Abstract
Background: White spot lesions (WSLs) are a problem commonly found in patients who use orthodontic devices. Fluoride varnish can reduce WSLs during orthodontic treatment with fixed appliances. The aim of this systematic review was to evaluate the efficacy of fluoride varnish compared with other agents for preventing WSLs during orthodontic treatment.
 Methods: Studies were searched from four databases- PubMed, Scopus, Web of Science and Cochrane Library- from January 1980 to May 2017; only studies with English abstracts were included.
 Results: Out of 432 studies searched from the databases, 33 studies were evaluated for eligibility. Of the 33 studies, 19 were excluded with reasons and 14 studies were included in the systematic review. Parameters of WSLs (decalcification score, prevalence, incidence, progression score, ΔQ and ΔZ and DiagnoDent (DD) pen score) were compared for the various treatments.
 Conclusions: Although there were some limitations for this systematic review study, the review showed that fluoride varnish combined with chlorhexidine (CHX) may be a good treatment for WSLs after orthodontic treatment, especially for a 6-month period, and that resin infiltration might also be effective for preventing WSLs. More studies are needed to further investigate these observations.
Highlights
Fixed orthodontic appliances create stagnation areas for plaque and difficulties for tooth cleaning
White spot lesions (WSLs) are a problem commonly found in patients who use orthodontic devices
The aim of this systematic review was to evaluate the efficacy of fluoride varnish, compared to other treatments, for preventing WSLs during orthodontic treatment with fixed appliances
Summary
Fixed orthodontic appliances create stagnation areas for plaque and difficulties for tooth cleaning. White spot lesions (WSLs) are a problem commonly found in patients who use orthodontic devices While it takes around 6 months for caries to progress in a patient not submitted to orthodontic therapy, it takes around 1 month for those who are (Lucchese and Gherlone, 2012). WSLs progress around orthodontic ligatures, brackets and bands because these appliances physically prevent thorough dental cleaning and potentiate bacterial biofilm accumulation on tooth surfaces (Lucchese and Gherlone, 2012; Tufekci et al, 2011). The aim of this systematic review was to evaluate the efficacy of fluoride varnish, compared to other treatments, for preventing WSLs during orthodontic treatment with fixed appliances. The aim of this systematic review was to evaluate the efficacy of fluoride varnish compared with other agents for preventing WSLs during orthodontic treatment.
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