Watch out for White Spots!

A common experience for those wearing braces is white spots appearing on the teeth near or under braces. These spots are more visible on front teeth but on closer inspection they can also be observed on back teeth. They are chalky white in colour and contrast with the normal shiny white creamy colour of surrounding enamel. The spots are not caused directly by the braces themselves but by plaque biofilm which has not been removed effectively with the braces in situ. It is more difficult to carry out oral hygiene properly while wearing braces.

How Tooth Enamel Keeps Its Colour

Despite what you might think, although tooth enamel is the hardest substance in the body, it is not a static material, it is dynamic and is in a state of flux with the oral environment. The outside layers are constantly changing in response to the composition of saliva which bathes the surface of the tooth. At a microscopic level calcium, phosphate, hydroxyl and fluoride ions on the surface of enamel are in a state of equilibrium with saliva at normal ph (acidity level). When the acidity level increases which is everytime we eat or drink something containing carbohydrate, mineral ions flow out of enamel into saliva (demineralisation). This process reverses itself after 20 minutes with buffering activity of saliva and the mineral ions flow back into the enamel (remineralisation). A peculiar thing happens when there are extra fluoride ions present in saliva. These ions replace hydroxyl ions in enamel making it harder and more resistant to further acid attack. This is the ideal scenario, the tooth enamel becomes harder and more resistant to tooth decay and the white creamy colour of enamel stays the same.

How White Spots Develop On Teeth.

White spots develop when the environment of the mouth changes. When braces are placed on the teeth, changes will gradually take place in the tooth enamel, if oral hygiene is not maintained at a high level.  Poor oral hygiene and frequent carbohydrate intakes will result in extra dental plaque biofilm accumulating on the enamel surfaces adjacent to the brace brackets on the teeth. This will result in a steady stream of acidic ions interacting with the tooth surface and calcium ions being lost from the outer layer first and then the deeper layers of enamel. This is the beginning of the process we call dental decay but this process is reversible even after a white appears on the tooth. A white spot represents an area of tooth that has been demineralised and remineralised through loss of calcium over a prolonged period of time with the loss of mineral being greatest beneath the white spot. The white spot is effectively a warning sign of a cavity developing beneath the white spot.

How White Spots Can be Prevented and Reversed

The good news is that white spots can be completely reversed if the environment around the teeth is altered. This can be achieved in a number of ways. 

• It is good practice to use a fluoride mouth rinse at least twice a day first thing in the morning and last thing at night while wearing a brace. 
• Ask your dentist to prescribe a high dose fluoride tooth paste (at 2,500 parts per million fluoride) to be used while you are wearing a brace and for about six months afterwards to insure that the tooth surfaces directly under the brace brackets completely re-mineralise.
•  In addition you will need additional instruction from a dental nurse or hygienist on how to clean your teeth while wearing a brace using different brushes,and special devices for cleaning in between your teeth.