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Orthodontics/White spot leasions

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Question
What prescription toothpaste is most effective at remineralizing white spot leasions? I had braces many years ago. I really looked at my teeth lately and noticed these wavy thin white lines at the gumline. My dentist said its probably from braces.

Answer


Hi Jim,

Your question on enamel demineralization addresses a classic challenge that continues to this day.  I apologize for the delayed response. You wrote:

“What prescription toothpaste is most effective at re-mineralizing white spot lesions? I had braces many years ago. I really looked at my teeth lately and noticed these wavy thin white lines at the gumline. My dentist said it’s probably from braces. “

I could talk a little about preventing these conditions, but in your case we can not undo the past, and the fact is, you now have these “white spot lesions”. The current question then is what can be done once the teeth are effected?  

In a nutshell, depending on the extent of the demineralization, there are several options including remineralization, micro-abrasion, and cosmetic adjunctive restorations. I do not have images of your teeth. Additionally, tooth enamel characteristics vary among individuals, and is often profoundly impacted by fluoride exposure during actual tooth development.  

(1)  Remineralization

The remineralization process can be helped with strong prescription toothpastes such as Colgate Prevident 5000. This is a prescription strength fluoride dentifrice. You can also rinse with a strong fluoride mouthwash as well. I would ask your dentist to advise you on these items, as they require a doctor’s prescription. If you wish to buy an over the counter fluoride containing mouthwash, then ACT is a good choice.

Even with demineralization, not all such white spot lesions with successfully remineralize. Aesthetically speaking, tooth blemishes may remain despite such remineralization. Therefore additional steps may be necessary. Physical polishing may therefore be the next step.

(2) Enamel Micro-abrasion

The depth and extent of demineralization and aesthetic spotting of the tooth enamel can vary. Imagine a piece of iron that has rusted a little. It may be possible to sand off the rust and end up with a nice shiny nail or piece of metal. Likewise a tooth may have superficial de-mineralized “spotting” which can be reduced by polishing the enamel.  This is not a procedure you can do Jim, but is for the dentist or dental hygienist to perform.   I recommend that you have the dentist evaluate your condition see if this is something which meets your needs.

In some cases the de-mineralized white spotting is very stubborn, and neither remineralization attempts, nor micro-abrasion procedures are enough to correct the aesthetic defects. In this case, cosmetic restorative procedures may be  needed.

(3) Cosmetic Dentistry

The options for cosmetic dental restorative procedures today are astounding. Aesthetic blemishes can be addressed by bonding, veneers, crowns, and other options. The One caution is that if a patient elects to further whiten the teeth, then the tooth bleaching should be done first so that the proper white shade can be selected for the restorative procedure.

Veneers of porcelain can be blended to match the adjacent teeth perfectly. This approach also provides an opportunity for the doctor to recontour and resize a tooth if needed. It is a chance to achieve an ideal result.

So Jim, there are at least three options for you to consider.  I hope that this has been helpful. Feel free to resubmit your question, and if you do so please include an image.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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