The White Spot Carious Lesions 7.

Diagnosing and Differentiating Between Active and Inactive lesions.  

 The white spot lesion is not considered as a distinct form of dental caries but a stage of the carious process.
      -This lesion can be active progressing to cavitation, it may be inactive not progressing or may even be healing.

Sound Enamel

Normal enamel texture and glossiness.  
  Smooth surface intact, smooth and glossy. 
  Pit and fissures intact possibly with some staining. 

      -Active lesions have  a porous surface which clinically appears chalky and with the explorer feels rough.  Under proper conditions these areas can remineralize and converted into arrested or nonactive lesions (1).

White spot lesion 

Active caries 
(Intact surface)

Surface of enamel is whitish/yellowish opaque with loss of luster.  It  feels rough when the tip of the probe is gently moved across the surface.  No clinically detectable loss of substance.

Smooth surface caries lesion typically located close to gingival margin.
Pit and fissures have intact fissure morphology.  Lesion may extend along the walls of the fissure.  

      -Nonactive lesions have a relatively non-porous  surface that is smooth, shinny and hard (2).

White spot
Inactive caries
 Surface of enamel is white, brown or black.  It is glossy with no loss of luster; feels smooth and hard when the tip of the probe is  gently  moved across the surface.  


The root/dentin lesion 
is hard and may be dark.

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1.  Holman et al, ACTA Odontol Scand 1987.
2.  Zero DT, Application of clinical models in remineralization research. J Clinical Dent, 10:74-85, 1999.

This table and classification is a modification of material found in  Nyvad B, Machiulskiene V, Baelum V, Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions.  Caries Res, 33:252-260, 1999.