White spot lesions (WSLs) are an early sign of demineralization on tooth enamel. These lesions appear as chalky white or opaque patches on the surface of teeth, often becoming noticeable after orthodontic appliances are removed. They are a common concern for individuals undergoing orthodontic treatment. While braces themselves do not cause WSLs, they can contribute to their appearance by making oral hygiene more challenging.
How They Develop
White spot lesions form when acids produced by bacteria in plaque dissolve minerals from the tooth enamel. Plaque, a sticky film of bacteria, naturally accumulates on tooth surfaces. When sugars from food and drinks are consumed, these bacteria metabolize them and release acids as byproducts.
Orthodontic appliances, such as braces, create areas where plaque can easily accumulate and become trapped, making it difficult to remove. These areas around brackets, bands, and wires foster the growth of acid-producing bacteria. Over time, prolonged exposure to these acids leads to the loss of calcium and phosphate ions from the enamel, resulting in the characteristic white, opaque appearance of a WSL.
Preventing Their Formation
Preventing white spot lesions during orthodontic treatment involves rigorous oral hygiene practices. Brushing techniques should be adapted to effectively clean around braces, using a soft-bristled toothbrush to clean each tooth surface, including above, below, and around the brackets. Flossing daily with specialized floss threaders or orthodontic floss is important to clean between teeth and under archwires, reaching areas a toothbrush cannot. Interdental brushes can further aid in cleaning tight spaces around orthodontic hardware.
Fluoride plays a significant role in strengthening enamel and promoting remineralization, which can counteract demineralization. Using fluoridated toothpaste twice daily is recommended. Your orthodontist or dentist may recommend fluoride mouthwashes or professional fluoride applications during appointments to provide additional protection. Limiting the intake of sugary and acidic foods and drinks, such as sodas, fruit juices, and candies, reduces the fuel available for acid-producing bacteria. Regular dental check-ups and professional cleanings every six months are also beneficial to remove plaque and tartar buildup that at-home brushing might miss, and to allow for early detection and intervention for any developing WSLs.
Treatment Options
Once white spot lesions have formed, several treatment options are available, ranging from non-invasive to more intensive approaches. Enhanced remineralization is often the first line of treatment, especially for new or shallow lesions. This involves using high-fluoride products, such as prescription-strength fluoride toothpastes or gels, which help reintroduce minerals into the demineralized enamel. Calcium phosphate technologies, like those found in some specialized toothpastes or topical creams, can also aid in rebuilding the enamel structure.
For more noticeable or persistent WSLs, microabrasion may be considered. This procedure involves the gentle removal of a very thin outer layer of enamel using an abrasive paste and a mild acid, which can improve the lesion’s appearance. Another effective non-invasive treatment is resin infiltration, where a tooth-colored resin is applied to the lesion after a mild acid etch. The resin penetrates the porous enamel, sealing the lesion and camouflaging its white appearance. In more severe cases where the lesion is deep or extensive, cosmetic bonding with tooth-colored composite resin or veneers might be used to cover the affected tooth surface.
Long-Term Outlook
The prognosis for white spot lesions varies depending on their severity and the individual’s oral hygiene practices after orthodontic treatment. While some WSLs may improve naturally through remineralization after braces are removed, this improvement depends on the lesion’s depth and often takes about six months. Saliva, which contains minerals, and the abrasive action of brushing contribute to this natural healing process.
Continued good oral hygiene post-orthodontic treatment, including consistent brushing, flossing, and fluoride use, is important for further remineralization and to prevent new lesions from forming. If left untreated, severe white spot lesions can persist and may even progress to cavities, affecting both the aesthetic outcome of orthodontic treatment and long-term dental health. Therefore, addressing existing WSLs through appropriate treatment options can help ensure a healthy and aesthetically pleasing smile.