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Once your child’s first set of teeth shows up, you may notice a couple of tiny white spots on them. Spots that form during early childhood are referred to as hypocalcification or enamel hypoplasia. The spots are not always milky white – they may be brown or yellow. In more severe cases of childhood enamel hypoplasia, the teeth may be thin or deformed in certain places.

Enamel hypoplasia in children often affects the back molars. That is why even though your child may not be showing any white spots on their front teeth, regularly examining their molars or scheduling routine dental checkups is key to arresting the hypoplasia at its early stages.

The causes of white spots in children are varied. Sometime the hypoplasia appears as distinct markings on just one tooth – a phenomenon known as Turner’s tooth – the cause of which may have been trauma or some form of disruption that took place during the mineralization that precedes the emergence of the tooth.

In other instances, the hypoplasia affects multiple or all teeth, appearing as cloudy opacities or diffuse streaks. Such widespread hypoplasia points to a systemic cause over a considerable time frame. A third but rarer cause of white spots in children is fluorosis, the result of too much fluoride in drinking water.

A key point in identifying the cause of the hypoplasia is whether the spots were there when the tooth emerged or if they formed later. If they spots appeared after the tooth emerged, this is often the first sign of tooth decay.

So what should parents do? Contrary to what some might expect, there is probably nothing you need to do. The only exception would be if the dentist determines the white spots as the early signs of tooth decay or if the front teeth are hypoplasmic and their appearance is a dent on the child’s self esteem.

Where early decay is the likely cause of the white spots, appropriate measures should be taken to stop enamel deterioration and prevent cavity formation. If the decay is on the molars, a crown may be required. But if the spots are still tiny and in their early phase, then white filling will do.

In instances where the white spots are not decay related but appear of the front teeth, cosmetic procedures such as microabrasion and some bleaching can improve the appearance and allow the child to confidently smile again. Severe white spots on the front teeth may call for more advanced approaches such as a porcelain veneer.

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