the simple blog

Here's a successfully finished remineralization case. We started with non-decayed teeth with white spots. We were going to do veneers, but we thought we would try this conservative non-surgical approach first. This is what they looked like before the treatment:



Lots of white spots on the cervical third of the tooth (that's the part near the gumline). The reason you get congenital (born with it) white spots is simple: there wasn't quite enough calcium right there to form strong, clear enamel. The weaker, hypocalcified enamel is frosty white in appearance, and often appears in bands or spots. You can also get white spots from too much plaque or too much acid in your mouth. The plaque contains bacteria that make lactic acid, which dissolves the calcium out of the enamel, causing it to break down and turn frosty white. (neglect it longer, and the enamel breaks down completely, leaving a hole we call a cavity)

I'm not a big fan of cutting down well shaped teeth if I don't have to. So we decided to try a protocol by GC America. The idea is simple: if the tooth is missing calcium, add it back in. MI paste is calcium phosphate (what your bones and teeth are made out of) wrapped in milk proteins that make it easier to absorb. You just have to soften the surface of the tooth a little bit to get it to soak in deeper. On the first visit, we acid-etched the teeth, and then polished them with pumice. This breaks down the outer layer of weak enamel. Then we applied MI paste, a white calcium phosphate cream made from dairy proteins, to the teeth for five full minutes. We instructed our patient to apply this creamy white paste to her teeth every night after brushing. We repeated the whole process for four visits, over a period of about two and a half months.

Coffee staining was the only complication. Even though we told her not to drink it, for some, the urge is just too strong. The treatment makes the teeth relatively porous and permeable to the MI paste, but it also makes them more susceptible to staining beverages like coffee and red wine. We had to spend a couple of weeks whitening and polishing to under the coffee. For future cases, I will strongly recommend Ultrabrite Advanced Whitening toothpaste during the treatment period, because it's a strong stain fighter--Consumer Reports said it is the best stain remover of all toothpastes. And it's a buck a tube at Walmart.

Here's what the teeth looked like after four treatments. I blew them dry to show the detail of the enamel. If they are wet (which they usually are), they look just about perfect.



After all was done, I applied a clear coat to the teeth (which should hopefully allow her to drink. There's a tiny little white spot on the right central incisor (#8), but it's usually hidden under her lip, and she really wanted to be able to drink coffee again. If we gave it a few more treatments, we probably would have gotten it all out.

All in all, this was a very successful re-mineralization case. We got rid of the white spots, and saved her from two very expensive (and difficult to match) veneers. A lot of dentists will read this case and think "I could have made a lot more money and been done much quicker if we did veneers." My philosophy is if you drill less, you might make less, but patients appreciate conservative care. After all, it's what I would want done in my own mouth.

Originally posted on my photodontist blog.