Enamel Protection


Permanent scars on enamel.  Swollen, infected gums. Lines and cavities. None of these should be present at the completion of orthodontic treatment, yet these negative consequences affect patients whose oral hygiene is less than acceptable. Plaque and food debris accumulate around braces, producing acid that leeches away calcium from the surfaces of the teeth and leaving a mark. In addition, the very high acid content from soft drinks, soda, sports drinks, energy drinks, flavored water, and sour candies contribute to destroyed enamel, too. Inflamed gums also cause teeth to move more slowly as the body is busy fighting infection.

Battling scars, cavities, and gingivitis requires regular and thorough toothbrushing several times per day. Only a toothbrush will disrupt these “bugs” and remove food debris stuck in the braces. Regular recall cleanings and examinations at your dentist’s office during orthodontics are also critical.

Duraflor HALO
Fluoride Varnish

Dr. Bowman has been a long-term proponent and has written a series of research articles describing the benefits of the application of fluoride varnishes around braces to strengthen the enamel surface. These materials are painted on the teeth at regular intervals during braces treatment. Varnishes have dramatically reduced the incidence and severity of scars or “white spot lesions;” however, they are not the only solution.

Scar Tactic

Recent research at Baylor University has demonstrated the effectiveness of the application of “sealant” on the front of teeth prior to placing braces. As a result, we are not only using Halo fluoride varnish routinely, but we are also applying Opal Seal for patients starting braces for an added “layer of protection.”


Fluoride varnishes have been replacing more traditional approaches to routine, in-office, and fluoride treatments originally in European and Canadian dental offices, and more recently in the U.S.  Specifically, Duraflor fluoride varnish provides a simple alternative to fluoride gels as a preventative measure in general practice.  For several years, Dr. Bowman has been spearheading a trend in orthodontics, calling for routine use of fluoride varnish to help reduce enamel demineralization stains.  This is especially important considering the diminishing oral health compliance by patients and the rise of increase consumption of acidic beverages (soft drinks in schools).

Substituting fluoride varnish for typical fluoride gel treatments in a dental office is a simple proposition and one that patients might find more palatable. Dental quadrant isolation with WYRED lip retractors (Glenroe Technologies), that Dr. Bowman designed, is followed by air-drying the teeth and then painting on a very thin layer of varnish on all surfaces of the teeth (much like putting on a thin layer of nail polish).  Research has shown that varnishes, when used as an alternative to topical gels, have reduced caries by an astounding 45-70%.  As a result, the ADA’s House of Delegates has provided their approval for fluoride varnishes in 2004.



We have assisted with a series of research collaborations with Dr. Bowman’s colleagues in Maringá, Brazil. Articles were published in the World Journal of Orthodontics and Orthodontic Craniofacial Researchevaluating the effectiveness of Duraflor in reducing enamel demineralization around orthodontic brackets.  The results corroborated other research, including our own clinical observations, of a dramatic reduction in enamel stains.  Although fluoride varnish cannot completely prevent decalcification, it can dramatically reduce its incidence and severity.  Specifically, our results demonstrated 44.3% less demineralization for teeth treated with fluoride varnish during 12 months of orthodontic treatment.

Fluoride Varnish


We have also completed work evaluating the applicability of the KaVo DIAGNOdent for objective measurements of developing demineralization (Journal of Clinical Orthodontics, 2011).  This device permits us to measure or “score” the enamel adjacent to orthodontic brackets during treatment, identify developing scars before they are clinically observed, and then perhaps prescribe more aggressive preventive measures.  Next up, we’ll be examining the effects of using Opal Seal (enamel sealant) to add more protection to the surface enamel and this will be followed by evaluation of remineralization with different calcium surface replacement methods.


DIAGNOdent Varnish


We are obviously quite concerned about patient care and involvement in their oral hygiene.  This is why we redesigned our in-house oral hygiene program with a new methodology of hygiene instruction using the latest innovations.  Specifically, we adopted the Oral Health Solutions program developed by Crest and Oral-B.  It is a program called Orthodontic Essentials and was designed for orthodontic patients featuring the Oral-B Professional Care SmartSeries 5000 toothbrush, Crest Pro-Health Toothpaste and Rinse.

The Oral-B Professional Care SmartSeries 5000 is the first power brush with a wireless remote to provide feedback to reinforce proper brushing habits.  Recent studies demonstrate that after 2 weeks, orthodontic patients who used this Ortho Essentials regimen had up to 40% less plaque than if they had used a regular manual toothbrush and toothpaste.



The Ortho Essentials (OE) program empowers patients to take charge of their own oral hygiene.  Patients are educated to assess their own level of hygiene using simple grading cards.  They learn to match the appearance of their own teeth to photos on these cards to determine their own score. This is also done chairside at the orthodontic office to reinforce improvements. Kalamazoo Orthodontics was once again the first orthodontic practice in the region to adopt this unique program.


• Demito CF, Rodrigues GV, Ramos AL, Bowman SJ. “Efficacy of a Fluoride Varnish in Preventing White-Spot Lesions as Measured with Laser Fluoresence.” Journal of Clinical Orthodontics, January 25-29, 2011.
• Vivaldi-Rodrigues, G, Demito, CF, Bowman, SJ, Ramos, AL.  “The Effectiveness of a Fluoride Varnish in Preventing the Development of White Spot Lesions.” World Journal of Orthodontics, Vol. 7 (2) 138-144, 2006.
• Demito CF, Vivaldi-Rodriques G, Ramos AL, Bowman SJ.  “The Efficacy of a Fluoride Varnish in Reducing Enamel Demineralization Adjacent to Orthodontic Brackets:  An In Vitro Study.” Orthodontic Craniofacial Research, Vol. 7, p. 205-210, 2004.
• Bowman, SJ.  “The Use of Fluoride Varnish to Reduce Decalcification,” Journal of Clinical Orthodontics, June, p. 377-9, 2000, [reprinted in (Canadian) Oral Health, 2001].
• Bowman, SJ and Carano, A.  “Scar Tactic: Fluoride Varnishes Flight Decalcification Stains in Orthodontic Patients,” Orthodontic Products, March, p. 32-5, 2002.
• Bowman, SJ.  “A Utilização do Duraflor na Redução da Decalcificação Durante o Tratamento Ortodôntico,”  Revista Dental Press de Ortodontia e Ortopedia Facial, Vol. 6, No. 1, 79-81, 2001.
• Bowman, SJ and Carano, A.  “Reducing the Scars in Orthodontics:  Duraflor Fluoride Varnish,”  Journal of the Indian Orthodontic Society, Vol. 35:94-98, 2002.