Protect Your Teeth While You Wear Your Aligner

Liu Q, Song Z. Incidence, severity, and risk factors for white spot lesions in adolescent patients treated with clear aligners. Orthodontics & Craniofacial Research. 2024;27:704–713. DOI: 10.1111/ocr.12791. 

https://onlinelibrary.wiley.com/doi/10.1111/ocr.12791

• 203 adolescent patients treated with clear aligners were evaluated retrospectively. 
• 35.5% developed at least one new white spot lesion (WSL) during treatment.  
• The maxillary lateral incisors were the most commonly affected teeth, followed by the canines and central incisors.  
• Most lesions were mild; no severe WSLs were identified.  

The authors found increased risk associated with:

• Existing white spot lesions before treatment. 
• Frequent consumption of carbonated beverages. 
• Lower tooth-brushing frequency. 
• Less frequent cleaning of aligners after eating while wearing them. 
• A greater number of anterior attachments.  

This study is noteworthy because it is one of the first large studies focusing only on adolescents receiving clear aligner therapy. However, it does not compare aligners with fixed braces, so it cannot conclude that aligners increase WSL risk relative to other orthodontic appliances. It simply reports that 35.5% of adolescents developed WSLs during aligner treatment. 

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Dry Mouth Disease:

 "Patients with primary Sjögren (disease) experience significantly greater dental caries and tooth loss than matched healthy controls, even though they report more frequent dental visits and better oral hygiene practices."  

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GERD/Reflux

GERD may increase caries risk through several mechanisms:

• Repeated exposure to gastric acid lowers oral pH. 
• Enamel softening and erosion make teeth more susceptible to bacterial attack. 
• Some GERD patients have reduced salivary flow, either from the disease itself or medications. 
• Nighttime reflux prolongs acid exposure when salivary protection is naturally reduced. 

Unlike Sjögren's syndrome, where xerostomia is the primary driver, GERD affects teeth through a combination of acid erosion, changes in the oral environment, and sometimes reduced saliva.

https://pubmed.ncbi.nlm.nih.gov/18373634/

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Medication-induced salivary gland dysfunction: A systematic review

This systematic review provides high-level evidence that:

• Numerous medications reduce salivary flow. 
• Medication-induced hyposalivation is associated with increased oral disease risk, including dental caries. 
• Polypharmacy significantly increases xerostomia prevalence.

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Cannabis use and untreated dental caries among U.S. adults

This is one of the largest population-based studies.

Findings:

• Adults who reported frequent cannabis use had higher odds of untreated coronal and root caries than non-users. 
• The association remained significant after adjusting for demographic and behavioral factors. 
• The association was strongest among frequent users. 

This is currently one of the strongest epidemiologic studies supporting a link between cannabis use and dental decay.

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 "Older adults have an increased risk of dental caries, particularly root caries. This increased risk is driven primarily by exposed root surfaces, medication-induced xerostomia, chronic disease, and the cumulative effects of restorations, rather than aging itself." 

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NOTE: There is limited current research on the environment under plastic aligners and retainers. New protocols that may reduce the incidence of decay are being explored. Consult with your trusted dental provider before using any particular home care strategy.