**Table 1.**

*Dean's fluorosis index [12].*

#### **2.2 Traumatic hypomineralization**

It is not unusual to find white spot lesions due to trauma in the primary dentition stage. An incidence rate of 74.1% is seen [15] following which the succeeding tooth may be hypoplastic, or display discoloration (**Figure 2**).

Traumatic hypomineralization is usually asymmetric in presentation and involves a single tooth with unusual patches.

Physical trauma such as a break or fracture of the tooth or chemical trauma such as a periapical infection of the primary tooth can cause a severe periapical inflammation which disturbs and influences the underlying mineralisation of the tooth, resulting in accelerated deposition of minerals. These are commonly seen as punctiform lesions of the dental crowns or the incisal one thirds [16].

#### **2.3 Demineralization**

Enamel demineralization is a complication associated with poor hygiene during orthodontic treatment. When there is prolonged and excessive plaque accumulation, in the course of treatment, WSLs are seen along the appliance margins at various sites. 46–73% is the prevalence rate of demineralization following orthodontic treatment and this poses a grave challenge to the clinicians [17]. The subsurface demineralization is a predisposing factor to caries formation and is commonly seen around the bracket attachments and underneath the molar bands.

These areas are mostly noticed in orthodontic patients who are unable to adequately clean the tooth surface with the toothbrush which later appears as white spots. They are white chalky in appearance and unusually located (**Figure 3**).

#### **2.4 Molar incisor hypomineralization (MIH)**

Weerheijm et al. introduced the term molar-incisor hypomineralization (MIH) [18], wherein they defined it as a hypomineralization of systemic origin, which presented itself as a demarcated, qualitative defect of the enamel of 1–4 first permanent molars, frequently associated with enamel opacities. In these cases, due to the qualitative defects, the teeth exhibit post-eruptive breakdown of the enamel. This causes rapidly progressive caries and severe sensitivity of the teeth.

The causes of MIH are still not clear, it is thought that there is a systemic disruption of amelogenesis which includes, malnutrition, hypoxia, common childhood illness and use of antibiotics before the age of 3 years that causes this effect [16].

**Figure 2.** *Traumatic hypomineralization.*

*White Spot Lesions and Remineralization DOI: http://dx.doi.org/10.5772/intechopen.101372*

#### **Figure 3.** *Demineralization with braces.*

Clinically they are seen as white-creamy or yellow-brown opacities, usually larger than 1 mm and post-eruptive breakdown of at least one first permanent molar.

A history of illness in the first three years, difficulty during birthing, or prenatal illness helps with the diagnosis.
