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Aetiology and Treatment of Enamel White Enamel Lesions



The presence of clinically detectable, localized areas of enamel mineralization disturbance, observed as white, off white or yellow/brown spot lesions of different opacity can have different origin.  White spot lesions are not only the result of demineralization they can be also indication of fluorosis, hypomineralization/hypomaturation and hypoplasia.  Dental professionals need to perform differential diagnosis to determine the aetiology of white spot lesions, as well as providing appropriate treatment and aesthetic management that will meet patients’ expectations.

Considering the various aetiologies of white spot lesions, it is imperative to establish a proper diagnosis.  This is based on a thorough review of dental and medical history, and clinical examination evaluating the location, symmetry, outline form, depth and opacity of the lesion.  The information gathered must include a history of neonatal or early childhood illness, use of drugs and medications, and past infections or trauma related to primary teeth.

Minimal intervention is an ideal approach in managing white spot lesions.  These techniques will include no treatment that maybe an option in some cases, remineralization therapies with use of fluoride and CPP-ACP paste, tooth whitening, enamel microabrasion, resin infiltration or restorative treatments with composites.

Learning Objectives

  • Understand the different aetiological factors of the white enamel lesions
  • Understand the clinical appearance of the white enamel lesions from different origin
  • Differential diagnosis of the white spot lesions
  • Understand when lesions can be managed with minimal intervention 
  • Understand when lesions is necessary to be treated with restorative interventions
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