Early ECC: White Spots

White spots and lines are demineralized areas of enamelĀ that represent the first clinical signs of caries.

AppearanceĀ & Symptoms

  • Caries typically affects the teeth that emerge first and are least protected by saliva (e.g., the upper incisors).
  • White spots or white lines typically begin at the gingival margin.
  • If the disease process is not managed, the lesions will progress and the demineralized enamel will break down to frank cavities that initially appear pale yellow.
  • In time, these lesions will progress to larger brown cavities.

TreatmentĀ & Referral

  • Immediate dental referral should be arranged.
  • If the clinician cannot determine whether an enamel lesion represents enamel hypoplasia or early caries, refer to establish a dental home, as the child is at high risk for ECC in both scenarios.Use topical fluoride to reverse or arrest lesions.
  • Dietary and oral hygiene counseling should be given.

Early Stage ECC

Joanna Douglass, BDS, DDS
Joanna Douglass, BDS, DDS
Joanna Douglass, BDS, DDS


Weyant, Robert J. et al. Topical Fluoride For Caries Prevention. JADA, Nov 2013, Volume 144 (11): 1279-1291.