What Causes White Spots on Teeth?

Few 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? Sadly, these are all questions that we hear from time to time.

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 our office we begin oral hygiene coaching at the very first appointment. We give brushing instructions to the patient and parent and provide information about the foods and drinks that should be avoided during treatment. We encourage the use of fluoridated toothpaste and provide floss threaders to make flossing easier. During treatment we reward good brushers with an ongoing hygiene contest 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.

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. 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. 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 toothbrush. Keep dental plaque off of your teeth and white spot lesions will never ruin your deband celebration!