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.