Early ECC: White Spots
White spots and lines are demineralized areas of enamel that represent the first clinical signs of caries.
Appearance & Symptoms
- Caries typically affects teeth that emerge first and are least protected by saliva (e.g. the upper incisors).
- White spots or white lines typically begin along the gingival margin.
- If the disease process is not managed, lesions will progress and the demineralized enamel will break down into frank cavities that initially appear pale yellow.
- In time, these lesions will progress to larger brown cavities.
Treatment & 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
References
Weyant, Robert J. et al. Topical Fluoride For Caries Prevention. JADA, 2013, Volume 144 (11): 1279-1291.
American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): Unique challenges and treatment options. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023: 92-3.