The orthodontic topic for today is DECALCIFICATION. We want to explain it and then tell you how it can be prevented. Decalcification is the loss of protective minerals in a tooth’s enamel. (In serious cases, it can lead to an early cavity.) Just like a piece of marble is etched when you leave vinegar on it, a tooth becomes microscopically roughened when acid stays in contact with it too long. Dental plaque is full of bacteria that release acids. When orthodontic patients leave plaque around their brackets and bands, these acids start to change the appearance of their enamel. On the day their braces are removed, these patients get a sad surprise. Instead of beautiful straight teeth, they have dark and light mottled straight teeth. Some even some white “window panes” that show exactly where their brackets used to be. Unfortunately, many orthodontic patients need to have restorations placed to repair cavities that began while they were in their appliances. Click on this link to see photographs of this kind of decalcification: Teeth after Poorly Brushed Braces Removed

So what can you do to prevent decalcification?

    1. Please pay attention when our dental assistants tell you that brushing needs to improve. Sometimes we have parents who are upset when their child finishes treatment and need some fillings due to decalcification. “You didn’t tell us that Susie wasn’t brushing!” Then we look in Susie’s chart and see that we told the parent and the patient at almost every appointment that the brushing needed to improve. It is a frustrating situation for everyone. This job is too important to pass onto a young child. Many don’t have the dexterity or patience to do it well. As you work with your child, try to make it a pleasant experience. Encourage them and reward them as they begin to assume the tasks themselves. If your child is a teen, we know it is difficult to motivate them to focus on their brushing. Perhaps have them look at the scary photos in the link above. Maybe figure out a small reward if they get an oral hygiene “Thumbs Up” at their next orthodontic appointment.

Practice with our staff at the brushing station as they show you how to brush and floss.

    1. We have two sinks available for these demonstrations and are happy to work with you as many times as you need to get the desired results. Good oral hygiene should take at least five minutes each day for people who don’t have braces. It takes even longer if you have orthodontic appliances. This time needs to be factored into your morning and evening hygiene routines.
  1. Understand why good oral hygiene is important during orthodontic therapy. If you know why you need to do something, you will do it better. Besides keeping the enamel surface nice and smooth, cleaning your teeth moves the treatment along in a timely fashion. Puffy gums slow down the movement of the teeth. T H I N K as you brush. Divide your mouth into sections and spend sufficient time in each part. Give the sides of the teeth that face your tongue or roof of your mouth as much attention as the parts you can see when you smile. When you are done brushing, L O O K at the brackets and banks to see if you missed any plaque around their edges.
  2. Good oral hygiene takes advantage of mechanical and chemotherapeutic devices. The mechanical devices are an electric toothbrush (Oral B Braun) and an oral irrigator (WaterPik.) The chemotherapeutic devices are a fluoridated toothpaste(Colgate Total), fluoride rinse (Dr. Foley can give you some), and a remineralization toothpaste. Powered toothbrushes remove more plaque than manual toothbrushes. One study said you would need to brush for six minutes with a manual toothbrush to remove the same amount of debris than an Oral B Braun can remove in sixty seconds. A WaterPik oral irrigator flushes the acid byproducts away, helping to reduce gingivitis and reducing decalcification. There are two remineralization toothpastes on the market. MI Paste is sold through dental offices and costs more than conventional toothpaste. Burt’s Bees toothpastes are on sale at WalMart, Target and Whole Foods and cost about $6. Both of these contain the calcium, sodium, and phosphosilicate minerals that normally circulate in your saliva. When the enamel begins to demineralize, these toothpastes provide extra minerals to get the surface back into balance. When you brush with a remineralization toothpaste, you don’t want to rinse afterwards. Just spit the excess toothpaste into the sink and then don’t eat or drink for a half hour. Some of our patients brush with Burt’s Bees in the morning and then their fluoridated toothpaste at night. They might also rinse with a fluoride rinse before going to bed.
  3. If you are really trying to have good oral hygiene and our staff still suggests that you need to be cleaning better, don’t get discouraged. They want you to succeed and will spend more time coaching you. You can do this! But it needs to be a priority to all patients and parents. It begins with accepting the fact that this is your responsibility and isn’t something that the orthodontist can do for you. Like many somewhat boring tasks, try to spice it up by playing music or making it a game. Some patients might benefit from a professional dental cleaning every 2-3 months instead of every six months. That seems extreme, but if it keeps your teeth healthy while you’re in braces, it will be worth it!

Dr. Foley and his staff look forward to the day you have your braces removed just as much as you do. They are thrilled when you smile for the first time and everything looks great. While there are some adjustments they can do in the office to balance out some small cases of demineralization, it is better for YOU if your enamel is smooth and gleaming. If you follow the suggestions outlined above, you’ll be on your way to an awesome smile!