White spots

Decalcification spots on the teeth can be most disappointing to orthodontist, patient, parents, and referring dentist (Fig. 11.7). The finger is often pointed towards the orthodontist concerning the cause of the problem. While this is generally not the case, if the patient's attention to oral hygiene early in the treatment is poor, it is important to minimize this problem. A suggested protocol can be considered and explained to the patient, in letter form, pre-treatment.

• At the first visit that poor oral hygiene is noticed, the patient is informed of the condition and told that if there is no improvement by the following visit, wires will be removed.

• The patient can then be checked briefly at 2 to 3 week intervals until there is improvement, which is usually the case.

• If no improvement occurs after two to three visits without archwires, the anterior brackets can be removed until there is improvement. This is rarely needed, if proper limits are set.

• If there is still no response, then removal of the appliances or transfer to another orthodontist is recommended. This is rare indeed.

The causes of local enamel decalcification are multifactorial.3'4 Good oral hygiene is important, but there is also individual variation in plaque type and composition. Some patients will have a greater risk of local changes in ecological balance, leading to decalcification.

It is not possible to identify those individuals who are predisposed to local decalcification, but it is clear that a small group of patients is responsible for a large percentage of the affected teeth. For some patients it may be helpful to advise one or two weeks of additional rinsing with proprietaiy 0.2% chlorhexidene rinse, according to the manufacturer's instructions. This may help to favorably change the bacterial flora and restore ecological balance.

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