**1. Introduction**

White spot lesion (WSL) is the demineralization of the enamel surface and subsurface that is devoid of cavitation [1–3]. They are a result of the imbalance between mineralisation and demineralization, which if not intervened, may further lead to irreversible damage [1, 2]. In early lesions the mineral content in the affected area is reduced, which in turn affects the translucent feature of the enamel, and the colour of these areas appear more opaque white, hence, they are termed as white spot lesions. They are the first visible findings in caries formation and are considered as initial lesions by many clinicians. However, it should be remembered that, for demineralization to be visible, it must have a minimum depth of 300–500 μm implying that a considerable amount of damage to sound tooth structure has already begun [4–7].

These lesions are commonly associated with poor oral hygiene and increased plaque accumulation. In addition to the above other risk factors such as poor dietary habits, high DMFS (Decayed, Missing or Filled Surfaces) index, and lack of preventive measures during orthodontic treatment always prevail.

A white spot may be intrinsic or extrinsic in origin [2], enamel defects such as fluorosis, hypomineralisation, hypomaturation of enamel, hypoplastic defects can lead to noncarious intrinsic white spots of the enamel. These developmental

anomalies are greatly influenced by genetic aberrations, environmental variations, metabolic diseases, drug abuse, use of chemicals, radiation and trauma [4]. The differential diagnosis is imperative to the treatment plan.

An early enamel lesion can easily be identified as a white opaque spot when airdried and is the most efficient way to detect it [5]. What may appear to be a smooth, shiny, non-carious lesion under light may be a rough, opaque and porous lesion on cleaning and drying [6]. It is challenging for a clinician to detect these in a regular check-up, and the diagnosis can only be established subjective to the clinician. Since these discolorations may be a result of several factors, it is usually challenging to arrive at an accurate diagnosis for the same.
