmless and we can leave them alone until something changes," said Lederman. "But as long as they aren’t developing into cavities, there’s no need to intervene unless the patient wants to."

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