It is always a difficult conversation in the orthodontic office when decalcification is found at an adjustment visit. Too often it is after the plaque is cleared away enough to finally see the teeth beneath the braces.
At this point, it does not help when we can point to previous treatment card notes outlining several discussions about the need for improved oral hygiene techniques, including the prescription for Prevident Plus and MI Paste. "I told you so" (which we don't say, of course) feels woefully inadequate when the parent's face shows obvious despair and gives equally blaming looks to the squirming patient and orthodontist.
I find even more anguish when oral hygiene is reasonable, and we find the white wash decalcification and outright pitting of enamel at the brace and tooth interface. This is evidence of the "power of sour" at work.
As professionals, we were unaware for a long time about the rapid enamel destruction that dietary acids can work on our teeth. Parents are often shocked to learn about this and, unfortunately, are disbelieving that brushing is the worst thing to do after consuming acidic foods and beverages.
For most practitioners, perimolysis comes to mind with GERD and other acid reflux issues. Put a brace on a soda swisher or sour-candy fan and perimolysis can quickly trench a good brusher's enamel. It is most often found on the upper incisors where brushing efforts for the social six are the strongest. Then gravity packs a punch on the lower teeth where the acidity lingers. It does not help when the gingival tissues enlarge like groping fingers to hold the acids in tightly away from any cleansing action.
Although, like oral hygiene instructions, it takes action to make a difference, there are some great handouts that can educate parents and their adolescent brace wearers on the dangers of the acid world. "Sip All Day, Get Decay" and "Power of Sour" are brochures with excellent information presented with researched facts and photos. When braces are placed, they can go hand-in-hand with the "Foods to Avoid" list and oral hygiene instructions. Have them handy for those future winning smiles.
I guarantee smiles all around when, upon removing braces, a beautiful, flawless smile is revealed.
(For more articles by Donna Stenberg, click here.)
Donna J. Stenberg D.D.S., M.S., P.A. Spear Visiting Faculty and Contributing Author,