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White enamel lesions in children: considering caries, chronological and congenital causes and their consequent care


White enamel lesions are a common presentation to the general dentist and aesthetic concerns are the most frequent presenting problem. Aetiology may be multifactorial and management of such lesions is heavily dependent on the cause. In the paediatric patient, differentiating white lesions caused by caries, fluorosis and genetic and developmental disorders is key to offering optimal long-term treatment outcomes. Early intervention allows for carefully planned management of less common disorders. Many of these disorders exist along a spectrum, and white lesions offer a useful clue to prompt intervention and referral to the relevant specialists. This article overviews common white lesions of the teeth and outlines the hierarchy of management options available.

Key points

  • Early enamel caries may present as white lesions; it is important to treat these successfully to avoid progression and the need for invasive treatment.

  • White lesions may be of chronological aetiology such as dental fluorosis and molar-incisor hypomineralisation.

  • Genetic disorders such as amelogenesis imperfecta may also present as white enamel lesions.

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With thanks to the young patients and their parents/guardians for allowing us to reproduce their clinical photographs.

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All authors (Jai Jandu, Nikita Dzyuba and Siobhan Barry) have contributed equally to the work.

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Correspondence to Siobhan Barry.

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The authors declare no conflict of interests and received no funding for this article.

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Jandu, J., Dzyuba, N. & Barry, S. White enamel lesions in children: considering caries, chronological and congenital causes and their consequent care. Br Dent J 230, 523–527 (2021).

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