Do aligners cause teeth erosion over time?

As an orthodontist, one of my most significant concerns is maintaining the health of my patient’s teeth during orthodontic treatment. Developing tooth decay during treatment is a risk, whether you wear braces or clear aligners, but it’s entirely preventable!


In this blog article I’ll discuss patient concerns about whether aligners can damage enamel, how to prevent it and how to best care for your teeth and aligners before, during and after treatment.



The Why, When and How Teeth Decay


Teeth are covered by a hard mineralised layer called enamel. Our mouths play host to a variety of bacteria, which combine with residual food to form a soft, sticky film called dental plaque. It forms on your teeth every 24 hours. Some of the bacteria feast on sugar in our diet and convert it into an acid that dissolves, or demineralises the enamel. The acid initially causes surface blemishes (white spots or decalcifications) and eventually progresses to formation of soft areas that become holes (decay) in the tooth. This is a process that begins immediately upon eating and for about 20 minutes after.


With multiple meals and snacks, this silent damage to our teeth progresses over days, weeks and months. Fortunately, our saliva has some ability to prevent this process by neutralising the acid before tooth damage occurs. Saliva can also repair any early damage by putting calcium back into the teeth (remineralising the enamel).



Are aligners safe?


When wearing clear aligners, the teeth are completely covered by plastic. The plastic prevents contact with normal saliva flow, which helps protect the teeth from damage. So, if you don't brush your teeth before meals and you put your aligners in, the acid release from the plaque can begin to damage your teeth. That's why it's important that you brush your teeth regularly especially after every meal and snack. If you can't brush your teeth, rinse your mouth with water or mouthwash. Aligners are completely safe to wear, as long as you keep up with your oral hygiene.





How to prevent tooth decay when wearing aligners


Removal of dental plaque with daily tooth brushing and flossing will prevent white spots and decay, while undergoing clear aligner treatment. If no plaque is present, no enamel damage will occur, and wearing clear aligners will never cause any white spots or erosion.


Additionally, brushing your teeth with a fluoride toothpaste not only removes plaque, but can prevent damage, because the fluoride gets absorbed by the enamel and hardens it to make the tooth more acid resistant. Some toothpastes are antibacterial and kill decay-causing bacteria as well.



Does tooth decay affect everyone?


There are 3 factors that determine if decay will form: Amount and presence of bacterial plaque; amount of carbohydrates in the diet; and individual host factors such as enamel hardness and saliva flow.


Some individuals are just more prone than others to developing white spots and decay. Patients who are prone to decay should not only brush more frequently with a fluoride toothpaste, but also rinse with a fluoride mouthwash, which will further protect against damage. Also, patients who are prone to a dry mouth (a side effect of some medications or a sign of a salivary gland disorder) will be more prone to tooth decay. If you frequently have a dry mouth, see your dentist for treatment.



Preventing tooth decay when wearing clear aligners


Here are recommendations to ensure great dental health before, during and after clear aligner wear:

  • Eat fewer between-meal, carbohydrate-rich snacks. More frequent snacks cause more additive plaque acid attacks on the teeth (and reduce your aligner wear time).

  • If you wear aligners, it is best to brush your teeth after eating. This will remove food and plaque which if left behind will lead to enamel damage. If you can’t brush your teeth, rinse your mouth with water or mouth wash shortly after eating, and brush later. Rinsing will at least remove food particles and neutralise some plaque acids.

  • While brushing with a fluoride toothpaste after every meal is ideal, it’s especially important to brush after breakfast and before bedtime (during sleep, saliva flow is reduced, and teeth are at greatest risk).

  • Brush your clear aligners, because aligners build up plaque just like teeth! And putting plaque laden aligners back on your teeth is both yucky and harmful to your teeth; brush your aligners with lukewarm water with the option of using a bit of liquid soap.

  • Never wear your aligners while eating: The plastic will be damaged from the forces of chewing; the plastic could stain from food pigments, and food could get wedged between teeth, gums and aligners.

  • Always keep your aligners in a case to avoid picking up germs.

  • See your dentist twice a year to get a thorough cleaning and examination, which can remove plaque deposits and detect possible minor problems before they become major ones.


In short: Do aligners cause tooth decay, damage or erosion?


No, they don't. The best way to avoid tooth decay when wearing aligners is to brush your teeth after every meal and snack to ensure that your teeth are clean when putting your aligners back on. Use a fluoride toothpaste, especially after breakfast and before bed.


If your teeth are clean when wearing your aligners the chances of plaque getting stuck between the aligner and your teeth is reduced and that is the key to avoiding decay. Remember that plaque releases an acid and this is what damages your enamel and can lead to decay. Also, remember to brush your clear aligners with warm water and some liquid soap if desired.


These recommendations will benefit you before, during and after your WonderSmile aligner treatment. With proper dental hygiene, wearing clear aligners is harmless to the tooth enamel and will not cause tooth erosion over time. With the peace of mind that WonderSmile clear aligner wear is safe for your teeth, learn more about how WonderSmile aligners can transform your smile in an average of 6 months.


To begin your new smile journey, you can visit one of our WonderSmile locations.


Written by Dr. Richard Schechtman, Head Orthodontist at WonderSmile