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.