White spots on baby teeth

Babies get their first teeth at around 6 months of age (the lower front teeth) and the first adult tooth at 6 years old (the first molars). During this time, you may have noticed a few extra white streaks or spots in your child’s smile.

White spots on baby teeth are most commonly seen on the front upper teeth, as these teeth are the most evident during smiling or laughing. But they can also affect other teeth surfaces.

Though your first thought may be that there is something wrong with your child’s teeth, or that you should take them to the dentist as soon as possible, you may be relieved to know that in the majority of the cases, these white spots don’t necessarily mean something serious.

White spots on baby teeth

5 Things White Spots on Baby Teeth Could Mean and 5 Ways To Get Rid of Them

You could be concerned about your child’s oral health, or maybe you could also feel like the appearance of your child’s smile has been affected by these spots.

Even though “white spots” is a very imprecise term and could mean many things in dentistry, here is a list of the 5 most common things that white spots on your baby’s teeth could mean:

5 things white spots on baby teeth could mean:

1. Dental Fluorosis

Now don’t panic yet! Fluoride is an essential part of healthy teeth, it keeps the outer layer of your teeth (enamel) healthy and is extremely important to fight decay.

Always make sure that you’re brushing your teeth using toothpaste containing at least 1450 ppm Fluoride.

Having said that, taking in too much fluoride as teeth are forming (before they have even erupted through the gums) can cause dental fluorosis. This usually happens by children swallowing small amounts of fluoride, either in toothpaste, or in some places fluoride is present in tap water, and naturally in the soil.

White spots that have occurred because of dental fluorosis are usually hard, and can’t be scraped off.

Dental fluorosis doesn’t mean that your child’s tooth is “sick” or weak, on the contrary, the white spots mean that the tooth has undergone more minerlization and is stronger (1) in that area and will not be decayed as easily as the rest of the tooth surface.

How to prevent Dental Fluorosis

  • The American Academy of Pediatrics recommends that you switch to a fluoridated toothpaste immediately as soon as your child’s teeth begin to come in (1), you can tilt their head forward as you assist them in brushing their teeth to avoid any swallowing.
  • If your child is younger than 3 years old, use only a small smear (no larger than a grain of rice) of fluoride toothpaste. For children older than 3 years old use a pea-sized amount of fluoride toothpaste.
White spots on baby teeth
Amount of toothpaste your child should be using
  • Unless your child has a condition were it’s important and has been instructed by a dentist to use them, mouthwashes containing fluoride are completely unnecessary for your child as long as they’re brushing properly twice a day.
  • Always administer your children brushing their teeth until they get older, or until you feel that they no longer require instructions from somebody.
  • The American Dental Academy recommends that you breastfeed your child, and at 6 months introduce solid food. If you must use infant formula, then it may be wise to consult your doctor on the best type of formula to use for your child as some of the products contain fluoride (2).

Fluorosis doesn’t affect tooth function and may only affect the appearance of your child’s smile.

Most of the time the spots are extremely unnoticeable and usually won’t be seen other than during a dental checkup.

If you’re really bothered by the fluorosis in your child’s teeth and think that it has a negative effect on your child’s self-esteem or behaviour, then continue reading below as I mention 5 ways to get rid of white spots.

2. Tooth decay:

Unfortunately, white spots on teeth could also be a sign of the first stages of tooth decay.

In dentistry, we refer to this as “incipient caries”, and it’s characterised by an “appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel” (3).

If the white spot on your child’s tooth has a white soft chalky texture to it that can be scraped off, then that could be a strong indicator of tooth decay and will require a visit to the dentist.

For children, a very common location for caries is at the gumline, (cervical caries), and so if the white spots are located just by the gumline, that’s another strong sign that the white spot is because of caries, and not fluorosis or anything else.

White spots on baby teeth
The beginning of cavities, notice the “white line” near the gum-line of the upper teeth

If you suspect that the white spots on your child’s teeth are due to caries, or if you want another opinion, then it’s strongly recommended to let a dentist examine your child, especially to prevent progression of the lesion into something more serious and painful.

If the white spot does indeed turn out to be tooth decay, depending on the severity of the lesion, your child may need a filling, or something less invasive, like a fissure sealant.

3. Tooth erosion due to a high-sugar diet:

If your child frequently enjoys eating sweet food, and drinking sugary fizzy drinks, this could be a direct cause of the white spots on their teeth.

Other than the fact that sugar is consumed by bacteria that then produces acid and in turn tooth caries – the acidity in sweet fizzy drinks (like Cola or Fanta) can cause wear and erosion of the outer layer of teeth, the enamel.

This wear of tooth surface due to a chemical is referred to in Dentistry as erosion. It is generally caused by sugary drinks and fizzy drinks that are acidic in nature.

Natural juices like orange juice or lemonade are also highly acidic and can cause tooth erosion.

Tooth erosion “eats” away at the outer layer of the tooth, the enamel, exposing the sensitive inner surface called dentin. Dentin is more sensitive than enamel and it’s yellow in colour.

Advanced cases of tooth erosion manifest as very yellow. In the early stages however, they can present with white spots as the enamel begins to become under-mineralized by the acidic drinks.

Tooth erosion is a sensitive and painful dental condition and usually takes a while to develop. Most people complaining of tooth erosion are usually older and so it may be uncommon for your child to be experiencing it.

4. Enamel Hypoplasia:

Enamel hypoplasia is a dental condition in which not enough enamel is created in the tooth as it’s developing and forming.

This is known as defective enamel development, and it’s still unclear exactly why enamel hypoplasia happens, but it’s often associated with other syndromes like Down’s syndrome.

Enamel hypoplasia can present as white spots, but also as grooves and pits on the tooth surface.

It could range from mild to severe, in which the latter would lead to further dental problems like sensitivity, pain, and increased susceptibility to dental caries.

It’s quite an obvious dental condition, and if your child is suffering form it, your child’s dentist will be able to diagnose it quite easily.

Enamel hypoplasia requires professional dental work and your child’s dentist will deal promptly with it, firstly – and most importantly – by giving you advice on how best to take care of your child’s teeth.

In this case, prevention is crucially important, and keeping teeth affected with enamel hypoplasia clean will save a great deal of pain and further dental work in the future.

5. Poor Oral Hygiene

If you don’t brush enough, plaque will accumulate on your teeth surfaces (in addition to countless other dental problems). Plaque accumulation can present as a yellow or white film, or spots on the surfaces of teeth.

Plaque is a sticky film that forms on your teeth (minutes after you have brushed them) consisting of millions of bacteria that live in your mouth.

If plaque is not removed through brushing, it leads to gingivitis (gum inflammation), and can cause cavities to form.

Brushing twice a day and flossing once a day remains as the number one rule for having proper dental hygiene. This is equally important for children, but children don’t need flossing (as they don’t have tight contacts between their teeth), but they still need to brush their teeth twice a day.

If the white spots that are present on your child’s teeth seem to be soft and can be removed with  tissue paper, or disappear after they brush their teeth, then most probably the white spots are due to plaque accumulation, and you should make sure your child improves their oral hygiene.

5 Ways to Remove White Spots on Baby Teeth

The treatment will depend greatly on the nature of the dental condition, and the cause of the white spot on your child’s teeth.

White spots due to fluorosis will most likely not be aggressively removed by the dentist. There would be absolutely no point in removing sound and healthy tooth structure from a baby tooth to remove a white spot simply for cosmetic purposes.

For white spots that pose a more serious threat to your child’s dental health, such as enamel hypoplasia or tooth decay, your dentist may introduce these options to you:

1. Composite (white) fillings

Composite fillings require removal of the decayed or affected tooth structure, and then filling with a composite material.

This would be the treatment of choice if your child has been diagnosed with tooth cavities. Other filling materials are available such as amalgam (silver) or glass ionomer fillings.

2. Crowns

This is a common dental technique in restoring baby molars.

If you’ve noticed a white spot on your child’s back teeth, it may indicate a cavity from beneath. Stainless steel crowns are usually used for larger and deeper cavities that have infected a large part of molars.

Stainless steel crowns usually last the whole life-time of the baby tooth and get exfoliated along with it. They have a very good success rate.

For front teeth, crowns made from composite can be formed. This is also usually the treatment of choice for front teeth badly affected by enamel hyoplasia.

3. Dental sealants

Dental sealants are thin almost fluid resins that are brushed onto the surface of teeth and bond to them, filling any pits, fissures, and grooves.

They are usually done to prevent tooth decay. but are sometimes used by dentists to treat early cavities that may present as white spots.

4. Enamel microabrasion

In Enamel microabrasion, a very thin layer is removed from the enamel (the external surface of a tooth) in order to remove the white spots.

This technique is usually done for older patients with permanent teeth and it’s not very common for child patients with baby teeth

5. Prevention

Prevention is the most important aspect for dental fluorosis.

Follow the tips I mentioned above under dental fluorosis and make sure your child is not swallowing toothpaste containing fluoride, or drinking excess water that contains fluoride.

White spots on baby teeth: conclusion

If you’ve noticed white spots on your child’s teeth, especially along the tips of the incisors, then most probably it’s a case of dental fluorosis. If that’s the case, depending on the severity of the situation,  it would be wise not to worry about it, rather – embrace your child’s smile and motivate them for having squeaky clean teeth that are extra white and strong.

White spots warranting further attention (especially along the gumline of your child’s teeth) will require a professional dental exam, and may need further dental treatment.

Early diagnosis is especially important in such cases, so make sure to visit your child’ dentist as soon as you notice anything requiring a closer look, especially if your child is complaining of sensitivity or pain in the area of the white spot.

Written by Dr. Khaled Mahmoud

Khaled Mahmoud completed his dental education and obtained his Bachelor of Dental Surgery (BDS) in 2017. His interests lie in cosmetic dentistry and non-surgical facial aesthetics. He is active in dental research, contemporary cosmetic materials and techniques, and has been a member of numerous public health outreach programs.