White Spots: The Early Stage of ECC

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

Appearance & Symptoms

  • Caries typically affects the teeth that emerge first and are least protected by saliva, e.g., the upper incisors.
  • White spots/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, the 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 hypoplasia or early caries, in both cases, the child is at high risk for ECC and requires referral to establish a dental home.
  • Provide dietary and oral hygiene counseling.
  • Use topical fluoride varnish to reverse or arrest lesions.

Clinical examples of early stage ECC

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