Chalky, opaque white areas appearing on tooth enamel after braces are removed are a common concern. These patches often contrast sharply with the surrounding healthy tooth structure, compromising the aesthetic result of orthodontic treatment. The spots are a sign that the surface of your teeth has undergone a change. This article will explain the biological process behind these white marks and detail the modern treatment options available to restore your smile’s uniform appearance.
What Causes White Spot Lesions
These white marks are the earliest clinical manifestation of tooth decay, known scientifically as White Spot Lesions (WSLs). A WSL is founded on demineralization, where the hard, mineral structure of the enamel is dissolved. Acids, produced by oral bacteria metabolizing sugar, strip away the calcium and phosphate ions that form the crystalline structure of the enamel. This mineral loss creates a porous, honeycomb-like structure beneath the outer layer of the enamel. When light hits this porous area, it scatters instead of passing smoothly through the translucent enamel, making the tooth surface appear white and opaque.
Orthodontic Treatment and Increased Risk
Fixed orthodontic appliances, such as traditional braces, significantly increase the risk of developing white spots. The brackets, bands, and wires create a complex network of surfaces and crevices that are difficult to reach with a toothbrush and floss. This mechanical challenge leads to the prolonged accumulation of bacterial plaque against the tooth surface. The trapped plaque creates a highly localized, acidic environment that constantly attacks the enamel, especially surrounding the bracket base. Studies indicate that the prevalence of WSLs following the removal of fixed braces can be as high as 50 to 90 percent. Since the appliances often hide these areas, the damage can progress undetected until the braces are removed.
Stopping White Spots From Forming
Preventing white spots relies on maintaining an environment that promotes remineralization over demineralization. This requires a meticulous oral hygiene protocol throughout orthodontic treatment. Brushing needs to be done with extra care, utilizing specific techniques to clean above, below, and directly on the brackets to dislodge trapped plaque.
Using specialized tools is necessary to clean the tight spaces between the wire and the tooth surface that a regular brush cannot access. These tools include interdental brushes, orthodontic flossers, or water flossers. Fluoride is a primary defense, and patients should use a fluoridated toothpaste, often supplemented with a prescription-strength fluoride rinse or in-office fluoride varnish applications. Fluoride helps strengthen the enamel by forming a more acid-resistant mineral structure.
Dietary adjustments are also important, as the bacteria feed on sugar and fermentable carbohydrates. Limiting the frequency of consuming sugary drinks and acidic foods reduces the number of acid attacks on the enamel. Integrating a sugar substitute like xylitol or consuming cheese at the end of a meal can help stimulate saliva flow, which naturally buffers the acid.
Fixing Existing White Spots
For white spots that remain visible after braces are removed, several effective corrective procedures are available, ranging from non-invasive to minimally invasive techniques. The initial approach often involves non-invasive remineralization therapies, such as high-concentration fluoride varnish applications or pastes containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). These treatments aim to reintroduce calcium and phosphate ions into the porous enamel structure, which can be effective for shallow or newly formed lesions.
Resin Infiltration
A highly effective, minimally invasive technique is resin infiltration, often performed using a product like Icon. This procedure involves applying a low-concentration acid gel to gently etch the outer surface of the lesion, opening the pores. A low-viscosity resin is then flowed into the exposed porous enamel, filling the microscopic spaces. Because the resin has a refractive index similar to healthy enamel, it prevents the light from scattering, visually masking the white spot and making the lesion appear translucent. This technique is often preferred as it requires no drilling and stabilizes the lesion, preventing further decay.
Microabrasion and Restoration
For slightly deeper or more stubborn white spots, microabrasion may be used. Microabrasion involves the mechanical removal of a thin layer of the affected enamel using a compound that combines a mild acid, such as hydrochloric acid, with an abrasive material like pumice. This process physically polishes away the outermost layer of demineralized enamel to reveal the healthier, underlying tooth structure. For cases with extensive or very deep lesions that do not respond to these minimal treatments, options such as composite resin bonding or the placement of dental veneers may be considered to fully cover and restore the tooth’s surface.