Fig. 1 Fig. 2 By Chris Baker, RN, DMD W hite spot lesions on teeth result from acid-producing pathogenic bacteria that demineralize the tooth surface. This begins the process of tooth decay. While these lesions occur in patients without any orthodontic or other dental inter-vention, they also occur during orthodontic treatment. The tooth damage results from the bacterial acids etching and eating away at the tooth structure. There is some-thing you can do to greatly reduce the risk -more on that below. The interplay between three areas will determine the risk and actuality of damage during orthodontic treatment: These are the orthodontic treatment (medi-cal intervention); secondly, the complex human body existing in its environment, nature, including the trillions of microbes we call the microbiome; and third, the patients’ and parents’ degree of participation in care of that body. Which of these areas can you impact to reduce the risk of damage? How can you provide that impact? The answers to these questions are important to all of us who offer and provide orthodontic treatment to trans-form lives. To address these, we examine the aforementioned three factors of interplay: ᕡ The Medical Intervention ᕢ The Human Body Existing in its Environment, Nature ᕣ The patient’s (and, for a child patient, the parents’) degree of participation. Our ability to reduce the risk lies almost completely in the first area of the medical intervention, the orthodontic treatment. The health of the human body and its microbiome is almost completely out of our purview, except that we can encourage the patient/parent to be aware of healthful practices that strengthen, not weaken, the microbiome. The degree of participation of the patient/parent is again, almost completely out of our purview. But, we can encourage the oral health care practices (regular dental care, excellent oral hygiene and related) and the proper partic-ipation in orthodontic therapy. This includes wearing elastics and appliances and controlling oral hygiene so as to reduce the time of the orthodontic appliances being in situ (on the teeth). The area of medical interven-tion is the area where we have some ways to mitigate the risk of white spot lesions. Unfortunately, this amounts to only one-third of the total factors at play. Remem-ber that each human body is part 14 Winter 2018 JAOS
Journal of the American Orthodontic Society Winter 2018: Page 14
