Having white spots on the gums should alarm the dentist for possible immunodeficiency states.

Sometimes the patients complain of white spots on their front teeth. Such condition may be hereditary but most of the times are due to some other factors that we will discuss in this article.

The white spots on the teeth are mainly a cosmetic issue but should be taken under serious consideration because it may be an early sign of initial tooth decay. The white spots are usually a result of enamel demineralization. This is how the caries begins – the acids from the bacteria that reside in the mouth and the acids from the food cause this loss of minerals. If the ph stays lower than 5.5 there is no balance between the demineralization and remineralization and loss of minerals is at place. This process can be seen on the tooth as opaque areas.  These opaque areas have a white color and people complain of “white spots on their teeth”.

Having such hypocalcified spots does not mean that the patient’s hygiene is bad, sometimes can be caused by other factors like wearing braces for a long time. In these cases the hygiene is hard to be improved due to this plaque retention factor.  The mineral loss can be caused by consuming too much acidic foods (citric fruits, drinking juices with low ph). People do not realize how acidic some foods may be. Let’s take for example Coca Cola. While drinking it you feel the sweet taste but that does not mean that it does not contain acidic components. As a matter of fact such juices and drinks are the most dangerous for the enamel, you feel they are sweet but they contain a huge amount of acids and sugar at the same time. Keep in mind that the cariogenic bacteria in the mouth use simple sugars for living and their final metabolic product are acids. In this way acids are delivered by the juice itself and from the bacterial terminal products of metabolism. These demineralized areas can be restored if the ph is raised over 6.5 ph.

The white spots can also be a result of hereditary conditions such as enamel and dentine hypoplasia. The mineralization of the tooth tissue is lower than usual but that is not a consequence of acidic foods or poor hygiene but other factors we will discuss later on.

Sometimes babies have teeth that are present in their mouth at the time of their birth. They are called natal teeth and their presence is very uncommon. According to National Institute of Health studies they appear in one of 2000-3000 babies. Usually this is the set of the lower central incisors. The babies born with teeth have to be monitored because this condition could cause some problems.

What to do with the natal teeth?

The doctors should decide what to do with the natal teeth. They can be extracted before the mother has started nursing. The natal tooth can hurt the mother’s breasts and also cause choking if the tooth is loose and at some point it falls in the baby’s throat. Don’t worry if your child has lost his natal tooth because he will still have his decidous and adult teeth and won’t affect their development and eruption. If the babies are born with a loose tooth it is better to be extracted.

Another decision the dentist can take is to keep the natal tooth. If it doesn’t have pointy and sharp edges and doesn’t bother the breastfeeding the tooth can be kept. Keep in mind that it is a retention factor and should be cleaned often. That can happen by rinsing or rubbing the gums with cloth soaked in hydrogen hydroxide. If the tooth is sharp it can be polished with a bur and other polishing brushes and disks. The baby can hurt the mother’s breast and even himself when sucking his own teeth.

It is very important for the clinician to be aware of the teeth eruption dates. Not only for the primary but also for the permanent teeth. In this way the diagnosis of the supernumerary tooth will be easier to place. The eruption dates can vary and depend on hereditary factors but there are certain periods in which the tooth eruption is considered as premature or delayed eruption. The baby teeth chart will help you orientate about the normal eruption dates. The presence of these conditions should alert the dentist to a potential problem.

Assessment of the oral soft tissues and dental check-up must be executed. After the assessment the dentist should write down all the information received during the intra-oral examination. The following factors should be included in the dental charting

Sometimes the patients complain about a weird change in the color of their gums. They come to us complaining about their bad outlook and want to solve this problem as soon as possible. This situation may happen very often in the regular dental practice since most of the patients are concerned only about the esthetic point of view. On the other hand the clinicians have a different way of evaluating these conditions and are mostly concerned about the function and anatomical health of the surrounding tissues. As a matter of fact both points of view meet in the right clinical decision when it comes to gum diseases.

The best way to evaluate the importance of the clinical case is by obtaining the medical history information- what the complaints are, the history of the complaint, past dental issues, social and family dental and medical history. The patients have noticed a significant change in the gingiva margin which is close to the tooth crown. They say “Doctor, my gums turned black and look awful. Is there an explanation for this color change and what can I do to restore their previous color?” When we observe a healthy gingiva its normal color is pink. Actually this pink color comes from the small arteries and capillaries in the gums.

All of our teeth have individual numbers so that the dentists can specify the location of the tooth in the dentition.

Microdontia is the condition when one tooth, group of teeth or all of the teeth have unusually smaller size.