It just doesn't seem possible that anything could ever be designed that would make it harder for someone to effectively brush and floss their teeth than braces. And because of this increased difficulty with plaque removal, it is extremely important for anyone with braces (and their parents) to realize during that time frame when the braces are in place that there will be at increased risk for tooth decay formation.
White spot lesions form where plaque accumulates. A special complication associated with not removing dental plaque effectively when braces are in place has to do with the formation of "white spot lesions." As you know from our text, tooth decay is caused by a demineralization of a tooth's enamel. Acids produced by oral bacteria found in dental plaque actually dissolve away the mineral content in teeth.
Because this demineralization process changes the quantity and quality of the tooth's mineral, the appearance of the tooth's enamel will change. In fact, dentists term the earliest stage of tooth decay formation a "white spot lesion," because the tooth's enamel takes on an opaque whitish color in the area where the demineralization is taking place.
So, if dental plaque is allowed to persistently accumulate around a person's braces, white spot lesions will form in the tooth's enamel. The portion of the tooth that lies underneath the orthodontic brackets, however, will have been protected from the plaque and therefore this portion of the tooth's enamel will not change in appearance. When the person's orthodontic treatment has been completed and the braces are removed, a white spot lesion outlining the original position of the orthodontic bracket will be obvious and spoil the cosmetic appearance of the tooth.
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