Decalcification of Tooth Enamel and Caries
Dental braces are normally anchored to the teeth and so generally hinder the natural self-cleaning process of the teeth as well as normal dental care at home. Although they are not a very efficient way of moving individual teeth, removable braces can at least be taken out to clean the teeth. So, whilst they are of limited therapeutic value, they do not cause any actual damage to the enamel.
But a fixed brace is always there even when the teeth need to be cleaned. And they create unevenness, nooks and recesses where, without any brace, there would just be smooth enamel. This is why hygiene automatically becomes a more difficult matter in the case of a fixed brace. Young patients in particular, who are normally taken to the orthodontist by their parents rather than going of their own accord, tend to neglect proper cleaning of the teeth. So, during the course of their treatment, these patients often develop so-called enamel decalcification in addition to a white discoloration of the tooth enamel around the brackets. In the worst cases this discoloration can become brownish and can even result in caries.
It is not the brace that destroys enamel but dental plaque.
But even where there is very poor dental hygiene, new, healthy enamel always develops under the brackets once the brace has been removed. What actually destroys the tooth enamel where there is poor dental hygiene is the unremoved dental plaque. This is actually a dental hygiene problem that can be completely avoided with a little motivation and skill. Although it is true that the unsightly decalcification that people usually complain about, normally improves somewhat after the end of the treatment, it often remains visible for the rest of the patient’s life. Orthodontists can often exercise prevention here by ensuring that fixed braces are only used for patients who have good dental hygiene and by monitoring their hygiene at every check-up. Unfortunately, many orthodontists do not see this as part of their job. And patients themselves should be aware that poor dental hygiene will cause damage to their teeth, and consequently they should clean their teeth thoroughly if they have fixed brackets.
Tip: Orthodontic treatment should ideally be avoided in young patients who are not interested in having a brace or who have poor dental hygiene. But even switching to a hygienic removable brace will not help these patients, because they are exactly the people who will not wear such an appliance. Best to stay away from braces altogether!