Orthodontic therapy is a much needed and desired treatment of dental service. However, when patient oral hygiene performance is inadequate, undesirable white spot enamel lesions can appear. If unchecked, they may progress to frank caries. The various etiological factors are discussed and preventive strategies are proposed to combat such lesions. This information will help specialists and general dentists alike to better predict, diagnose, and prevent these lesions while providing active orthodontic treatment.