White Spot Lesions: Prevention and Management During the Orthodontic Treatment

Abstract The formation of white spot lesions, or enamel demineralization, around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which marks the result of a successfully completed case. This article is a contemporary review of the risk factors and preventive methods of these orthodontics scars. Preventive programmes must be emphasized to all orthodontic patients. The responsibility of an orthodontist is to minimize the risk of the patient having decalcification as a consequence of orthodontic treatment by educating and motivating the patients for excellent oral hygiene practice. Prophylaxis with topical fluoride application should be implemented: high-fluoride toothpastes, fluoride mouthwashes, gels and varnishes during and after the orthodontic treatment, especially for patients at high risk of caries.

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Caries prevention during orthodontic treatment: In-vivo assessment of high-fluoride varnish to prevent white spot lesions

American Journal of Orthodontics and Dentofacial Orthopedics ◽

10.1016/j.ajodo.2015.07.039 ◽

2016 ◽

Vol 149 (2) ◽

pp. 238-243 ◽

Cited By ~ 17

Author(s):

Federico Perrini ◽

Luca Lombardo ◽

Angela Arreghini ◽

Silvia Medori ◽

Giuseppe Siciliani

Keyword(s):

Orthodontic Treatment ◽

Caries Prevention ◽

White Spot ◽

Fluoride Varnish ◽

White Spot Lesions ◽

High Fluoride ◽

In Vivo Assessment

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Effect of Chlorhexidine Varnish and Fluoride Varnish on White Spot Lesions in Orthodontic Patients- a Systematic Review

The Open Dentistry Journal ◽

10.2174/1874210602115010151 ◽

2021 ◽

Vol 15 (1) ◽

pp. 151-159

Author(s):

Aravinthrajkumar Govindaraj ◽

S.P. Saravana Dinesh

Keyword(s):

Systematic Review ◽

Oral Hygiene ◽

Orthodontic Treatment ◽

Significant Risk ◽

White Spot ◽

Fluoride Varnish ◽

Cochrane Library ◽

White Spot Lesions ◽

Manual Search ◽

Orthodontic Patients

Aim: The aim of this study is to critically review the studies that studied the effect of Chlorhexidine varnish and fluoride varnish on White Spot Lesion (WSL) in patients undergoing orthodontic treatment. Materials and Methods: The electronic database PubMed, The Cochrane Library, Medline, Embase, Google Scholar, Web of Knowledge along with a complimentary manual search of all orthodontic journals till the first week of December 2019 was searched. English language study performed on humans, randomized or nonrandomized clinical trials, comparing the effect of fluoride and chlorhexidine varnish on WSL was included in the review. Quality assessment of included studies was performed. Clinical Significance: The need for an adjunct oral hygiene aid to reduce the incidence and prevalence of white spot lesions in orthodontic patients is necessary. The use of these varnishes will aid in the same and thus make the adverse effects of fixed orthodontic treatment negligible. Review of Literature: Enamel demineralization is a significant risk associated with orthodontic treatment when oral hygiene is poor. Prevention of demineralization during orthodontic treatment is one of the greatest challenges faced by clinicians despite modern advances in caries prevention. The development of White Spot Lesions (WSLs) is attributed to prolonged plaque accumulation around the brackets. Results: The search identified a total of 3 studies that were included in this review. One study had Low risk of bias and the remaining 2 studies had moderate overall risk. Results showed that there was a reduction in the incidence of white spot lesions in orthodontic patients after application of chlorhexidine and Fluoride varnish. Conclusion: Low level evidence is available to conclude that the use of chlorhexidine varnishes and fluoride varnishes reduces the prevalence of white spot lesions in patients undergoing fixed orthodontic treatment. Due to its limitations, the results of this systematic review should be handled with caution and further well-planned Randomized Clinical Trial (RCT) are needed to provide a discrete conclusion.

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Effect of topical fluoride gel and fluoride varnish in the prevention of white spot lesions in patients undergoing fixed orthodontic treatment: An in vivo study

APOS Trends in Orthodontics ◽

10.25259/apos_170_2020 ◽

2022 ◽

Vol 11 ◽

pp. 301-308

Author(s):

Vivek Kumar Thakur ◽

Raghuvinder S. Vats ◽

M. P. Prasanna Kumar ◽

Sanjeev Datana ◽

Mohit Sharma ◽

...

Keyword(s):

Orthodontic Treatment ◽

Visual Observation ◽

Primary Objective ◽

Laser Fluorescence ◽

White Spot ◽

Fluoride Varnish ◽

White Spot Lesions ◽

Orthodontic Bracket ◽

Topical Fluoride

Objectives: Our primary objective was to establish the efficacy of fluoride gel and fluoride varnish in the prevention of white spot lesions (WSLs) development during fixed orthodontic treatment. Materials and Methods: The study sample consisted of 60 adult patients in a prospective split-mouth study design. Interventions, that is, topical fluoride gel and topical fluoride varnish were assigned at the time of bonding to either the right or left halves of the dentition. In all subjects, repeated evaluation of demineralization was done on the facial surfaces of sample teeth in each quadrant. Evaluation using laser fluorescence and by direct visual observation under magnification was carried out at bonding (T0), 3 months (T1), and 6 months (T2). Results: The distribution of mean DIAGNOdent score at T1 (3.14 ± 1.00 vs. 2.81 ± 0.852) and T2 (4.17 ± 1.41 vs. 3.51 ± 1.13) was observed which is significantly higher in the Gel group compared to the Varnish group. In the Gel group, the distribution of mean DIAGNOdent score at T1 (3.14 ± 1.00) and T2 (4.17 ± 1.41) is significantly higher compared to mean DIAGNOdent score at baseline T0 (2.07 ± 0.66). In the Varnish group, the distribution of mean DIAGNOdent score at T1 (2.81 ± 0.852) and T2 (3.51 ± 1.13) is significantly higher compared to the mean DIAGNOdent score at T0 (2.07 ± 0.66). Visual scores also correlated with DIAGNOdent scores. Conclusion: Fluoride varnish is more efficacious than fluoride gel in reducing enamel demineralization. Initial application of fluoride varnish around the orthodontic bracket at bonding appointment can offer significant protection against WSLs.

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Role of taste perception in white spot lesion formation during orthodontic treatment

The Angle Orthodontist ◽

10.2319/091918-680.1 ◽

2019 ◽

Vol 89 (4) ◽

pp. 624-629 ◽

Cited By ~ 1

Author(s):

Abrar Alanzi ◽

Marianna Velissariou ◽

Manal Abu Al-Melh ◽

Donald Ferguson ◽

Katerina Kavvadia

Keyword(s):

Free Group ◽

Oral Hygiene ◽

Orthodontic Treatment ◽

Taste Perception ◽

White Spot ◽

Caries Experience ◽

White Spot Lesions ◽

Significant Difference ◽

Orthodontic Patients

ABSTRACT Objectives: To investigate the role of individual's taste sensitivity using 6-n-propylthiouracil (PROP) in the development of white spot lesions (WSLs) in adolescent orthodontic patients. Materials and Methods: 44 healthy adolescents, aged 12 to 16 years old, who were in fixed-appliance orthodontic treatment for at least 6 months, consented to participate in this cross-sectional study. Data regarding participants' demographic information, oral hygiene practices, and dietary habits were obtained by a questionnaire. An oral clinical examination was performed to determine the oral hygiene status, the presence of WSLs and dental caries experience. The taste phenotype of the participants was evaluated through PROP test and they were accordingly divided into PROP nontasters and PROP tasters. Results: The sample consisted of 24 subjects in the WSL group and 20 subjects in the WSL-free group. The WSL group demonstrated higher mean plaque score (48.2), mean decayed, missing, and filled surfaces (2.38), and mean decayed, missing, and filled teeth (1.96) scores compared to the WSL-free group (38.7, 0.85, and 0.55, respectively), but no significant differences were found. Most subjects in the WSL group were PROP nontasters (66.6%) whereas most subjects in the WSL-free group were PROP tasters (75%); a significant difference was observed between the groups (P = .006). Conclusions: The prevalence of white spot lesions was significantly higher in adolescent orthodontic patients who were PROP nontasters compared to PROP tasters. A PROP taste perception could be a potential risk factor for the formation of WSLs during fixed orthodontic treatment that warrants further attention.

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Deproteinization of tooth enamel surfaces to prevent white spot lesions and bracket bond failure: A revolution in orthodontic bonding

APOS Trends in Orthodontics ◽

10.4103/2321-1407.186431 ◽

2016 ◽

Vol 6 ◽

pp. 179-184

Author(s):

Roberto Justus

Keyword(s):

Orthodontic Treatment ◽

Tooth Enamel ◽

Treatment Success ◽

Glass Ionomer Cement ◽

White Spot ◽

White Spot Lesions ◽

Bond Failure ◽

Orthodontic Patients ◽

Phosphoric Acid Etching ◽

Ionomer Cement

Orthodontic treatment success is jeopardized by the risk of development of white spot lesions (WSLs) around orthodontic brackets. Unfortunately, the formation of WSLs still remains a common complication during treatment in patients with poor oral hygiene. Nearly 75% of orthodontic patients are reported to develop enamel decalcification because of prolonged plaque retention around brackets. It is the orthodontist’s responsibility to minimize the risk of patients having enamel decalcifications as a consequence of orthodontic treatment. This can be achieved by using hybrid, fluoride-releasing, glass ionomer cement to bond brackets, with deproteinization of the enamel surface before phosphoric acid etching.

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White spot lesions after orthodontic treatment assessed by clinical photographs and by quantitative light-induced fluorescence imaging; a retrospective study

BDJ ◽

10.1038/sj.bdj.2015.617 ◽

2015 ◽

Vol 219 (3) ◽

pp. 117-117

Keyword(s):

Retrospective Study ◽

Fluorescence Imaging ◽

Orthodontic Treatment ◽

White Spot ◽

White Spot Lesions

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Prevalence of White Spot Lesion during Orthodontic Treatment with Fixed Appliance

Update Dental College Journal ◽

10.3329/updcj.v9i2.43739 ◽

2019 ◽

Vol 9 (2) ◽

pp. 40-42

Author(s):

Md Ali Kawsar ◽

Md Nurul Islam ◽

Moutithi Sen ◽

Subodh Chandra Chakraborty ◽

Muhammad Tanvir Siddiqui

Keyword(s):

Orthodontic Treatment ◽

Demographic Data ◽

Significant Risk ◽

White Spot ◽

White Spot Lesion ◽

White Spot Lesions ◽

Orthodontic Appliance ◽

Fixed Appliance ◽

Group 12 ◽

Dentofacial Orthopedics

Background: White spot lesions (enamel demineralization) is one of the most common and a significant risk associated with orthodontic treatment. Objective: To determine the prevalence of white spot lesion during fixed orthodontic treatment. Method: This prospective observational study and was conducted in the Department of Orthodontics and Dentofacial Orthopedics from January 2016 to December 2017 over a period of two years. Patients with fixed orthodontic appliance age between 12-30 years of both sex attended for follow up were included in this study. After taking written consent, a questionnaire included socio-demographic data, clinical and outcome variables including routine clinical photographs to examine WSL were filled up for each patient. Routine clinical photographs to examine WSL were taken after 6 months and 12 months of fixing orthodontics appliance. Qualitative data were expressed as frequency distribution and percentage. Results: Maximum patients were in age group 12 – 16 years and prevalence of WSL was also sought maximum in this group. Out of 36 cases with WSL, 14 (38.9%) were male and 22 (61.1%) were female. Prevalence of WSL after six month of fixing orthodontic appliance was 21.8% and 26.1% after 12 months. Prevalence of WSL after six month of fixing orthodontic appliance in male was 26.4% & in female was 19.6% and after 12 month of fixing orthodontic appliance it was 30.2% in male and 24.1% in female. After six months of fixing orthodontic appliance 1-3 WSLs was found in 17.0% cases and ≥ 4 WSLs in 4.8% cases. After twelve months of fixing orthodontic appliance 1-3 WSLs was found in 19.4% cases and ≥ 4 WSLs in 6.7% cases. Maximum WSL was found in maxillary incisors. Conclusion: This study showed that 21.8% of the study subjects developed white spot lesions during orthodontic procedure and incisors were the most common affected teeth. Update Dent. Coll. j: 2019; 9 (2): 40-42

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Fluoride varnish for the prevention of white spot lesions during orthodontic treatment with fixed appliances: a randomized controlled trial

European Journal of Orthodontics ◽

10.1093/ejo/cjz045 ◽

2019 ◽

Vol 42 (3) ◽

pp. 326-330 ◽

Cited By ~ 6

Author(s):

Mikael Sonesson ◽

Anna Brechter ◽

Salem Abdulraheem ◽

Rolf Lindman ◽

Svante Twetman

Keyword(s):

Placebo Group ◽

Orthodontic Treatment ◽

Test Group ◽

Ammonium Fluoride ◽

Dropout Rate ◽

White Spot ◽

Fluoride Varnish ◽

White Spot Lesions ◽

Randomized Controlled ◽

Fixed Appliances

Summary Background Self-applied and professional fluorides are key elements to limit caries-related side-effects during orthodontic treatment with fixed appliances. Objective To evaluate the effectiveness of a new fluoride varnish formula containing 1.5% ammonium fluoride in preventing white spot lesions (WSLs) in adolescents undergoing multi-bracket orthodontic treatment. Subjects and methods The study employed a randomized controlled triple-blinded design with two parallel arms. One hundred eighty-two healthy adolescents (12–18 years) referred to three orthodontic specialist clinics were eligible and consecutively enrolled. Informed consent was obtained from 166 patients and they were randomly allocated to a test or a placebo group (with aid of a computer program, generating sequence numbers in blocks of 15). In the test group, fluoride varnish was applied in a thin layer around the bracket base every sixth week during the orthodontic treatment, while patients in the placebo group received a varnish without fluoride. The intervention started at onset of the fixed appliances and continued until debonding. The endpoint was prevalence and severity of WSLs on the labial surfaces of the maxillary incisors, canines, and premolars as scored from high-resolution pre- and post-treatment digital photos with aid of a four-level score. Results One hundred forty-eight patients completed the trial, 75 in the test group and 73 in the placebo group (dropout rate 10.8%). The total prevalence of WSL’s on subject level after debonding was 41.8% in the test group and 43.8% in the placebo group. The number of patients exhibiting more severe lesions (score 3 + 4) was higher in the placebo group (P < 0.05); the absolute risk reduction was 14% and the number needed to treat was 7.1. Limitations The multicentre design with somewhat diverging routines at the different clinics may have increased risk for performance bias. No health-economic evaluation was carried out. Conclusions Regular applications of an ammonium fluoride varnish reduced the prevalence of advanced WSL during treatment with fixed orthodontic appliances. Clinical trial registration ClinicalTrials.gov (NCT03725020). Protocol The protocol was not published before trial commencement.

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