🦷 Mondays with Mark: The Hidden Dangers of Clear Aligners: What You Need to Know

Today’s topic is yet another mind-blowing example of how oral microbiome science is REWRITING conventional dental wisdom.

Did you know that clear aligners, despite their sleek appearance, might not be as harmless to your teeth as you think? When Invisalign first hit the scene, I was thrilled by the idea of a nearly invisible, removable option for straightening teeth.

No more unsightly brackets or wires, no more worrying about white spot lesions—the telltale chalky white spots that signal the early stages of a cavity.

But what if I told you that even clear aligners, despite being removable, can cause white spot lesions as well?

Today, we’re diving into the surprising connection between clear aligners and these pesky white spots, known as WSLs (white spot lesions), and what you can do to protect your smile.

Nearly half (45.8%) of patients who receive fixed hardware orthodontic treatment (that’s brackets, wires, even expanders that are fixed) get these white spot lesions! WSLs are more than just cosmetic concerns; they’re early indicators of enamel demineralization, often linked to orthodontic treatments.

For almost a century, dentists and patients have known that one of the prevalent side effects of conventional, fixed orthodontics is getting a permanent scar on your tooth—a white spot lesion (WSL).

That’s because, when you glue something onto the tooth, it’s not smooth anymore—there’s a little ledge that can lead to accumulation of plaque in the same spot every single time, leading to white spots.

Along comes Invisalign. We can move the teeth, but we can take out the thing moving the teeth, scrub and brush as if nothing is there, and pop it back in! White spot lesions problem solved, right?
Wrong!

The risk of white spot lesions is still there, according to this new study, even with clear aligners, albeit a little less than with fixed orthodontic hardware. This study contradicts the previously held notion that if you got Invisalign, you were not at risk whatsoever of white spot lesions! In this study, surprisingly, 35% of young patients develop WSLs during this treatment, a lower incidence compared to traditional braces (45.8%) but still significant.

So, why are patients getting white spot lesions if they’re able to remove the aligner and brush and floss?

It turns out, aligners cover more tooth surfaces and alter the mouth’s natural microbiota. This disturbance in the oral microbiome, combined with reduced saliva interaction, creates an environment ripe for enamel demineralization.

Saliva has nutrients in it—and a tooth covered by an aligner is not getting bathed in that all-important saliva.

So, if your dentist tells you that there’s no chance of white spot lesions with clear aligner therapy such as Invisalign, show them this new research! And make sure you take the steps below to protect yourself:

What can you do if you’re considering or currently using clear aligners? Here are my top recommendations:

1. Swish with water and chewing gum: Swish with water after meals, snacks, and drinks. And chew a xylitol gum! This one is the one I like.
2. Take an oral probiotic: I recommend Bristle, available through Fygg.com
3. Don’t brush your aligners: Don’t roughen up the aligner by brushing it with toothpaste, making it more likely to collect plaque. Use a dental pod.
4. Use a nano-HAP toothpaste or varnish with arginine and prebiotics: All of these ingredients target white spot lesions in a biomimetic way. Daily brushing with Fygg pro varnish is what I would recommend as the ideal toothpaste for preventing white spot lesions.
5. Don’t sleep with your mouth open! That’s going to make those white spot lesions develop very quickly. This is the mouth tape I use—find one that you like and make sure that mouth is closed, and you’re breathing through your nose all night long (and all day long too!) For those that cannot breathe through their nose, consider delaying orthodontic treatment until you can fix your nose breathing. It’s that important! I use this nasal spray each night to help with nasal breathing.

Any other questions about white spot lesions or the oral microbiome? Hit reply!

Warm regards,
Dr. Mark Burhenne

P.S. All of my recommended products are linked at askthedentist.com/shop