The parents notice it first. A white patch on your child’s front tooth. A chalky edge on a new molar. Those white patches on teeth aren’t always the same—a birth defect in the enamel of teeth called molar–incisor hypomineralization (MIH) or the beginning of tooth decay (a white-spot lesion). Knowing which one your kid is dealing with is reassuring, so you can start the right treatment early and preserve your child’s smile.

What those white spots can be

White-spot lesions (early decay or demineralization)

White-spot lesions are the very first indication that enamel demineralization is starting to occur—minerals are dissolving underneath, but the surface itself is not yet affected. With immediate proper oral care, these spots can remineralize and won’t need drilling.

MIH (molar–incisor hypomineralization)

MIH is an enamel developmental defect that typically occurs in first permanent molars and incisors at eruption. The enamel is softer and more porous, and this can lead to sensitivity and chipping. More recent studies suggest that MIH occurs in an estimated 13–16% of children.

How to tell them apart (and why it matters)

Location and timing offer clues. MIH occurs on first permanent molars and sometimes incisors during eruption; white-spot caries may occur anywhere plaque is still present. Texture is also unique—MIH lesions may be creamy/yellow-brown and papery; early caries are matte and chalky but have an intact surface. Your child’s pediatric dentist carries out the diagnosis with a thorough examination and bitewing radiographs when necessary.

Why repair now? Tooth decay remains common in U.S. kids; CDC data show about 11–18% of young children have untreated decay. Early treatment helps children avoid pain, infection, and missing school days.

If you are trying to decide whether it is a cavity or MIH, here’s the real-world playbook below.

What you can do today

Make an early appointment if you see white spots that persist after brushing.

• Strengthen daily care: fluoride toothpaste (a rice-grain size for under age 3; pea-sized for 3–6+), brushing assistance twice daily, and flossing between teeth.
• Monitor snacks and sips: limit frequent sugars and acidic drinks; offer water between meals.
• Ask about fluoride varnish at dental visits to build enamel in high-risk zones.

The treatment your dentist may prescribe

For early white-spot decay

Preventive dentistry aims to rebuild minerals and stop progression: professional fluoride varnish, improved home oral care, and, in some cases, resin infiltration to strengthen the subsurface and blend the spot’s look. Studies support resin infiltration for small, non-cavitated lesions. 

Your child’s dentist may also suggest dental fillings if the spot progresses to cavitation (a hole) or fails to stabilize despite preventive oral care. 

For MIH

Objectives include reducing sensitivity, preventing post-eruptive breakdown, and protecting chewing surfaces. These are listed in order of severity, from desensitizing agents and fluoride varnish to pit-and-fissure sealants to glass ionomer or composite restorations; severely broken molars may benefit from preformed (stainless steel) crowns to preserve function. 

White spots are deserving of a second glance—but not panic. White spots on teeth can typically be reduced, hardened, and cosmetically improved in most cases without drilling if detected early. A tailored protection plan makes sensitive teeth comfortable and function normally throughout childhood and well into the future. With prevention and treatment at the right time, children eat, speak, and smile confidently.

If you’ve noticed new white areas on your child’s teeth, schedule a visit with Creekside Kids Dentistry.