The Dreaded White Spots

 

Many parents fear the dreaded white spots.  They ask regularly during their child’s orthodontic treatment if their child is getting white spot lesions. What they often forget is that the white spot lesions are not from the braces. They are from not keeping the teeth clean enough, and they can happen with or without braces.

White spots on teeth are actually white scars, and once they appear, they may become permanent.  The white spots are the first step in the caries process; white spots become cavities. Poor oral hygiene allows plaque to build up on the tooth surface.  Maintaining adequate hygiene is even more difficult when braces are present because the brackets create hiding places for this bacterial accumulation.  The bacteria in the plaque eat the food which is left on the tooth surfaces; they especially like to eat sweet and sugary foods. The bacteria then “poop” on the teeth. This acidic bacterial excrement can erode or “decalcify” the enamel surface of the teeth.  Demineralization (a decrease in the mineral content of the enamel) can happen on the surfaces you can see, but it can also happen between the teeth if dental floss or waterpik irrigation is not used daily. (The decalcifications between the teeth are seen on x-rays as “incipient lesions”, i.e. early cavities.)  As fluoride and the natural minerals of your saliva fight to keep the enamel strong, the decalcified areas are recalcified.  This process of decalcification and remineralization creates unsightly color changes (both white spots and dark areas) of the tooth surface.

White spot lesions are also common in people who have dry mouth issues.  Reduced saliva flow lower’s the mouth’s natural ability to neutralize the acids. Many people with dry mouth “self -medicate” with lemon drops. Although the lemon drops increase salivation, they also feed the bacteria on the tooth surface as well as increase the mouth’s acidity directly (lemons are acidic). Both acid from the bacteria, and acid from the food increase demineralization of the tooth surfaces. Remember, this demineralization is the first step in tooth decay. A better option to increase salivary flow would be using xylitol candies and sprays, such as Xylimelt dry mouth lozenges or Carifree spray, because xylitol inhibits bacterial growth.

Another factor in white spot lesions, in addition to accumulation of bacteria, is the application of dietary acid straight on tooth surfaces. Many foods and beverages are acidic.  When people sip a lot of acidic beverages, like carbonated beverages (seltzer and soda), lemonade, sports drinks, tea with lemon, or coffee, they bathe the tooth surfaces in acid. The longer the period of time during which the acidic beverage is applied, the more damage it does.  This is why Dr. Okun recommends drinking the acidic beverages with a meal so that there is increased salivary flow as well as other foods to decrease the acidity of the mouth. She also recommends limiting the time that sugary foods are in the mouth. (Eat a cookie and then rinse out rather than suck on a candy or lick a lollipop for more than 10 minutes.) Dr. Okun recommends rinsing with water after eating or drinking, to wash the food particles and acid off of the teeth. It is also beneficial to rinse with fluoride daily to strengthen the tooth surfaces and to help the teeth re-calcify following acid attacks.

For help with proper cleaning of the teeth, see our hygiene videos on our website https://www.okunortho.com/brushing-and-flossing.  Be sure to brush thoroughly at least two times a day, and either floss or use the “Waterpik” dental irrigator daily to clean between the teeth.

How Long Does Orthodontic Treatment Take?

 

Orthodontic treatment is a carefully planned process that focuses on both function and appearance. Patients often ask how long orthodontic treatment with braces or aligners like Invisalign will take, and the answer depends on several individual factors. While the average orthodontic treatment timeline is about two years, each case follows a unique path based on the patient’s needs.

In many cases, traditional braces are worn for 18 to 30 months. This timeframe allows for gradual, controlled tooth movement that protects the health of the gums and bone. Some patients may complete treatment sooner, especially if alignment issues are mild, while more complex cases (such as those with impacted teeth) can take longer.

Aligner treatment timelines (for example, Invisalign or Spark clear aligner systems) are often similar, though they can vary depending on how consistently the aligners are worn. Most Aligner (Invisalign or Spark) patients receive a series of custom trays designed to shift teeth step by step. Each set is typically worn for one to two weeks before moving to the next, creating steady progress over time.

Age plays a role in how long orthodontic treatment takes. Younger patients often respond more quickly because their jaws are still developing, making tooth movement more efficient. Adults can achieve excellent results as well, though treatment may take slightly longer due to denser bone structure.

Consistency is one of the most important factors influencing treatment duration. Following instructions, such as wearing elastics with braces, or wearing aligners for the recommended hours each day or maintaining proper care with braces, helps prevent delays. Missed appointments or inconsistent habits can extend the overall timeline.

Orthodontic treatment moves at a pace that protects long-term oral health, not just the speed of results. This approach ensures that teeth are correctly positioned and remain stable after treatment. Rushing the process can lead to complications or relapse, which may require additional correction later.

Patients in Westchester County (including White Plains, Rye, Rye Brook, and Port Chester) often ask how their local orthodontic treatment timeline compares to national averages. In most cases, the duration is similar, as orthodontic principles remain consistent regardless of location. What matters most is the individualized treatment plan created after a thorough evaluation.

Regular check-ins allow orthodontists to monitor progress and make necessary adjustments. These visits are essential for keeping treatment on track and addressing any concerns early. Whether using braces or Aligners (such as Invisalign or Spark clear aligner systems), small changes over time lead to meaningful, lasting improvements.

Ultimately, orthodontic care is an investment in both health and confidence. While two years may seem like a long commitment, the gradual process is designed to deliver stable, functional results that last well beyond the treatment period.

Keywords Used: orthodontic treatment timeline, how long do braces take, Invisalign treatment timeline, braces duration, orthodontic treatment White Plains, NY, average braces time, Invisalign aligners

What to Eat and What to Avoid when Wearing Braces

Changing your eating habits is one of the most difficult adjustments when wearing braces. Some foods are more likely to damage your braces and your teeth than others. I advise patients to avoid:

1. Candy and other high sugar content foods, especially if they will spend a long time in your mouth.  Eating a cookie and then rinsing with water will do much less damage than sucking a sugar candy for 10 minutes.  The bacteria in your mouth will eat the sugar and give off acid which will decalcify the tooth surfaces.

2. Soda (all carbonated beverages i.e. carbonic acid) and other acidic beverages (like lemonade, fruit smoothies, and energy drinks.) Acid will decalcify (eat away) the part of your teeth that are not covered by the brackets, leaving a change of color which will later finish turning into a cavity. If you drink the acidic beverage be sure to rinse it off your teeth with water instead of leaving the residue in your mouth.

3. Sticky things like chewing gum, taffy, Ike and Mikes, gummy bears, and caramels will bend the metal.  This will cause the glue to crack underneath the brackets and bands. As the cracked glue washes out the metal pieces will come loose.  The sticky things will also deform the wires, causing the bent wires to push the teeth to incorrect positions. 

4. Foods with a hard back (ribs and corn on the cob) should be separated from the hard back (the bone and the cob) in order to not break off the front brackets.

5. Hard and Doughy Foods that have resistance to bite into should be cut thin. Don't bite straight into an apple, carrot, bagel, pizza crust, or fat sandwich.  Cut them into thin pieces before eating. Also, eat one piece at a time. One potato chip will not break your braces, but a handful all-at-once may.

6. Energy and Power bars are too hard and chewy. Cereal bars and thin snack bars are better choices, especially if you break them into small pieces before putting them into your mouth.

7. Seeds and popcorn (with a husk) should be avoided when wearing a palatal expander because the small hard pieces get stuck between the plastic and the palate causing a wound.

The link for the article which I wrote for HelloNation (and which they edited, i.e. changed) is below, followed by a screenshot of the first page.

https://orthodontistexpertinwhiteplainsny.org/navigating-braces-what-to-eat-and-avoid-in-white-plains-ny/

Age to Start Braces

It's never too late to wear braces.  We can improve alignment and function at any age, but there are some ages that are more ideal than others.  For example, I cannot change the bone structure in an adult, but I can change it in a growing patient.  Palatal expansion (changing the width of the upper arch) is most effective below age 12 for a girl, and below age 14 for a boy.  Headgears can restrain growth of the upper jaw, but only if there is more growth available, therefor starting by age 8 is more efficacious. If treatment is started after facial growth is finished we are more likely to need to remove adult teeth or reshape the existing teeth in order to achieve alignment. Treating adults limits the facial and jaw balance that can be achieved.

HelloNation published my first article on the best age to start braces.  Unfortunately, working with them also means accepting their edits to match their writing style. The photos in the hello nation articles are theirs too. Here is the link and a screenshot to the first page of the article. 

 https://orthodontistexpertinwhiteplainsny.org/when-kids-should-get-braces-guidance-for-families-in-white-plains-ny/

Healthy Gums do not Bleed

 

When I was a teenager, my father arranged for me to observe dentists in several dental offices, in order to convince me that dentistry was not what I wanted to do for my livelihood.  My parents’ plan backfired.  I loved what I saw, and knew in my heart that I would be a good dentist. Some of what I heard, however, did not sit well with me.  One dentist, in response to his patient’s concern about her bleeding gums, stated “everybody’s gums bleed.” NO! Everybody’s gums do not bleed, and they should not bleed.

If your hands bled when you washed them, you would be concerned.  You should also be concerned if you clean your teeth and your gums bleed.  Bleeding gums are sick gums. 

Healthy gums are light pink in color, are flat to the tooth surface, come to a neat point between the teeth, and are stippled like an orange peel.  Sick gums are more red in color, especially around the necks of the teeth, they are rolled like a bagel near the tooth surface, the triangular areas between the teeth are bulbous (they puff out) and the surface is shiny. The first stage of gum disease is gingivitis, the inflammation in the gums that creates the red appearance, that allows the gum tissue to flop in the breeze, and which bleeds when you brush, floss, or touch it. The more you avoid touching it, the more the bacteria build up, the more the tissue reacts to the toxins from the bacteria, the worse the inflammation gets.  You can only break the cycle by brushing and flossing (or brushing and irrigating with a water-pik.)  If your gums are bleeding they are saying, “Help, I’m sick. Please clean me.” If you continue to neglect your gums, the disease process will progress to periodontitis.  Now the whole attachment around the teeth is inflamed, and the bone that holds the teeth in your mouth starts to go away so that the necks of the teeth start to stick out of the gums. Over time the teeth also get loose, and some will fall out.  Gum disease is the leading cause of tooth loss in adults.

If you move teeth orthodontically, or with mouth habits like leaning your tongue on your teeth or sucking your thumb, and your teeth are not clean, you are at risk of accelerating the damage caused by gum disease.  For information on how to clean your teeth, watch our hygiene videos on-line at https://www.okunortho.com/brushing-and-flossing

Spring is in the air, Let's keep our teeth for a lifetime

 

Spring is in the air (the snow is starting to melt). Soon all the seedlings will sprout and new plants will crop up everywhere.  If only it were so easy with teeth.  We only get two sets.  Most of the time, if everything is normal, we grow a total of 20 primary teeth.  These baby teeth are replaced between the ages of five and twelve (on average) with adult teeth.  New adult teeth also erupt distal to (further towards the back of the mouth than) the full set of primary teeth. The total number of permanent teeth, including wisdom teeth which erupt in adulthood, is 32.  We do not get replacements for the “second set.”  Despite the fact that we call adult teeth “the permanent dentition”, if we don’t take care of these adult teeth they do not last for a lifetime. Neglect can lead to a lifetime of restoring the damage with fillings, gum grafts, and replacement teeth (bridges, implant crowns, and dentures.)

In my recent agricultural volunteer experiences, I have learned that growing plants is not effort-free. It is not simply waiting for new plants to crop up everywhere. In addition to planting seeds in containers, clearing and fertilizing the fields and planting the seedlings in the ground, keeping the plants well-watered, and weeding out the unwanted vegetation, the plants need pruning (removing extra leaves that are sapping nutrients and removing extra fruits that are too heavy for the plant), pests have to be kept away from the plants, the plants need to be protected from the weather, and the fruits need to be harvested, boxed, and sent to market. (Did you know that cauliflower gets sunburned [i.e. it turns brown] if it gets too much sun?  The farmers need to bent the leaves over the head of the cauliflower daily to keep the cauliflower white.) Farmers don’t just plant the seeds and harvest the fruit.

People have to take care of their oral health with just as much effort.  We need to properly brush and floss to remove bacteria from our teeth daily in order to prevent cavities and gum disease.  We can also use other aids for cleaning our teeth like the Waterpik Dental Irrigator and ultrasonic electric toothbrushes like the Philips Sonicare toothbrush. Many of us need to use fluoride rinse daily to strengthen the enamel to resist decay and discoloration. We can use special rinses to keep the gums healthy (examples are The Natural Dentist Healthy Gums rinse, StellaLife VEGA rinse, warm salt water, or a combination of hydrogen peroxide and water.) We need to visit our dentist every 6 months to make sure that we are keeping the disease processes at bay.  If we are having issues, like cleaning the crooked teeth, or having enough space for the adult teeth to erupt properly, we need to visit the orthodontist to make the teeth easier to clean.  The orthodontist also puts the teeth into their best positions to withstand the functional forces of chewing and talking.  If we have parafunctional habits that put excessive forces on our teeth, we need to have the orthodontist make acrylic devices to wear on our teeth at night to protect our teeth from habits like grinding our teeth, leaning our tongue on our teeth. We also need to break habits like chewing our shirtsleeves, sucking our fingers, or biting our pens. Keeping teeth for a life-time is a lot of work!

 

Valentine’s Day is coming and millions of Americans are planning to take their loved ones out to eat, buy them flowers, and buy them jewelry.  Relationships take effort and time to maintain, even relationships with family members, friends and co-workers.

Teeth also take effort and time to maintain. We need to clean them effectively (brushing and flossing daily (https://www.okunortho.com/brushing-and-flossing) is the number one priority, because all diseases of the mouth are caused by the bad bacteria which build up when you don’t clean effectively. Eating fewer sugary things, keeping the time that the sugar is bathing your teeth to a minimum, and rinsing the sugar off your teeth after eating, will all help to minimize dental decay.  Eating fewer acidic things, and rinsing after having acidic beverages (like carbonated beverages, fruit smoothies and sports drinks) will help to keep decay and erosion to a minimum. 

Teeth that are well aligned are easier to clean than teeth that are crowded. Dr. Okun will happily show you how to clean difficult areas, but she will also recommend orthodontic treatment (braces) when it is indicated for the longevity of your teeth. Properly aligned teeth are in positions and angulations that help them to function at their best, and to hold up to the functional forces of chewing and speaking. But even well aligned teeth have trouble holding up to excessive forces that are generated by clenching and grinding your teeth (bruxism) and generated by leaning your tongue on your teeth at rest or when swallowing (tongue thrust).  Obviously, it’s best to eliminate these damaging habits, but it’s impossible to monitor habits when you are sleeping.  Therefore, if Dr. Okun diagnoses you with one of these habits, she will recommend that you wear acrylic appliances (such as a hard full occlusal coverage maxillary guard, or a Hawley retainer) at night (indefinitely) to protect your teeth and their supporting structures from these damaging habits.

(NOTE: This blog was written in January, and  did not post on it's scheduled post date. Sorry it's late.)

Help your teeth celebrate the New Year

 

New Years 2026 blog

How did you celebrate New Year’s? Did you curl up with a book, watch a movie on TV with your family, or go out with friends?

Human beings are social creatures.  We often share our special occasions with other people.  Too much “alone time” often leads to depression. Teeth are not too different.  One tooth that stands alone does not do very well; it has too many forces applied to it from chewing, speech, and swallowing.  But if that tooth has “friends” nearby, they can share the functional forces, and each one “suffers” less. When orthodontists rearrange teeth to a more ideal alignment, each tooth gets less abuse. The front teeth, with narrow edges, incise or cut the food. The corner more pointy teeth guide the chewing forces. The back teeth, with a wide biting surface, support the vertical forces of chewing.  The back teeth also support the vertical height of the face, while the front teeth help the tongue and lips to enunciate (speak more clearly).

The teeth are only one component of the chewing process.  The chewing muscles, tongue, and saliva also play a role.  The muscles help the jaws open, close, and move sideways in order to cut and crush food.  The tongue helps push food onto the chewing surfaces so the teeth can crush the food. The saliva helps by moisturizing the chewed food and filling it with digestive enzymes before swallowing.

There are also some “bad players” that live in the mouth's neighborhood.  Anaerobic bacteria (the ones that live without oxygen) cause cavities and gum disease.  It is our job to help our teeth by effectively removing the bacterial build-up daily with proper home care. If we don’t remove the bacteria effectively, within 24 hours the plaque layer gets thick enough to provide a place for the bad bacteria to live.

If you are not sure how to clean your teeth properly, please view our hygiene videos at https://www.okunortho.com/brushing-and-flossing.