Small spots, holes, rough spots, or discolorations on the most outer layer of the tooth can be caused by several different events. It may be a developmental defect of enamel that occurred before eruption, or an area of focused trauma caused by a fall as a child while the tooth is developing. Fracture of the enamel caused by physical or chemical can also appear in this way occasionally. The most common cause is however dental caries, or tooth decay. The only way to truly know what is going on is to be diagnosed by a dental professional. To answer the question "How do I know..." trust yourself and your relationship with your body. You know when something isnt right. I encourage you to not try not to diagnose yourself from the internet however. Only a professional can give you the proper diagnosis and possible treatment options. Many of my patients in your situation have found that something they thought was serious was minor and vice verse. Its worth the peace of mind to know that answer from the start. Good Luck, DGHill, DDS

Daniel G. Hill