Orthodontic care increases the difficulty in maintaining good oral hygiene. For this reason demineralized enamel areas, termed "white spot lesions," frequently occur. White spot lesions can be remineralized, which is much more desirable than having to progress to restorative dental care. Enamel can be remineralized with meticulous toothbrushing, twice per day, with fluoridated dentifrice. Additional fluoride can further enhance the remineralization process. This would include higher dose fluoridated dentifrice, over-the-counter 0.05% sodium fluoride rinses, topical fluoride gels, fluoride varnishes, and professionally applied topical fluoride such as 2% sodium fluoride, 8% stannous fluoride, and 1.23% acidulated phosphate fluoride. Enamel can also be remineralized with casein phosphopeptide-amorphous calcium phosphate preparations. Chewing gums and pastes are available that contain casein phosphopeptide-amorphous calcium phosphate. When white spot lesions are remineralized, the white appearance of the remineralized lesion may remain. Bleaching can successfully camouflage these white enamel areas. If bleaching alone does not camouflage the white appearance of the remineralized areas, enamel microabrasion can be performed. Enamel microabrasion abrades the enamel surface, leaving a highly polished surface with calcium phosphate packed into the interprismatic enamel surface space. This highly polished enamel surface can then be bleached. This technique has been demonstrated to improve the appearance of enamel surfaces that had white spots.
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