At Orthodontics Only in Miami, we know that having braces can pose special challenges for maintaining healthy teeth.  One challenge is preventing and recovering from demineralization of tooth enamel.

Demineralization and remineralization are processes that can occur in tooth enamel depending on several factors such as the cleanliness of ones mouth, acids present, calcium in and around teeth, and the presence of saliva to transfer minerals.  The process can swing one way then the next…always in a state of equilibrium.

Demineralization

Demineralization happens when sugars and acids erode minerals from the surfaces of your teeth, which lowers the pH level inside the mouth.  This can lead to sensitive teeth, white spots on teeth, and eventually cavities that may require a filling.  If you catch the process before cavities form, you can remineralize the enamel surface of your teeth.  Remineralization happens when the pH level increases due to the buffer function of saliva.  The chances of remineralization occur by reducing the amount of simple sugars that are consumed, brushing more frequently and using a fluoride mouth rinse.

The Role of Diet in Demineralization

We all learned early in childhood that sugar is bad for our teeth.  Sugary foods, acidic foods, and even whole grain foods can gradually erode minerals from tooth enamel.  Sugary and/or acidic beverages are prime culprits (coffee, tea, fruit, soda…even sports drinks).  Gummy sugars aren’t just in candy.  The starches in whole grains also stick to teeth and feed harmful bacteria that set up the demineralization process.  Some of these foods are part of a healthy, balanced diet, so avoidance isn’t the answer.  Ideally patients should brush after each meal and floss at least once a day.

The Increased Challenge of Braces

A special challenge is created for patients with traditional bracket and wire braces, because studies have shown that demineralization can occur around orthodontic appliances as early as one month into treatment.  There are definitely ways to prevent this (outlined below), but it is very common for white spots to be visible on tooth enamel after braces are removed.  Happily, there are also ways for you and your dentist to work together to recover and repair any demineralization damage done.  The good news is demineralization can be avoided, even while wearing traditional braces, and if it occurs, actions can be taken to remineralize tooth enamel before cavities develop that require a restoration.

There are significant advantages for patients with removable orthodontic appliances such as Invisalign, since the appliances can be removed before brushing.  This provides much greater access to all surface areas of the teeth and gums for proper cleaning, thus making it easier to prevent demineralization.

Remineralization

Remineralization occurs when minerals fill in the pores of the teeth, making the pores smaller and the enamel thus stronger.  The process of remineralization requires proactive steps.  Although there are several methods for aiding remineralization, none of the techniques can heal a cavity or restore enamel on a broken tooth.  A dentist may need to be consulted before remineralization can be attempted in a tooth that has a defect or obvious area of decay.  Any serious issues (significant sensitivity, pain on biting, and cavities) should always be addressed by a dentist as soon as possible.

Note: The presence of saliva affects the relationship between demineralization and remineralization because it facilitates the transportation of mineral ions (good), oral bacteria (bad), and fermentable carbohydrates (bad) to the exposed surfaces of teeth.

The Role of Diet in Remineralization

Certain foods actually help remineralization of teeth because they are calcium rich and promote saliva production.  Included among these are butter, milk, yogurt, cheeses, lean meats, soup stocks made with bones, and vegetables.  Vitamin D supplements are also important, and many dentists recommend foods high in probiotics like sauerkraut and pickled vegetables.

Over the Counter and Clinical Treatments to Prevent Demineralization and to Remineralize Enamel

Demineralization around orthodontic bands can be stopped and/or reversed by the use of commercially available fluoride products such as prescription fluoride toothpastes and professionally applied fluoride varnish.  Some demineralization methods may work for “white spot lesions” but not necessarily all tooth surfaces.  Dr. Sanders and your dentist will advise you about the best options for your situation.

Antimicrobial mouth rinses, such as Peridex, also eliminate bacteria that cause enamel demineralization.  There are also over-the-counter fluoride rinses, such as Phos-Flur, that can help and most contain 0.05 percent sodium fluoride.  This level of fluoride clears quickly from the mouth and patients should not depend on it to fully prevent demineralization or to remineralize teeth.

Calcium phosphate products are now available that contain a synthetic mineral composed of calcium, sodium, phosphorous and silica.  When this material binds to the tooth surface, it not only strengthens the tooth surface but also releases the synthetic mineral into the enamel when the tooth is exposed to acids.  It has been proven effective for making teeth less sensitive and remineralizing enamel lesions.  Dr. Sanders and your dentist can tell you about toothpastes, such as Clinpro 5000, that contain calcium phosphate.

Why not prevent pain, white spots and cavities from the get go?

You are investing in your mouth with your braces and part of making the process as comfortable and fast as possible is keeping your mouth optimally healthy. This includes a pro-mineralization diet, thorough and frequent oral hygiene, pre-orthodontic treatment of any existing lesions and cavities by your dentist, and post-orthodontic follow up by your dentist to treat all white spots (lesions) and cavities that develop while you are wearing braces.

Thorough oral hygiene consists of brushing teeth well after every meal and snack, flossing at least once a day, using an antimicrobial mouthwash, and having teeth professionally cleaned every 3 to 4 months while you are wearing braces.  Dr. Sanders and his team will be happy to tell you about the types of toothbrushes and mouth cleaning products they recommend.