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

The Jorgensen Orthodontics Blog

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!

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

  1. lydia says:

    Hello

    I am into my 8th month of wearing braces and i notice white lines forming around my brackets. Its been 5 months since they started to appear. Is it possible to get rid of them while i still have my braces on?

    • Brush, brush, brush!!! If they are very small they may improve on their own. The key is keeping the plaque of the enamel surface. I also encourage my patients to invest in gadgets that help them do a better job. One that I have see good results with is the Philips “Air Flosser.” It is like a power washer for the teeth. Keep your teeth clean and you’re have very few if any damage to the enamel during treatment.

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  3. Sylvia Schlachter says:

    My son is only 13 and has the spots. I feel so sad I know my husband and I should have helped him brush more. The orthodontist never mentioned my son had any problems though until they took the braces off yesterday. They said they were going to give him some flouride to put in his retainers next week. So, he shouldn’t do that after reading your informtion.
    Does he need to wait 6 months to get the bleaching process done?
    Also, have you heard of the Luster Pro Light Teeth Whitening System and if so when could he begin using it? It uses accelerator mouth rinse and super whitening gel.
    Also, I heard of the GC Tooth moouse could he use that and does it help?
    He will be going to the dentist soon, but should he wait the 6 months for the microabrasion, reinfiltration, or cosmetic bonding. I would gladly appreciate your advice.

    • Your orthodontist may not have been able to see the white spots until the braces came off. The most current recommendations are that you wait to apply extra fluoride because it will remineralize the top layer and prevent deeper remineralization. This was a new concept to me also. Ask your orthodontist if that makes sense to him. By the way, we’ve done some resin infiltration procedures in our office (Ikon) and they work great. Mention that to your orthodontist or dentist. It really works.

  4. Sylvia Schlachter says:

    Thanks for the advice!!! So, does he have to wait 6 months for the (ikon) or bleaching procedure? Also, would you advise against the Pro Light or wait 6 months even before using it?

    • According to the most current research, the best approach is to let nature take its course for the first 6 months. Anything before that is more superficial than permanent. The best thing is to just encourage good brushing and flossing.

  5. Sylvia says:

    I showed my child’s dentist your information. It has not been 6 months yet and I told them it has not been 6 months. They said they have some Icon Resin that you do not have to wait 6 months with. Is that true and how should I approach that if it is not true? I don’t want to make them mad when they purchased this icon to try with my son. They are the dentist and I don’t want them to think I don’t value their expertise. Does the icon expire?

    • I like the Icon product and use it myself. I cannot examine your child’s teeth specifically, so I’ll have to leave it up to your dentist to help you with that decision for him. If he feels that the resin infiltration technique is going to be needed ultimately and that the problem is bigger that what will resolve on its own, I have no problem doing the procedure now. While there will be improvement in 6 months, it will probably not be 100%.

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