Getting Ahead of White Spot Lesions

The Ortho Hurdle: Why Brackets Are a Plaque Magnet

White spot lesions remain the most common iatrogenic risk of orthodontic treatment, with nearly half of patients at risk during care. They tend to appear in a very predictable place: the maxillary canines and lateral incisors (teeth 6 through 11).

Reaching those specific surfaces at the correct angle around a bracket demands far more manual skill than posterior teeth or central incisors require.

Willo developed its Ortho brush head in collaboration with Dr. Andrew Serrano, DMD, MPH, a board-certified orthodontist and Diplomate of the American Board of Orthodontics. He describes the underlying challenge plainly:

"Brackets create a surface that is very hard for patients to clean. Removing the plaque and tartar around the bracket is critical to preventing white spots, which is the scarring we see." — Dr. Andrew Serrano, DMD, MPH · Diplomate, American Board of Orthodontics

The Insight: Effort vs. Execution

Poor bracket-area hygiene is usually a technique problem, not a motivation problem.

Many adolescents brush twice a day for the full two minutes and still develop demineralization because they simply cannot manipulate a manual or power brush to the ~45° angle that effective bracket cleaning requires.

                  THE HYGIENE GAP
┌─────────────────────────┐     ┌─────────────────────────┐
│     MOTIVATION          │     │       EXECUTION         │
│  Brushing 2x daily      │  ≠  │  Reaching 45° angle     │
│  Full 2-minute timer    │     │  Around brackets & wire │
└─────────────────────────┘     └─────────────────────────┘

When we treat poor hygiene as a lack of effort, we miss the underlying mechanism. When we treat it as a technique barrier, we can actually solve it.

"The idea of the Willo toothbrush is that you are taking the technique away from the patient. All of the technique is built into the toothbrush, and it becomes very easy for them to comply, cooperate, and prevent white spots from forming." — Dr. Andrew Serrano, DMD, MPH

Where Hygiene Breaks Down

The pattern is consistent across young patients. Kids are naturally better at brushing the back teeth and central incisors because those areas require less wrist manipulation.

The difficulty concentrates on the canines and lateral incisors, where the brush has to arrive at a precise angle around the bracket. Patients struggle to manipulate standard brush heads to that angle, making these exact surfaces the primary epicenter for white spot lesion formation.²

Removing Technique from the Equation

The Willo Ortho brush head is engineered to target these high-risk surfaces automatically:

• Dedicated Bracket Slot: Keeps continuous contact with the tooth surface without catching on appliances.
• Recessed Middle Bristles: Cleans above, directly on, and below each bracket simultaneously.
• Raised Fourth Row: Extends from canine to canine to sweep from the bracket down to the gingival margin.
• Automated Motion: Replicates the Modified Bass Technique continuously for a full two-minute cycle.

How Brushing Approaches Compare

Putting It to Work in Your Practice

1. Prioritize High-Risk Patients: Target adolescents in active treatment, patients with special healthcare needs, and children with sensory sensitivities who struggle with manual dexterity.
2. Choose an Integration Point: Embed Willo into treatment plans from Day 1, or introduce it selectively when patients demonstrate repeated OHI warnings during check-ups.
3. Keep the Recommendation Clinically Honest: Willo replaces technique-dependent brushing. Interdental cleaning remains essential, which is why the Ortho kit includes dedicated braces flossers.