Decalcification -- Will Fluoride Help?

My seven-year-old daughter has a large white area on her permanent front tooth. The dentist has called it a spot of decalcification. Can topical fluoride applications do anything to strengthen this area and improve its appearance?

Question:

These white spots on enamel have many different names, such as decalcification, hypocalcification, demineralization, dysmineralization, and opacities. They can be caused by trauma or infection, but many times we are unsure of the cause. This incomplete mineralization causes a change in the porosity of the enamel, resulting in an opacity or white spot. If caused by a developmental defect, these opacities are generally located below the intact enamel surface. These opacities can also appear after development, usually as a result of plaque which has been allowed to remain in place for long periods of time. In these cases, the enamel surface may not remain intact.

Treatment for these anomalies is variable depending upon the type of defect and the depth of the discoloration. The application of topical fluoride may be somewhat beneficial in strengthening these areas, especially if the defect has occurred after development of the tooth. However, fluoride will not improve the aesthetics of the area. If the stain is superficial, it might be removed with microabrasion techniques using 3 percent hydrogen peroxide, pumice, and hydrochloric acid. Abrasion with pumice, acid etching, and polishing with rotary instruments may also be successful in removing superficial stains.

If the stain is deeper, bonding with composite resin (i.e. tooth-colored filling material) may be necessary. The microabrasion or abrasion technique could be attempted first, with the understanding that a composite resin filling will be necessary if the discoloration is too deep for these treatments to be effective.

Some research has shown that microabrasion techniques can remove superficial enamel opacities. With careful application of the correct compound, it is not harmful to the pulp tissue (i.e. nerve and blood vessels in the tooth). This remedy appears to be permanent because the discolored enamel is actually removed. Microabrasion does not appear to increase susceptibility to decay. In fact, clinical results show that a shiny, glasslike surface appears over time. Plaque is less adherent to these microabraded areas. More research still needs to be done to determine the exact nature of long-term enamel changes with microabrasion.

Research has also shown that about 50 to 75 percent of white discolorations are successfully treated with microabrasion techniques (JADA, April 1990, pp. 411-415). Even if composite resin is necessary, preliminary treatment with microabrasive techniques may give a better overall result. You may wish to discuss microabrasion and abrasion techniques with your dentist. It is possible one of these treatments may be helpful. If necessary, composite resin can also be used now to cover the opacity. In the future, a porcelain veneer can be placed for improved aesthetics.

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