Dr. Greg Jorgensen
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1401 Barbara Loop SE
Rio Rancho, NM 87124

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Do Orthodontic Braces Cause White Spots on Teeth?

Posted by Dr. Jorgensen on August 15th, 2013

White spot lesionsFew events are as exciting for you, your parents, and your orthodontist as the day your braces come off. Few things can ruin that celebration like discovering white spot lesions on the teeth at the end of an otherwise well-treated orthodontic case. Do braces cause white spot lesions? Can they be prevented? Can they be fixed after they appear? These are the questions I hope to answer in this article.

White spot lesions (also called decalcification or demineralization) are subsurface porosities caused by dental plaque (the same thing that causes cavities). The white, chalky marks on the teeth appear when acids created by the plaque remove minerals from the tooth surface and change the way it reflects light. The most common area for white spot lesions is between the gums and the brackets where brushing is most difficult. Many times white spots develop under swollen gum tissue making their detection difficult until after the braces are removed and swelling subsides. University studies have found that white spot lesions occur in 24% of adolescents who have never had braces (again caused by plaque left on the teeth). This number jumps to as high as 50% in teenagers with braces! Although braces DO NOT cause white spots on the teeth, they do complicate the removal of the plaque which is responsible.

Can white spot lesions be prevented? Yes. Current approaches can be grouped into three categories: 1) plaque removal, 2) hardening the enamel surface, and 3) protecting the enamel with a coating. Plaque removal is the ONLY sure way to prevent white spot lesions. In my office we begin oral hygiene coaching at the very first appointment. We provide a brushing chart and a list of the foods and drinks that should be avoided during treatment (including an emphasis on reducing the amount of acidic soda). We explain the importance of removing plaque, show the patients a picture of severe decalcification, and let the patients and parents know that white spots are a possibility if plaque is not removed (this is specifically spelled out on our consent form). We encourage the use of fluoridated toothpaste and provide special toothbrushes and floss threaders at every appointment. During treatment we reward good brushers with contest points and give additional instruction to patients who are struggling. When we notice that white spots are developing, we point them out to the family. We have even removed braces early in some patients with severe problems. The bottom line is that if plaque is regularly removed from the teeth, white spot lesions cannot form.

Orthodontists would love to find a way to prevent decalcification without relying on patient cooperation. There is no question that fluoride strengthens the teeth and makes them more resistant to demineralization. The question is how much is enough? For years we have been told (and sold) that prescription fluoride application (at home and in the dental office), fluoride rinses, and fluoride varnishes painted on the teeth can prevent decay. Controlled studies however have failed to show that these expensive products give any better results than just the daily use of fluoridated toothpaste. Brushing the teeth right before bed, spitting out the foam, and leaving the residue on the teeth has been shown to be just as effective as prescription fluoride. For this reason I do not dispense or prescribe additional fluoride products to patients in my practice. There is also a lot of interest in sealants that prevent the plaque from contacting the enamel during treatment. While we are hopeful that effective products will be developed, those currently available lose efficacy fairly quickly and their long-term benefits have yet to be proven. Neither fluoride nor sealants can replace good oral hygiene when it comes to preventing white spot lesions.

What can be done if you have white spots on your teeth after your braces come off? The first step is just to keep your teeth clean and let your enamel be bathed in your normal oral fluids for at least six months after appliance removal. All white spots improve some with time and minor ones may disappear altogether. Experts advise AGAINST applying extra fluoride during this healing period as it may seal the surface of the lesion and prevent remineralization below the surface. After six months, low concentration over-the-counter fluoride rinses and remineralization pastes (like Recaldent and MI Paste) can then be applied. Bleaching has been shown to lighten the enamel surrounding white spot lesions and reopen the “pores” overlying subsurface porosities. White spots then blend in better and actually improve as the effects of the bleaching wear off. One fairly new procedure that works well for mild to moderate white spots is resin infiltration (products like Icon resin). The resin infiltration reopens porosities and replaces lost tooth structure with a material that has optical properties closer to natural enamel. For more severe problems, your dentist may perform microabrasion (removing superficial white spots), cosmetic bonding (replacing damaged enamel), or place porcelain veneers (covering badly damaged surfaces).

In the end, white spot lesions are caused by plaque. Coating your teeth with extra fluoride or sealing your teeth with the newest products may help some, but the best solution is the daily, methodical removal of plaque with a regular toothbursh. Keep dental plaque off of your teeth and white spot lesions will never ruin your deband celebration!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

28 comments so far in response to “Do Orthodontic Braces Cause White Spots on Teeth?”

  1. P says:

    I was just reading above where you talked about having acidic things, would Vitamin C tablets be considered an issue?

  2. paul says:

    You say it is only plaque, but then how do I have a white spot on some of my teeth straight from leaving the office of getting my Damon braces put on?

    There are two small white spots that i can see, both not anywhere close to the bracket. What is that? And how am I going to get rid of it?

    • The white spots are caused by the acids in plaque that remove some of the calcium from your enamel and change the light reflecting characteristics of the enamel. The braces do not cause the problem, they are just a factor in patients being able to keep the teeth clean. The brackets themselves actually protect the teeth. That is why when the braces come off on a patient who has had brushing problems during treatment, you can see the outline of where the bracket was attached. You can see that the part of the tooth under the bracket is unchanged. If you now have a white spot on your tooth that is not near any of the brackets, it may be that it was there before you got them and you have just now noticed it because you are paying closer attention to your teeth (that happens all the time). It is not uncommon for patients to have discoloration and marbling of their teeth before the braces go on. You need to return to your orthodontist, show him what is concerning you, and get an explanation.

  3. chila says:

    Will wearing invisalign cause the flurosis spots on teeth to become more noticeable? Since the plastic covers the teeth and dries your teeth and protects it from saliva, I am afraid that this will only result in the white spots become more noticeable and I don’t want to walk around for 2 years with white blotches on my teeth. Also, if I did treatment for the white spots (i.e. microabrasion tooth etching), will the aligners still fit properly? Thank You.

    • I am not aware of any studies claiming that clear aligners make fluorosis more noticeable. In my opinion, even if what you’re describing is true, it would only be temporary while the aligners are in place and would not be permanent. One of the advantages of clear aligners is that there is LESS damage to the teeth in the form of white spot lesions, decay, etc. since they can be removed for brushing. Also, microabrasion would not affect the fit of the aligners, but it might not be possible on the teeth that have the aligner “attachments”

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