Dr. Greg Jorgensen
(505) 891-9440
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!

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.

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

  1. Hailey M says:

    I had my braces on for about a year and 5 months and the orthodontist had taken off a rubberband that was covered across all of my brackets and when they took it off, later that day I realized I had white small chalky spots of the tip of one tooth and one near the gums!! I’m so nervous because I have a denist appointment tomorrow 1/28/16 and I don’t want cavities! Please help

    • White spot lesions occur where there has been plaque left on the teeth. The white spots by your gums may be due to plaque. The one on the tip of your tooth is probably not related since plaque rarely accumulates on the tips of teeth.

  2. Joe Stevens says:

    So basically im proper freaking out because im on my 7th week of having braces and getting them tightened in 2. Even though ive been brusshing after every meal for about 5 minutes each time im still getting promenant white marks all over my teeth and i dont know why because ive followed all my orthodontists instructions to the letter t! And now im really scared that my orthodontist is gonna remove my braces when i go to get them tightened!

    • I would be really surprised if you are getting PERMANENT whist spots after only 7 weeks. Please discuss this with your local orthodontist and have him determine if you really are getting permanent damage. You may just be getting a temporary buildup of something you’re eating.

      • Joe Stevens says:

        Thankyou very much for your reply.

        I went to the orthodontists today to get my braces tightened or adjusted i dont know which one but anyways she looked at my teeth and said they had moved alot so then she did all the procedure and stuff and it all whent fine however she said i had really good oral hygiene but she didnt mention the white marks so im taking that as a good sign but i dont know if i should be worried about it or not because im not sure if she just didnt see them or they arnt anything to be worried about or not if you get were im coming from?

        Sorry if im being slightly hypercondriac’ish but im a bit of a worrier

        • The best thing to do is to ask her specifically next time you’re in the office. Sometimes your doctor is looking at other things and doesn’t focus on the same things as you.

  3. Stephen says:

    Hello, so would an orthodontist be at fault if during braces procedure a client would suffer extreme demineralisation requiring many fillings and a root canal? Does an orthodontist not have the duty of care to a client and if their dental hygiene isn’t up to standard to remove the braces? Because can they not be taken to court for negligence, for not providing duty of care which has led to extremely bad teeth and dental work after the procedure?

    • Anybody can sue anybody for anything. That doesn’t mean they’ll win. The plaintiff would have to prove to the jury that the doctor was negligent. In my practice we grade the patients on their hygiene at ever appointment and notify them if we see a problem. Sometimes the decalcification is not evident until the braces come off. Ultimately however, the patient is responsible for brushing their teeth during treatment.

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