By: Dr. Semco

One question that is asked by some of my patients is: "Am I going to get those white marks on my teeth when my braces are taken off?" The answer primarily depends on the state of the patient's oral hygiene.  I've never seen white marks on the teeth of patients who keep their teeth free of plaque.  But in patients with poor oral hygiene, white marks can develop, usually towards the gum side and the sides between the braces. Fluoridated toothpaste certainly helps matters.  So brushing with fluoridated toothpaste three times per day for 2 minutes at a time should do the trick, whether using a manual or electric toothbrush. You can see in the mirror if plaque remains.  If it does, start brushing that area again. Remember to put extra effort in brushing between the braces and between the braces and the gum line, since those are the usual problem areas.

But sometimes patients just can't seem to keep their teeth clean.  And for them, we have a special tool in our toolbox. In a November 2011 article published by the American Journal of Orthodontics and Dentofacial Orthopedics, researchers discovered that a product called MI Paste Plus "helped prevent the development of new white spot lesions during orthodontic treatment and decreased the number of white spot lesions already present." For those who are familiar with how studies are developed, this was a very well done prospective randomized clinical trial of sixty patients, with fifty patients completing the study.

Over the past several years, I have been a big proponent of using MI Paste products. With regard to how use MI paste, the active ingredient in MI Paste binds to oral soft tissues, to dental pellicle and also to plaque. The binding elevates the salivary levels of calcium and phosphate for extended periods. For this reason, MI Paste works best in patients when it is applied at night before bed, since the salivary clearance rate is low during sleeping. It is recommended that MI Paste be applied immediately after flossing and brushing with fluoridated toothpaste, again, particularly at night before bed. 

Apply a pea-sized amount of MI paste to your teeth's surface using a clean finger, with special focus between the braces and between the braces and gum line.  Leave undisturbed for 3 minutes. Spit but do not rinse; leave the excess to slowly dissolve.  

Because of the degree of fluoride content in MI Paste Plus, it is not recommended for overnight application in children under the age of 12. Since a significant portion of my patient population is under the age of 12, I generally prescribe the fluoride-free MI Paste. I prescribe MI Paste Plus for special circumstances. Note that MI Paste is derived from the milk protein, casein and it is not to be used on patients with mild protein allergy (caesin IgE) and/or sensitivity to benzoate preservatives.