Oral appliances

Oral appliances are not one of the most common risk factors, but many people do require the use of oral appliances throughout their lifetime. Oral appliance refers to braces and orthodontic brackets, orthodontic retainers, “clear braces” aligners, sports mouth guards, night guards, sleep apnea appliances, whitening trays, and partial dentures—basically, any type of foreign dental object placed in the mouth for an extended period of time.

Oral appliances are a risk factor for caries for two reasons: oral appliances can create artificial areas on the teeth that are much harder to keep clean and remove the cavity-causing bacterial plaque and food debris, and oral appliances create artificial zones on the teeth that limit the exposure to protective saliva flow.

One of the primary oral appliance risks is orthodontic braces. Studies have shown that 60.9% of patients with braces (average of 1.9 years’ duration) experienced white spot lesions (tooth’s enamel has taken on an opaque color in the area where cavities are beginning to form).[1]

Regardless of other risk factors, and the patient’s present risk status, the high caries risk nature of these appliances for patients, especially braces, the dental professional should consider some form of additional prevention therapy such as pH neutralization, xylitol, nanohydroxyapatite for remineralization, and additional fluoride exposure. Oral rinses can be especially beneficial in assisting patients with oral appliances in delivering the therapeutic agents into hard-to reach areas due to the appliance. Some patients with night guards, sleep apnea appliances, and clear aligners can also place small amounts of neutralizing therapeutic gels into the tray and wear them overnight for increased protection.

If a patient is considering using oral appliances, braces, or clear aligners for cosmetic tooth alignment, or any other oral appliance for a non-health-related issue such as whitening, it is recommended that the patient identify their caries risk status first. The patient may decide to delay cosmetic dental procedures until they are low or low/moderate risk prior to moving forward if white spot lesions and increased caries activity are a concern.


  1. M. Enaia, N. Bock, and S. Ruf, “White-Spot Lesions during Multibracket Appliance Treatment: A Challenge for Clinical Excellence,” Am JOrthod Dentofacial Orthop 140, no. 1 (July 2011): e17–24.