White Spots

Published Date 05/13/2013

A 13-year-old female patient had a chief complaint that she hated the white spots and mini holes in her teeth.

A visual examination revealed several white spots, or hypocalcification. I explained to the patient that they were a breakdown process in the enamel.

I discussed several treatment options with the patient. One option was to give the patient composite fillings. A second option included a new minimally invasive white spot technique that would minimize the amount of restorative treatment we would have to do.

The patient and I chose the minimally invasive white spot technique as the best treatment option. This option was less invasive, and we also had the option to use composite fillings if the technique did not fully resolve the problem. The overall idea was to give a minimally invasive treatment.

First, I had the patient modify her diet to eliminate any acidic beverages, such as soda and lemonade, that could create more enamel breakdown. Then, I began an in-office treatment that included placing HCL pumice on her teeth to remove any loose enamel particles and to open the enamel pores. I acid etched the teeth with 37% phosphoric acid and then applied MI Paste (GC America) for 5 minutes in the office. I also created custom trays for the patient.

After the in-office treatment, the patient went home and wore MI Paste in her custom trays for as long as possible every day. During the patient's second visit, I performed an in-office etch and applied the MI Paste on the etched tooth surfaces for only 40 seconds. The patient then continued her at-home protocol.

When I saw 50% remineralization of the patient's teeth, I added pola night (SDI), an at-home whitening component, and continued this protocol until we were done with the case.

I did not encounter many challenges during this case. The only challenge was patient compliance, because she had to wear trays with MI Paste at home. Luckily, this patient was compliant.

The end result was successful and no fillings were needed. Both the patient and I were thrilled with the outcome of the case.

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