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.