Those are white spot lesions! Let’s talk a bit about why they happen and what we can do about them.

What Are White Spot Lesions (WSLs)?

White spot lesions are simply areas of decalcification of our enamel. Before we have a true cavity (a cavity results from decay entering the inner layer of our tooth, dentin, past the outer enamel layer), the enamel becomes decalcified. This results in a chalky-white appearance. White spot lesions are a common occurrence around the brackets of traditional fixed braces, but also may appear on your teeth throughout your life. A study has found that these ‘lesions’ can appear rapidly, up to four weeks after initiating orthodontic treatment in the presence of poor oral hygiene¹. With this in mind, let’s look more into studies about white spot lesions.

What Causes These Lesions?

Like mentioned above, these lesions are commonly associated with orthodontic treatment (but this isn’t their only cause!). When orthodontic treatment is started, the bacteria of the oral cavity is changed. One of those bacteria, S. mutans, is a major factor in the formation of cavities and was found to be increased in those who initiate orthodontic treatment². WSL’s are like ‘starter cavities,’ so it makes sense that they would be seen more in those with patients with a large microflora of S. mutans. The common areas that they appear are around the brackets (or under), as well as along the gingiva towards the top of teeth. Just because you don’t have braces doesn’t mean you can’t get these lesions, though – WSL’s are simply areas of decalcification and anything that promotes poor oral hygiene can contribute to them.

One study found that the key characteristics between developing WSL’s are the surface characteristics of the teeth, the saliva flow of the patient, as well as the distance of brackets from the gingiva in those who have orthodontics³.

So What Do We Do About Them?

The easiest thing to do is prevent. That means brushing your teeth twice a day with a fluoridated toothpaste, as well as watching your diet for carbohydrates (which the bacteria that contribute to cavities feed off of). Don’t fret, though, if you find yourself with these lesions. There are methods to make your teeth appear like their natural selves again.

The first method is to remineralize the teeth with repeated applications of fluoride. This can be jump-started by fluoride varnishes at your dentist, and continued with maintenance at home with fluoridated toothpastes. Next, an abrasive may be used to ‘rub away’ the lesion using a fine grit material and acidic substance. Finally, a new method of resin-infiltration has been proposed and is regularly used in dental offices today – this method involves injecting a tooth-colored filling material into the tooth to bring back its natural look. Not all dentists provide these services, though, and remineralization is generally the first and least-invasive method for these lesions.

Bonus: Eat cheese! On food that prevents cavities: ‘the most protective properties against caries formation was the one (cheese) that involves the greatest amount of casein phosphoproteins and calcium phosphate in its content³.’

To Summarize:

• White spot lesions are common and a result of demineralization of enamel
• WSL’s are more common in those with poor oral hygiene and fixed orthodontics
• There are numerous ways to combat WSL’s and it begins with prevention

References:

¹Khoroushi, M., & Kachuie, M. (2017). Prevention and Treatment of White Spot Lesions in Orthodontic Patients. Contemporary clinical dentistry, 8(1), 11–19. https://doi.org/10.4103/ccd.ccd_216_17

²Shukla, C., Maurya, R. K., Singh, V., & Tijare, M. (2016). Evaluation of changes in Streptococcus mutans colonies in microflora of the Indian population with fixed orthodontics appliances. Dental research journal, 13(4), 309–314. https://doi.org/10.4103/1735-3327.187876

³Temel SS, Kaya B (2019) Diagnosis, Prevention and Treatment of White Spot Lesions Related to Orthodontics. Int J Oral Dent Health 5:085. doi.org/10.23937/2469-5734/1510085

Liability Statement:

The medical advice given in this blog should only be utilized by a medical professional who has received a medical degree. I am not responsible for the medical advice given in this blog and each case should be reviewed extensively with sources outside my blog. This blog is for education purposes only and is not meant as a substitute for an academic institution.