Clear dental aligners, such as Invisalign, are an attractive proposition in orthodontics, thanks to their comfort and convenience. However, whilst they are a discrete alternative to fixed braces¹, aligners can present their own set of challenges, including a higher risk of enamel erosion caused by acid attacks and demineralisation of the teeth².
In this article, we’ll explore the risks associated with clear dental aligners, as well as detailing the steps that you can take to offset them.
What do enamel erosion and demineralisation of teeth enamel mean?
Before establishing any steps for prevention, it’s good to first understand what demineralisation is and how this could lead to erosion of teeth enamel.
Enamel demineralisation caused by acids – sometimes referred to as an ‘acid attack’ - happens when enamel comes into contact with acidic substances: either those introduced into the mouth in food and drink, or acids that are produced by the bacteria living in the mouth³.
Demineralisation of the teeth is the process whereby minerals present in the enamel are lost. Enamel is the hard, protective outer layer of your teeth, and up to 95% of your enamel is made up of mineral⁴. Loss of this mineral can be due to a number of factors, including erosion and dental caries, which, as we’ve seen, can be caused by ingesting acidic foods, or by a build-up of dental plaque⁵.
When you consume acidic food or drinks, your enamel can become softer. Often, natural remineralisation of your teeth is possible as saliva helps to neutralise these acids and promote the remineralisation process. It is worth noting that frequent contact with acidic substances makes it difficult for saliva to remineralise enamel and in this case, enamel can become damaged⁶.
As demineralisation of the teeth occurs, your enamel loses its protective power, and the exposure of the dentin and the pulp can give rise to unwanted symptoms.
As demineralisation of the teeth occurs, your enamel loses its protective power, and the exposure of the underlying dentine and the pulp can give rise to uncomfortable and unpleasant symptoms.
Symptoms associated with enamel erosion caused by demineralisation include:
- Sensitivity: In particular, when your teeth encounter hot, cold, or sour foods and drinks.
- Discolouration: As the white to an off-white protective layer of enamel is lost, it may leave your teeth looking yellow. This is exposed dentine.
- Damage: Cracks or chips are more likely as your teeth become more vulnerable to being damaged.
- Transparency: When tooth enamel gets thinner, teeth may look translucent. This is particularly noticeable at the biting edges.
- Tooth pain: If the protective layer of enamel is lost you may experience severe pain in your teeth.
So, now you know about enamel erosion and demineralisation and remineralisation of teeth, but where do dental aligners come into the equation? Let’s find out.
Can wearing dental aligners cause problems for your enamel?
While research on the potential side effects of invisible aligners relating to your enamel is limited, it is likely that there are a number of risks that may come into play whilst wearing braces⁸.
One key effect that aligners have is that, when worn, they can form a microenvironment around the teeth. This microenvironment can cause various problems for your teeth, including ²:
- Preventing the flow of saliva around the teeth. As we have seen, thanks to saliva, remineralisation of your teeth is possible due to its natural ability to neutralise acids and remineralise the enamel, however, this is limited when wearing aligners.
- Creating a niche where the bacteria that form dental plaque can develop, which can lead to enamel demineralisation, or tooth decay.
It is important to note that wearing clear aligners whilst eating and drinking is unadvisable for similar reasons. Sugary or acidic substances are trapped next to the teeth, exacerbating the risk of demineralisation of the teeth and tooth decay².
Can you remineralise enamel?
Demineralisation (and remineralisation) of teeth enamel mineral and visible loss of enamel mineral are two separate issues. Once your tooth enamel is damaged, not even the body can restore it – but you can help strengthen your enamel and protect it before it gets to that stage¹⁰.
Remineralisation of teeth enamel is the action of beneficial minerals – such as calcium, fluoride, and phosphate, being incorporated into the hard outer layers of your teeth (the enamel). There are various ways in which this happens – either naturally, through saliva, or with the help of products designed to encourage and aid the process of remineralisation like REGENERATE™ Enamel Science products, created with breakthrough NR-5™ technology.
Thanks to NR-5™ technology, you can reverse enamel erosion by regenerating enamel minerals with exactly the same mineral that tooth enamel is made of*. In fact, using the REGENERATE™ Advanced Toothpaste and the REGENERATE™ Enamel Science Serum combination is proven to regenerate 82% of enamel mineral after 3 days*, future proofing your smile.
For more information on the remineralisation process, read our guide on how to remineralise enamel.
How to prevent demineralisation of teeth enamel when wearing clear dental aligners
So, how exactly can you remineralise enamel whilst wearing a clear aligner such as Invisalign, and what steps can you take to prevent demineralisation in the first place? There are still several ways to aid this process:
- Wear your aligner as instructed and keep it clean⁹. This helps prevent the negative effects of the microenvironment aligners can create.
- Avoid sugary and acidic foods and drinks
- Drink plenty of water (though not sparkling water, as this has the potential erode enamel¹²) and rinse your mouth regularly.
- Regularly floss, or clean in between your teeth using an interdental brush.
- Consume foods with a high calcium content, such as milk, cheese, bony fish, and leafy green vegetables.
- Brush your teeth twice a day using a fluoride toothpaste that is designed to restore enamel mineral*, such as REGENERATE™ Advanced Toothpaste, formulated with breakthrough NR-5Ô technology, clinically proven to regenerate lost enamel mineral with exactly the same mineral tooth enamel is made of*.
- Use an enamel-remineralising, mouthwash to rinse your mouth, such as the REGENERATE™ Advanced Foaming Mouthwash, which works to restore tooth enamel mineral* reversing erosion and preventing further damage. With its compact, travel format, it is convenient to use on-the-go, even if you can't brush your teeth.
- Use the REGENERATE™ Advanced Enamel Boosting Serum to reverse enamel erosion with the remineralising formula that boosts the effectiveness of REGENERATE™ Advanced Toothpaste by 43%, and significantly increases enamel hardness**.
Visiting your dentist regularly to identify any areas of enamel weakness (such as white spots), or medications that can cause dry mouth, are also key in helping you to prevent demineralisation of the teeth.
So, are the side effects of invisible aligners actually harmful for your enamel? With improper care, wearing any aligner can present the risk of enamel demineralisation. However, diligent aligner hygiene and looking after your teeth by following a routine that encourages the remineralisation of teeth can help you to reduce this risk significantly.
*Acts on early invisible stages of enamel erosion. Helps to regenerate enamel by restoring its mineral content and micro hardness with regular use. Clinically proven.
**Based on an in-vitro test measuring enamel hardness after 3 days combined use of Toothpaste and Serum.
Disclaimer: The advice in this article does not constitute medical advice; it is solely available for information purposes. We recommend that you consult your dentist if you are experiencing any enamel problems.
Sources:
1 – T. Weir, Australian Dental Journal – Clear Aligners in Orthodontic Treatment
3 – NCBI - Abou Neel EA, et al. Demineralization-remineralization
4 – A. Akkus, et al. - Evaluation of mineral content in healthy permanent human enamel
5 – ibid.
6 - Oral Health Foundation – Dental Erosion
7 – Healthline, Enamel Erosion
9 – Moshiri, M, et. Al - Consequences of poor oral hygiene during aligner therapy
10 - International Dental Journal - R.J.M. Lynch, et al.
11 – NHS – Tooth Decay
12 – Reddy et al. - The pH of Beverages in the United States
