White spots on teeth are areas of decalcification or demineralization of the tooth structure. If plaque is not cleaned off of the teeth, the acid from the plaque starts to take away the mineral from the tooth, leaving a softer, chalkier white area behind. These spots are like scars on the teeth because they do not brush away.
White spots can occur with or without braces. Braces do not cause white spots. However, people who are mediocre or poor brushers can be more prone to develop these spots while wearing orthodontic appliances because it can be more challenging to brush and floss. The area between the brackets and the gum tissue tend to be the most common area where white spots develop. Therefore it is of particular importance to brush well around the brackets and gently brush the edge of the gum tissue.
The good news is that white spots are preventable! Brushing well and removing all the plaque from the surfaces of teeth will ensure that white spots do not develop. You can also use a fluoride rinse for extra protection. Simple, right? For some patients it is very easy, and for some it can be very challenging. It requires consistent effort to brush 2-3 times each day. Spots do not develop in a day- but they can sometimes develop within several weeks if brushing is neglected often. The thing that is most unfair is that some people are more susceptible to white spots than others. I have seen some patients with poor hygiene who rarely brush at all (yes, at all!), and somehow they do not develop white spots. Yet, spots can start to develop in other patients who for one reason or another have a small period of several weeks in which they don’t brush very well but otherwise have kept up with their hygiene during treatment. So, the take home message should be to brush well always.
What if white spots have developed? Is there anything that can be done? If the spots are small, sometimes with good brushing and time the spots will lessen in appearance and will not be very visible. If the spots are more significant, we may recommend using a special re-mineralizing toothpaste (MI paste) once the braces come off to reduce the appearance of white spots. The best way to avoid this scenario is to get in the habit of good brushing early and to keep it up! This is a life-long commitment that should be made with or without braces because braces are only on for a small period of time, but your teeth are with you forever.