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White Stains and Microabrasion

The smile may be perfect, but one white stain can ruin the whole thing.



What are those white stains on the surface of the teeth?
Stains testify to a local problem in the development of the tooth’s enamel. The stain can appear in various shapes, as one or more specks on the surface of the tooth, or as streaks. Sometimes, there are several teeth involved. The different shade of the stain (shining chalky white or sometimes yellow/brown) is due to a local disorder of the calcification of the tooth’s enamel. The depth and location of the stain varies.

Reasons for the formation of white stains on the surface of the teeth:
It is important to distinguish between stains that were “always” there, meaning since the tooth erupted, and stains that developed at later stages.

Reasons for the appearance of white stains since the tooth’s eruption:

1. Injury – This is the most common reason. Damage to the baby teeth may interfere with the development of the permanent tooth’s enamel before it has even erupted.

2. A systemic disease during childhood, such as a severe febrile illness, could interfere with the development of the teeth’s enamel.

3. Fluorosis – Fluoride is known to strengthen the tooth’s enamel. We must differentiate between fluoride administered as a local treatment, such as fluoride in toothpaste, and fluoride given as a systemic treatment, such as fluoridated drinking water or fluoride drops which were administered to babies in the past. Fluoride administered in a form which is swallowed when the teeth buds are developing penetrates the enamel and strengthens it. In cases in which fluoride consumption was increased (for example, a combination of fluoridated drinking water + fluoride drops and/or a child who often swallows the toothpaste), white streaks may appear on the surface of the teeth, and sometimes brown stains.

4. Developmental disorders which damage the structure of the tooth enamel.
It is not always possible to know for certain the reason for the development of the stains that “were born” with the tooth, but we can roughly estimate at what age the damage to the development of the tooth enamel took place according to the location of the stains (like geological layers in stone).
Reasons for the appearance of white stains at a later stage:

1. Early caries – This is one of the common reasons for the appearance of white stains at a later stage. Preliminary caries decay causes demineralization of the tooth enamel and the decay is a white chalky color at first. If we do not treat the caries problem on time, it will worsen.

2. Stains appearing after orthodontic treatment – Braces and rings affixed to the teeth during an orthodontic treatment prevent that area of the tooth enamel from being exposed to saliva and to processes of remineralization. In addition, if oral hygiene is not maintained adequately, these areas become points of accumulation for bacterial plaque. Therefore, after braces are removed, white stains may appear in those areas.
How is this treated?
First, the stain must be diagnosed and the reason for its appearance discerned. Stains which developed at a later stage are different than stains which developed before the tooth erupted, and therefore their treatment must be addressed differently.

The best way to treat later-stage stains is of course to prevent their development from the start. Maintaining proper oral hygiene and regular visits to the dental hygienist and dentist will help prevent the stains, which attest to early caries. If a stain is diagnosed as early caries, it may be treated using protective measures such as applying fluoride locally, improving oral hygiene and using a preparation called Tooth Mousse (manufactured by GC). The mousse is essentially a cream which includes bovine milk protein, casein and minerals important for the enamel. The casein adheres to the tooth and thus the minerals are more readily available to the enamel for performing remineralization. In addition, during an orthodontic treatment, it is very important to maintain proper oral hygiene and visit the dental hygienist regularly. The mousse cream can also be used as a preventative measure.
A stain that developed before the eruption of the tooth usually does not require treatment, unless it appears on the front surface of the tooth and is aesthetically unpleasing. One of the ways to eliminate such a white stain is using the
microabrasion method.

Microabrasion:

This is essentially similar to “peeling.” A cream containing acid at a medium level, as well as abrasive particles, is used. The cream is spread onto the stain and rubbed gently…the process is repeated several times, each time for a short period of ten seconds. The process itself does not hurt and does not require numbing. It is important to apply fluoride gel onto the tooth following the treatment, to brush well and to use the mousse cream. Using microabrasion, the stain will be either removed entirely or sometimes just lightened, depending on the depth of the stain.

Photo 1: Before Microabrasion



Photo 2: After Microabrasion


In certain cases, the process will be completed using tooth whitening. It is important to note that if the teeth are whitened while there are still white stains which were not treated beforehand, the result may actually emphasize the stains; therefore, it is important to determine the most suitable course of treatment.

In cases when the treatment using microabrasion has not entirely removed the stain and the stain is still aesthetically displeasing to the patient, it is possible to cover the stain using a white filing or by covering the entire tooth with a laminate.


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