Enamel White Spot Research Articles

Enamel white spot lesions can remineralise using bio-active glass and polyacrylic acid-modified bio-active glass powders

ObjectiveTo evaluate the potential of bio-active glass (BAG) powder and BAG containing polyacrylic acid (PAA-BAG) to remineralise enamel white spot lesions (WSL). Methods32 human enamel samples with artificial WSLs were assigned to 4 experimental groups (n=8); (a) BAG slurry, (b) PAA-BAG slurry, (c) “standardised” remineralisation solution (positive control) and (d) de-ionised water (negative control). Mechanical properties of enamel were assessed using surface and cross-section Knoop microhardness. Micro-Raman spectroscopy in StreamLine™ scan mode was used to scan lesion cross-sections. The intensity of the Raman phosphate peak at 959cm−1 was fitted and measured producing depth profiles analysed using a double-step fitting function. A further 20 samples (n=5) were used to obtain 3D images of surfaces using non-contact white light profilometry permitting measurement of lesion step height in relation to the sound enamel reference level, and to scan the lesion surface using scanning electron microscopy (SEM). Data were analysed statistically using one-way ANOVA with Tukey's HSD post-hoc tests. ResultsBAG, PAA-BAG and the remineralisation solution exhibited statistically significantly higher surface and cross-section Knoop microhardness compared to the negative control. Micro-Raman spectroscopy detected significantly higher phosphate content within the treated groups compared to the negative control group. Lesions’ depth was not significantly reduced. SEM images revealed mineral depositions, with different sizes and shapes, within BAG, PAA-BAG and the positive control groups. ConclusionBAG and PAA-BAG surface treatments enhance enamel WSL remineralisation, assessed by the resultant improved mechanical properties, higher phosphate content and morphological changes within the artificial lesions.

Masking of white spot lesions by resin infiltration in vitro

ObjectivesThe aim of this in vitro study was to evaluate the ability of one commercial and five experimental infiltrating resins (infiltrants) to camouflage enamel white spot lesions immediately after resin infiltration and after a staining period. MethodsIn each of 120 bovine enamel samples, two artificial caries lesions were created (windows A and C; pH=4.95, 50 days), whereas two windows were protected serving as sound controls (B and D). After etching windows C and D (37% phosphoric acid), specimens were randomly allocated to 6 groups. Either one of 5 experimental infiltrants or a commercial infiltrant (Icon, DMG) (refractive indices 1.50–1.55) was applied and light cured. After half of each specimen was polished, samples were remineralized (pH=7.0) and stained with tea and red wine for 50 days. Photographic images after various treatment steps were obtained. Color differences (ΔE) of untreated (A) and treated lesions (C) as well as infiltrated sound enamel (D) were compared with untreated enamel (B). ResultsAll infiltrants showed significantly better color match with sound enamel (median ΔE [25th/75th percentile]: 2.2 [1.5/3.1]) than untreated controls (9.3 [8.0/10.9]) (p<0.001, Wilcoxon, post hoc Bonferroni). Moderate correlation between refractive index and ΔE of infiltrated lesions was demonstrated (R2=0.43, p>0.05). Staining was significantly reduced for polished infiltrated lesions compared to untreated or infiltrated unpolished lesions (p<0.001). ConclusionsResin infiltration is suitable to mask artificial white spot lesions. Polished infiltrated lesions are resistant to staining in vitro. Clinical significanceResin infiltration is a micro-invasive approach to camouflage post-orthodontic white spot lesions.

The effect of fractional CO2 laser irradiation on remineralization of enamel white spot lesions

This study investigated the combined effect of fractional CO(2) laser irradiation and fluoride on treatment of enamel caries. Sixty intact premolars were randomly assigned into four groups and then stored in a demineralizing solution to induce white spot lesions. Tooth color was determined at baseline (T1) and after demineralization (T2). Afterwards, the teeth in group 1 remained untreated (control), while group 2 was exposed to an acidulated phosphate fluoride (APF) gel for 4 min. In groups 3 and 4, a fractional CO(2) laser was applied (10 mJ, 200 Hz, 10 s) either before (group 3) or through (group 4) the APF gel. The teeth were then immersed in artificial saliva for 90 days while subjected to daily fluoride mouthrinse and weekly brushing. Color examinations were repeated after topical fluoride application (T3) and 90 days later (T4). Finally, the teeth were sectioned, and microhardness was measured at the enamel surface and at 30 and 60 μ from the surface. In both lased groups, the color change between T1 and T4 stages (∆E(T1-T4)) was significantly lower than those of the other groups (p < 0.05). Laser irradiation followed by fluoride application (group 3) caused a significant increase in surface microhardness compared to APF alone and control groups (p < 0.05). Microhardness at depths of 30 and 60 μ was also significantly greater in group 3 compared to those of all other groups (p < 0.05). Application of a fractional CO(2) laser before fluoride therapy is suggested for recovering the color and rehardening of demineralized enamel.

Comparison of Antibacterial Effect of New Herbal Mouth (Miswak) Wash With Different commercial Mouth Washes on Dental Biofilm From Orthodontic Ligatures –In Vitro Study

Clinical study has shown that patients who get the orthodontic treatment are more susceptible for having the enamel white spot formation (Eliades et al., 1995) (Badawi et al., 2003). Since the advent of fixed orthodontic appliance for adult patients and its use has become increasingly popular, bringing about the need to address questions regarding microorganism adherence and biofilm development (Menzaghi, 1991; Lee, 2000)

Management of Enamel White Spot Lesions

ABSTRACTDental caries is a highly prevalent multifactorial disease and is a major public health problem. A goal of modern dentistry is to manage enamel white spot lesions noninvasively and effectively an attempt to prevent disease progression and improve esthetics, strength and function. The progression of caries has been tried to be curbed at initial stage only but for that only use of fluoride application was suggested but with recent developments in dental materials other remineralization options as well as noninvasive masking procedure can be performed to attain best result. This article reviews all the materials and techniques mentioned in the literature to manage the world's most common disease in its initial stage only.How to cite this articleJoshi S, Joshi C. Management of Enamel White Spot Lesions. J Contemp Dent 2013;3(3):133-137.

Comparative evaluation of remineralization potential of casein phosphopeptide-amorphous calcium phosphate and casein phosphopeptide-amorphous calcium phosphate fluoride on artificial enamel white spot lesion: An in vitro light fluorescence study

World-wide, the contribution of dental caries to the burden of oral diseases is about 10 times higher than that of periodontal disease, the other common oral condition. Owing to its globally high prevalence, dental caries is a "pandemic" disease characterized by a high percentage of untreated carious cavities causing pain, discomfort and functional limitations. Untreated carious cavities; furthermore, have a significant impact on the general health of children and on the social and economic well-being of communities. A surgical approach to the elimination of carious lesion was developed a century ago; this approach was necessary at that time, because there was no valid alternative. The focus in caries has recently shifted to the development of methodologies for the detection of the early stages of caries lesions and the non-invasive treatment of these lesions. The non-invasive treatment of early lesions by remineralization has the potential to be a major advance in the clinical management of the disease. Remineralization of white-spot lesions may be possible with a variety of currently available agents containing fluoride, bioavailable calcium and phosphate and phosphate. This concept bridges the traditional gap between prevention and surgical procedures, which is just what dentistry needs today. The aim of this in vitro study was to evaluate and to compare the remineralization potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) on artificial white spot enamel lesions using the quantitative light fluorescence (QLF). A total of 45 caries-free extracted maxillary first premolars were embedded in acrylic resin. The samples were randomly divided into three groups namely control group, CPP-ACP group and CPP-ACFP group with 15 samples in each group. The samples of each group were subjected to demineralization process for a period of 96 h. The samples were then mounted in the artificial mouth model and subjected to remineralization and pH cycling for a period of 21 days. QLF readings were recorded at the end of demineralization (1st, 7th, 14th and 21st day) and were statistically analyzed. As compared with artificial saliva both CPP-ACP and CPP-ACFP produced significant amount of remineralization of the artificial enamel white spot lesion (P < 0.001), however when the remineralizing effect of CPP-ACP was compared with the remineralizing effect of CPP-ACFP there was no significant difference. Significant amount of remineralization was produced by CPP-ACP and CPP-ACFP only after the 7th day. After the 14th day, the remineralization produced by both CPP-ACP and CPP-ACFP as compared to artificial saliva was non-significant.

Induction of White Spot Enamel Lesion by S. mutans Biofilm in an Artificial Mouth System and Quantification by QLF

Objective: Aspects of an Artificial Mouth System (AMS) to model the caries process in bovine enamel biofilm induced white spot enamel lesions (WSEL) were analyzed. Methods: Square shaped and polished bovine enamel slabs were covered with modeling wax and 2.5 mm diameter window was prepared to expose enamel surface at the center of each slab. Artificial biofilms were grown inside an AMS on the slabs using freshly cultured S. mutans (MT8148) in suspended in phosphate buffered saline (PBS), heart infusion (HI) with 1% sucrose and PBS for 20, 30 and 40 hrs at 37°C. The severity of demineralization was quantified by Quantitative Light-induced Fluorescence (QLF, Inspektor, Netherlands). All experiments were repeated three times (n=5 for each group). Results: A circular WSEL could clearly be detected at the center of each slab by naked eyes, which was prominent after dehydration by mild air drying. QLF data showed that severity of demineralization occurred with the increase of time interval, after 40 hours both ?F (23+/-2.9) and ?Q (148.75+/- 26.78) were significantly more compared to ?F (10.14+/-2.3) and ?Q (47.63+/-30.67) of 20 hours. Conclusion: An advanced in vitro model of biolfilm induced WSEL was developed that showed promises to be useful in studying enamel demineralization.DOI: http://dx.doi.org/10.3329/cdcj.v9i1.11829 City Dental College Journal Vol.9(1) 2012 4-6

The color change in artificial white spot lesions measured using a spectroradiometer

The purpose of this study was to determine the color of white spot lesions. Human premolars were subjected to a pH cycling to produce artificial caries lesions and classified into groups (n = 10/group): group 1, immersion in deionized water; group 2, pH cycling without fluoride (F) application; group 3, pH cycling with immersion in 1,000ppm NaF solution; and group 4, pH cycling with immersion in 5,000ppm NaF solution. CIE L*a*b* color parameters of the tooth were determined using a spectroradiometer at baseline, after demineralization and after pH cycling. The extent of demineralization was evaluated by scanning electron microscopy (SEM) and electron microprobe analysis (EPMA). Significant degrees of color change (ΔE*) were observed after demineralization (p < 0.05). The changes were mainly due to an increase in lightness (L*) and a decrease in yellowness (b*). F application induced a significantly large ΔE* in group 4 (p < 0.05). The color reversal after remineralization was mostly due to the recovery of L*. SEM and EPMA verified that net mineral gains occurred in the subsurface lesions. The initially white appearance of enamel caries was a result of changes of L* and b*. F treatment partially restored the color of white spot lesions. F-driven remineralization induced both mineral gains and esthetic enhancement of artificially produced enamel white spot lesions. The increase of L* and the decrease of b* contributed to the color changes.

An X-ray Microtomographic Study of Natural White-spot Enamel Lesions

White-spot enamel lesions are an early presentation of dental caries and are ideally managed by non-invasive procedures. The aim of this study was to characterize white-spot enamel lesions by x-ray microtomography. In particular, mineral content across the lesion from the surface to the base of the lesion was measured and surface layers defined. Molars with long buccal white-spot enamel lesions were collected, photographed, and each sectioned to produce 3 500-µm-thick sections. The sections were mounted and imaged by quantitative x-ray microtomography at a 15-µm voxel size. We analyzed line profiles through the middle of each 3D image to determine mineral content and depth. The surface layer thickness of the lesions ranged from 35 to 130 µm, with the maximum mineral content in this layer being 74% to 100% of that of sound enamel. The average mineral content across the lesions ranged from 1.73 to 2.48 g/cm3. No significant differences could be found between lesions clinically categorized as active and those categorized as inactive. However, for depth-matched active and inactive lesions, the active lesions exhibited a more porous surface layer than the inactive lesions. White-spot enamel lesions are highly variable, with surface layers of considerable thickness.

The evaluation of resin infiltration for masking labial enamel white spot lesions

The aim of this study was to clinically assess the effectiveness of masking white spot enamel lesions using a resin infiltration technique that was recently developed to arrest incipient caries in a micro-invasive concept. Twenty teeth with a Developmental Defect of Enamel (DDE) and 18 teeth with Post-orthodontic Decalcification (POD) were selected and treated with resin infiltration. Standardized photographs were taken before, immediately after, and 1 week after treatment and were analysed using image analysing software to calculate the ΔE values. The results were classified into three groups: completely masked, partially masked, and unchanged. Among the 20 teeth with DDE, five teeth (25%) were classified as completely masked, whereas seven (35%) and eight teeth (40%) were partially masked and unchanged, respectively. Among the 18 teeth with POD, 11 teeth (61%) were completely masked, six teeth (33%) were partially masked, and one tooth (6%) was unchanged. In some teeth, the result was more improved after 1 week than immediately after infiltration. The masking effect was dramatic in some cases but not in others. The long-term colour stability of the result should be followed up through continuous clinical and scientific studies.

In vitro remineralization of human and bovine white-spot enamel lesions by NaF dentifrices: A pilot study.

The aim of this feasibility study was to evaluate the in vitro remineralization effects of four dentifrice systems using microhardness and fluoride uptake analyses. In vitro testing for the potential remineralization of the white-spot lesions in bovine and human enamel was performed using a 10-day pH cycling model. The study involved the following NaF silica-based dentifrices: 1) placebo (0 ppm F), 2) 500 ppm F, 3) 1150 ppm F, and 4) 500 ppm F plus functionalized tricalcium phosphate (fTCP). Each day consisted of four two-minute treatments, one four-hour acid challenge (pH = 5.0), and immersion in artificial saliva (pH = 7.0) between these events. After cycling, specimens were analyzed for surface microhardness (SMH), enamel fluoride uptake (EFU), and cross-sectional microhardness (CSM). Statistical analyses revealed significant differences (ANOVA, LSD, p<0.05) among the four groups, with the placebo and 500 ppm F dentifrices providing significantly less remineralization relative to the 1150 ppm F and 500 ppm F plus fTCP dentifrices. Notably, while CSM measurements for both enamel types generated similar profiles for the four groups, SMH and EFU revealed human enamel was more sensitive to the 500 ppm F dentifrice groups compared to bovine enamel. This apparent sensitivity may be due to the inherent structural differences between the two substrates.

The clinical application of surface pH measurements to longitudinally assess white spot enamel lesions

Objectives Means of objectively assessing white spot enamel lesions (WSEL) are critical for determining their potential activity and monitoring the success of preventive treatments. The aim of this study was to determine whether surface pH measurements of WSEL changed during a preventive course of care designed to remineralize the lesions. Methods Eight healthy subjects (1 male and 7 females) with at least one WSEL were recruited (19–64 years). Each subject was placed on a preventive treatment program including the daily application of a CPP-ACP paste (MI paste, GC Corp., Japan) with custom fitted trays for more than 6 months. The surface pH values of sound enamel and WSEL were monitored for up to 2 years using a micro-pH sensor. The visual appearance of the WSEL was monitored via digital photography, and images were analyzed qualitatively on a 5-point scale to assess the success of the remineralization preventive program. The relationship between the qualitative assessment of WSEL appearance and the WSEL pH was investigated using a Spearman's rho non-parametric correlation. Results The surface pH of the WSEL was different to that of the sound enamel surrounding it in all patients at all times. All lesions showed visual improvement as the treatment period progressed. The pH of the WSEL increased towards that of sound enamel over the course of treatment significantly correlating with the visual improvement of the lesion (rho = 0.63, p < 0.0001). Conclusions The clinical assessment of WSEL surface pH changes with time may have utility as an additional objective measure for the assessment of WSEL activity.

The VicGeneration study--a birth cohort to examine the environmental, behavioural and biological predictors of early childhood caries: background, aims and methods.

BackgroundDental caries (decay) during childhood is largely preventable however it remains a significant and costly public health concern, identified as the most prevalent chronic disease of childhood. Caries in children aged less than five years (early childhood caries) is a rapid and progressive disease that can be painful and debilitating, and significantly increases the likelihood of poor child growth, development and social outcomes. Early childhood caries may also result in a substantial social burden on families and significant costs to the public health system. A disproportionate burden of disease is also experienced by disadvantaged populations.Methods/DesignThis study involves the establishment of a birth cohort in disadvantaged communities in Victoria, Australia. Children will be followed for at least 18 months and the data gathered will explore longitudinal relationships and generate new evidence on the natural history of early childhood caries, the prevalence of the disease and relative contributions of risk and protective biological, environmental and behavioural factors. Specifically, the study aims to:1. Describe the natural history of early childhood caries (at ages 1, 6, 12 and 18 months), tracking pathways from early bacterial colonisation, through non-cavitated enamel white spot lesions to cavitated lesions extending into dentine.2. Enumerate oral bacterial species in the saliva of infants and their primary care giver.3. Identify the strength of concurrent associations between early childhood caries and putative risk and protective factors, including biological (eg microbiota, saliva), environmental (fluoride exposure) and socio-behavioural factors (proximal factors such as: feeding practices and oral hygiene; and distal factors such as parental health behaviours, physical health, coping and broader socio-economic conditions).4. Quantify the longitudinal relationships between these factors and the development and progression of early childhood caries from age 1-18 months.DiscussionThere is currently a lack of research describing the natural history of early childhood caries in very young children, or exploring the interactions between risk and protective factors that extend to include contemporary measures of socio-behavioural factors. This study will generate knowledge about pathways, prevalence and preventive opportunities for early childhood caries, the most prevalent child health inequality.

Nano-Indentation Characterisation of Natural Carious White Spot Lesions

The aim of this paper was to characterise the mechanical properties (MPs) and microstructural features of natural enamel white spot lesions (WSLs) using nano-indentation. Five natural WSLs from 4 extracted sound premolar teeth were cross-sectioned. Elastic modulus and hardness were measured systematically across the WSLs at intervals of 25 and 50 µm. The WSLs showed a large reduction in MPs compared to sound counterpart: elastic modulus was up to 83% lower (77.0 ± 2.2 to 13.4 ± 2.1 GPa) and hardness up to 91% lower (3.39 ± 0.41 to 0.29 ± 0.07 GPa). The intact surface layer above WSLs had less than 34% reduction in MPs. Detailed MP measurements were mapped as two-dimensional contour plots. Typically, WSLs displayed steep MP gradients at the lesion boundary and more uniform MPs with isolated variations in the lesion body. Despite the large reduction in MPs, the microstructure of WSLs remained intact. We postulate that loss of mineral and change of the hierarchical microstructure at the crystallite level contributed to the overall MPs of WSLs.

Prevalence of enamel white spots and risk factors in children up to 36 months old

The aim of this study was to determine the prevalence of enamel white spots and the quality of oral hygiene in children up to 36 months old, in municipalities with different fluoride levels in the water supply, analyzing the contribution of several variables. After approval of the Ethics Committee, the parents signed an informed consent form and were interviewed about their educational level, economic classification of the family, nursing habits, use of toothpaste, access to dental service and other information. The children were clinically examined using the same codes and criteria established by the WHO (World Health Organization) and ADA (American Dental Association). The data were processed and analyzed with the Epi-info software program, version 3.2, and Microsoft Excel. Fisher's exact test (p < 0.05) was applied to assess the association among the variables. The enamel white spot prevalence was 30.8% and the age group, duration of the bedtime milk feeding habit, age of initial practice of oral hygiene and presence of caries lesions with cavitation were considered statistically significant with regard to enamel white spot prevalence (p < 0.05). No association was found between oral hygiene quality and the study variables.

Characterisation of enamel white spot lesions using X-ray micro-tomography

Objectives The aim of this study was to characterise the mineral density (MD) of natural enamel white spot lesions (WSLs) using X-ray micro-tomography calibrated with different density hydroxyapatite phantoms. Methods Seven natural WSLs from four extracted non-carious premolar teeth were scanned at a voxel size of 7.6 μm using a desktop X-ray micro-tomography system. Five hydroxyapatite phantoms (sintered pellets of hydroxyapatite powder) with densities ranging from 1.52 to 3.14 g/cm 3 were used as calibration standards for each scan. Three-dimensional image reconstruction enabled MD gradients throughout the lesion to be quantified using an MD calibration equation derived from hydroxyapatite phantoms. Background noise generated during the measurement of MD was reduced using a Gaussian filter. Results Gaussian filter reduced the signal-to-noise ratio (standard deviation) significantly while the basic MD information (average value) remained intact. The mineral gradients through the WSLs examined were compared and are discussed in terms of existing literature. The MD of sound enamel, apparent intact surface layer of WSL, and lowest level of WSL was found to be 2.65–2.89 g/cm 3, 2.23–2.58 g/cm 3 and 1.48–2.03 g/cm 3, respectively. Our MD results are comparable with other studies. Conclusions X-ray micro-tomography is a sensitive in vitro technique capable of characterising and quantifying MD of small non-cavitated WSLs. This method has a promising potential for future carious and quantitative remineralisation studies.

The efficacy of a fluoride varnish in reducing enamel demineralization adjacent to orthodontic brackets: an in vitro study

To test the hypothesis that fluoride varnish is effective in reducing demineralization (white spot) lesions adjacent to bonded orthodontic brackets. Two similar samples of extracted bovine incisors, with bonded orthodontic brackets, were separated into an experimental group (fluoride varnish was applied) and control group (no fluoride varnish) to examine the preventive effects of fluoride varnish. The dental clinic of the State University of Maringá--UEM (Maringá, Paraná, Brazil). Thirty-eight extracted bovine incisors with bonded orthodontic brackets. Fluoride varnish was applied topically to half of the sample of extracted bovine teeth. No varnish was applied to the other half. The depths of enamel demineralization (white spot) lesions were measured from polarized light microscopy images using image analysis software. The teeth in both the experimental and control groups had been exposed to a cariogenic environment twice a day for 35 days. Those teeth that had been treated with two applications of fluoride varnish (one at the outset and another 15 days later) demonstrated about 38% less mean lesion depth than teeth where no varnish had been applied. Orthodontists may wish to consider the application of fluoride varnish during fixed orthodontic therapy to help reduce the development of enamel white spot lesions.

In vitro quantification of white spot enamel lesions adjacent to fixed orthodontic appliances using quantitative light‐induced fluorescence and DIAGNOdent

The aims of this in vitro study were 2‐fold: 1) to evaluate two fluorescence methods (DIAGNOdent and QLF (quantitative light‐induced fluorescence)) for quantification of white spot lesions adjacent to fixed orthodontic appliances; and 2) to determine the inter‐observer agreement of the DIAGNOdent and QLF methods for quantification of incipient enamel lesions adjacent to fixed orthodontic appliances. Forty‐one premolar teeth with visually sound smooth surfaces or visually white spot enamel lesions were included in the study. Orthodontic brackets were fixed adjacent to the lesions, thus simulating the position of fixed appliances during orthodontic treatment. All teeth were measured using both the DIAGNOdent and QLF methods. Of the 41 teeth, 20 smooth surfaces were randomly selected and analyzed by 4 operators using both DIAGNOdent and QLF. The teeth were sectioned into 300‐μm‐thick slices using a water‐cooled diamond saw and the slices manually ground to 80–100 μm thickness. Histopathology and transverse microradiography were performed to provide the gold standards for verification of lesion depth and mineral loss, respectively. The Spearman rank correlation coefficients between lesion depth determined by histopathology and the DIAGNOdent and QLF were 0.76 and 0.82, respectively, whereas the Pearson correlation coefficients between mineral loss and the two methods were 0.64 and 0.84, respectively. Inter‐observer agreement was found to be 0.80 and 0.93 for DIAGNOdent and QLF, respectively. In conclusion, QLF may be a suitable method for quantifying incipient carious lesions adjacent to fixed orthodontic appliances.

Modified composite or conventional glass ionomer for band cementation? A comparative clinical trial

The time to first failure, the position of band failure at deband, and the change in enamel white spot lesions of teeth bonded with a modified composite or a conventional glass ionomer were compared in a randomized half-mouth trial over the full course of orthodontic treatment. One hundred forty band pairs were cemented in 98 subjects. Overall band failure rates of 5% and 2.8% were recorded for the modified composite and the conventional glass ionomer, respectively, with no significant difference found between their times to first band failure. At the end-of-treatment deband, the position of band failure was predominantly at the enamel-cement interface for the modified composite and at the band-cement interface for the conventional glass ionomer (P ||.001). A comparison of changes in mean enamel white spot lesion scores during treatment did not reveal significant differences between the cement groups (P =.16). (Am J Orthod Dentofacial Orthop 2001;120:49-53)

Reproducibility of Quantitative Measurement of White Enamel Demineralisation by Image Analysis

The reproducibility of measuring artificial enamel white spot lesions from captured photographic images using computerised image analysis was assessed. Enamel lesions were induced on the buccal surface of 22 human teeth over periods of 3, 7 and 14 days. Standardised photographs were taken from above and below the occlusal plane. These were repeated after 2 weeks. The photographs were converted into TIFF images and mean grey scale levels of the areas of etched enamel were measured using computerised image analysis. Assessment of repeat readings of the same slide showed good reproducibility for photographs taken below the occlusal plane. The limits of agreement showed reasonable agreement between readings carried out on two slides of the same tooth. Capturing TIFF images via 35–mm film and measuring grey scale levels by computerised image analysis is a useful method of quantitative study of early enamel demineralisation. This may be developed for application in the clinical setting.