Hypocalcified Teeth: White, Yellow and Brown Blemishes

Teeth occasionally experience a disturbance during development that results in the enamel developing atypically. It is usually observed as a discoloration; white, yellow or brown. I most commonly see it on the first permanent molars and central incisors (two front teeth) though it can happen to any of the teeth.

When this anomaly occurs on the front teeth, there may be some cosmetic concerns to address. In its mildest form it shows as white marks on the teeth, typically near the chewing edge, though it may be anywhere on the tooth. They are often hydration dependent meaning if the tooth dries out the white spots become prominent and when the tooth remains wet the spots diminish or disappear. These are a cosmetic concern only and since an adult’s facial posture keeps lips closed more than children, these blemishes typically remain wet and diminish. We do not recommend any treatment procedures until at least the mid teen years when a more adult facial posture has developed.

White blemishes that are larger and more opaque will likely need removal of the blemish and filling with a cosmetic filling material.

Blemishes of a more yellow or brown nature are often improved with bleaching techniques that can be done at any age. If the blemish does not respond to bleaching we can offer other cosmetic procedures to remove discolorations and refill the blemishes with cosmetic filling materials

If the aberration is severe enough it will result in soft enamel that chips and/or decays easily. It may also result in an atypical shape for the tooth. I usually observe this on the molar teeth. When this occurs, it is important to remove the very soft enamel and place a filling in the area. I do this in a conservative fashion by bonding on a filling material to replace the lost or decayed portion of the tooth. This usually needs “touching up” as the tooth grows and exposes more of the compromised enamel. The soft enamel may also chip around the bonded filling necessitating occasional repairs. Occasionally the aberration in the enamel is extensive enough that we recommend a stainless steel crown as a temporary crown during the growing years. A large percentage of these molar teeth will be best served with a full crown restoration after all permanent teeth have emerged, growth is finished and the occlusion has stabilized (age 18 or older). In the mean time we will maintain the integrity of the teeth with conservative repairs.

These teeth can also be very sensitive teeth for reasons we do not know. Restoring or covering the hypocalcified enamel will occasionally help this. Toothpastes for sensitive teeth (i.e. Sensodyne, Thermodent) can also be helpful. Avoiding highly acidic snack patterns (carbonated beverages, fruit juices, sour candies) will likely be very helpful as well.