Orthodontic Treatment and Dental Hygiene

Author: Angela Weaver-Blake, RDH

This blogs topic will be aimed primarily to those patients who have completed orthodontic therapy and notice that they have some disturbing white spots on their teeth where their brackets were placed.

Orthodontic treatment is initiated for lots of different reasons. Sometimes we are treating a skeletal problem and are trying to influence growth in a developing adolescent. Other times we are addressing crowding and a developing malocclusion. Having malformed or congenitally missing teeth is also a problem that can be solved through orthodontics as well as impacted teeth that need our assistance in erupting into the mouth. Whatever your diagnostic problem is, having anchorage to address these problems through orthodontic brackets and bands may lead to these unaesthetic white spots. The white spots do not develop because of bracket placement and are not an inevitable side effect with orthodontic treatment. They develop because of hypo-mineralized enamel around the bonded surface of orthodontic brackets. These hypo-mineralized areas are usually a result of less than optimal oral hygiene while undergoing orthodontic treatment. Bands, brackets, arch wires, ligatures and elastics all work to complicate plaque removal during brushing, flossing and other oral home care efforts. Having stellar home care and routine dental hygiene visits are a large part of avoiding these hypo-mineralized areas. They are unsightly and are usually only visualized after bracket removal. But what are my options? Should I notice them after braces are taken off? The answer is now available for you and your hygienist to explore.

Your registered dental hygienist can talk with you about a specially developed infiltration product for smooth tooth surfaces, particularly well suited to remove white spots and treat incipient caries, especially those related to orthodontic treatment. It is designed for esthetic improvement of non-caries related lesions caused by demineralization and/or mild to moderate fluorosis on smooth surfaces. This product cannot be used for areas that have developed caries that are through the enamel (you need a dentist to restore these areas). But areas that are demineralized within the enamel can be treated effectively without anesthesia (numbness) with a long-lasting result. As with all dentistry, the results and their longevity are tied to individual home care and appropriate maintenance.

The procedure discussed above involves isolating the teeth with white spots and etching out with acids all of the pigmented discoloration. An ethanol drying agent is then applied to the involved teeth to allow a resin infiltration material to flow into the etched surface. This is hardened with an LED polymerization light and subsequently polished. This technique can also be applied to any tooth that is discolored or unsightly as long as the diagnosis is that the discoloration is within the enamel layer. The resin infiltration layer does not preclude the tooth from getting further dental treatment should it be necessary or absolutely protect it from potential dental disease in the future. The technique simply reinforces less than perfect enamel and fills in at a microscopic level the imperfections that may be present in the tooth’s facial enamel structure.

As an esthetic procedure, you will find that there probably is no insurance coverage for this procedure. We are currently offering this procedure at $94.00 per treated tooth. Sensitivity and an imperfect correction of the white spot are potential downsides. Most patients have reported that sensitivity is decreased with this procedure and while perfect esthetic results are not always achieved, a much better esthetic result is the normal outcome.

Address your concerns with your hygienist. They are there to answer all of your questions.