Fixed orthodontic appliances are associated with an increased level of enamel decalcification, as well as with a significant increase in white spot lesions. The etiology of dental caries includes behavioral, local, infection, systemic, and genetic components.
Carious white spot lesions involve active caries with a porous enamel surface. An
arrested white spot lesion is actually remineralized, with an intact enamel surface that is no longer an active carious lesion. A white spot lesion is confined to the enamel, approximately 100-150 microns deep, with an intact but porous layer. It is best observed on a dry tooth surface, which will be seen to have lost its surface shine. This opacity results from the porous enamel surface, which could be described as a “lid.” The presence of this enamel lid is essential for remineralization, so do not destroy
this surface. White spot lesions can be prevented through excellent diet and oral hygiene, the use of fluoride toothpaste, fluoride rinses, and fluoride varnishes, Dr, Staley recommends establishing a patient protocol for nutrition and oral hygiene before placement of fixed orthodontic appliances. Educational pamphlets can assist the patient, and he recommends being positive without dwelling excessively on the potential negative aspects of decalcification.