Prevalence Of White Spot Lesions Research Articles

Evaluation of the Prevalence of White Spot Lesions During Fixed Orthodontic Treatment Among Patients Reporting for Correction of Malocclusion: A Prevalence Study.

Despite recent breakthroughs in caries preventive measures, one of the biggest issues clinicians confront is preventing demineralization while undergoing orthodontic therapy. The buildup of plaques around orthodontic brackets over time causes white spot lesions (WSLs). The goal of the present research was to assess the prevalence of WSLs in patients undergoing orthodontic treatment before starting therapy and at six and 12 months into therapy, adopting the visual examination approach. We looked for WSLs on tooth surfaces gingival to an archwire because this is the area most likely to experience enamel demineralization during orthodontic treatment. The visual assessment was conducted using the following scale at baseline, six months, and 12 months for orthodontic patients: score 0: no demineralization or noticeable white patches on the surface; score 1: mild demineralization with a visible white spot but no surface disruption; score 2: moderate demineralization with a noticeable WSLthat has a roughened surface but does not need repair; and score 3: severe demineralization with a noticeable WSLthat needs repair.Fisher's exact test was used after a chi-square analysis to determine whether there were any differences between all three categories (six months, 12 months, and control). The frequency of WSL in patients at 12 months of orthodontic treatment was 46.57%, while it was 11.86% in patients who just started orthodontic treatment. The difference was statistically significant (p = 0.01), showing that the frequency was greater in patients at 12 months of orthodontic treatment as compared to patients who had just started undergoing orthodontic treatment. The frequency of WSL in patients at six months of orthodontic treatment was 37.34%, while it was 11.86% in patients who just started orthodontic treatment. The difference was statistically significant (p = 0.03), showing that the frequency was greater in patients at six months of orthodontic treatment as compared to patients who had just started undergoing orthodontic treatment. The frequency of WSL in patients at six months of orthodontic treatment was 37.34%, while it was 46.57% in patients at 12 months of orthodontic treatment. The frequency was greater in patients at 12 months of orthodontic treatment as compared to patients at six months of orthodontic treatment; however, the difference was non-significant statistically (p = 0.76). This clinical investigation revealed that the number of WSLs increased significantly during the first six months of treatment and then increased gradually until the final 12 months. During the first few months of treatment, doctors should assess the patients' dental hygiene habits and, if necessary, take further precautions to prevent demineralization.

Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting

The objective of this study was to determine the prevalence of white spot lesions (WSL) in orthodontic patients in an academic setting. Specific aims include using a novel combination to measure plaque accumulation (PA) and detect the association between WSL and PA and the associations between multiple independent variables. Cross-sectional data were collected on 111 patients. To enhance standardization, a combination of plaque-disclosing agents and standardized intraoral photographs was used to analyze plaque index (PI) and WSL for all teeth except molars. Factors including time in fixed appliances (FA), number of teeth, location of the lesions, and demographic information were reported. A multiple linear regression model was used to detect associations between the PI and WSL and the independent variables (P<0.05). Approximately 79.3% of participants had at least one WSL, with a mean of 4 affected teeth per patient. A significant association was found between time in FA and the more severe PI reporting (P<0.001). There was no significant association between WSL and PI or the other variables. WSL was greater in the maxilla than in the mandible. PI was greater on the left than on the right side. Interexaminer reliability was assessed for PI and WSL (κ= 0.93 and 0.92). The prevalence of WSL for orthodontic patients treated at this institution was greater than previously reported in the literature. In addition, the severity of PI was associated with increased time in FAs. Combining the proposed method of reporting PA facilitates standardization, calibration, and documentation in an academic environment.

Intervention of White Spot Lesions. A Contemporary Review of 20 years

White spot lesion is incipient caries and it manifests as white opacity lesion on the demineralised enamel surface. White spot lesions are a common adverse effect among post orthodontic patients. The prevalence of white spot lesions in post orthodontic patients varies from 2% to 97%. Therefore, it is imperative for dental practitioners to be able to manage white spot lesions. Thus, this article is a contemporary review on the management of white spot lesions. After reviewing this article, it comes to a consensus that non- invasive treatments should be the first line management of white spot lesions. Non-invasive treatments such as patient education, motivation, oral hygiene reinforcement, and attempts to remineralise with various forms of fluoride preparation should be prioritised in the treatment plan. If the white spot lesions fail to respond more invasive treatment options might be considered.

Prevalence of white spot lesions in children up to 71 months of age in Gujarat state.

The earliest sign of a new carious lesion is the appearance of chalky white spots on the surface of the tooth, indicating an area of demineralization of enamel. At this stage, the demineralization process can be reversed or arrested. This study aimed to determine the prevalence of white spot lesions (WSLs) among children up to 71 months in Gujarat state and to increase awareness among parents about its various preventive measures. Oral examination was done using the mouth mirror and tongue depressor. The prevalence of WSL was recorded using the International Caries Detection and Assessment System II coding and WSL index by Gorelick. The overall prevalence of WSL was 31.8% (n = 2025) in Gujarat state. The parents of the participating children explained the various preventive measures to prevent decay followed by diet counseling and toothbrushing techniques. Knowledge of the actual prevalence of WSL will help in the implementation of appropriate and timely preventive measures required to decrease the incidence of early childhood caries in that region.

Prevalence of White Spot Lesions in Patients Treated with Passive Selfligation Orthodontic Appliances: A Retrospective Study

Introduction: White Spot Lesions (WSLs), also known as “white opacity,” are the result of the demineralisation occurring on tooth surfaces in patients undergoing fixed orthodontic treatment. In addition to the various other factors, development of WSLs can also be influenced by the type of brackets and ligation employed. Aim: Evaluating the prevalence of WSL among patients who underwent fixed orthodontic treatment with passive self-ligation mechanotherapy. Materials and Methods: This retrospective study was conducted using photographic records of patients who received orthodontic treatment using a passive self-ligation system at Saveetha Dental College in Chennai, Tamil Nadu, India. The records of 97 patients in the age range of 10 to 30 years who received orthodontic treatment using the Damon self-ligating system regardless of gender were obtained from April 2016 to April 2021. The presence of WSL was investigated retrospectively before and after treatment. Modified Gorelick’s scale was used for scoring the lesions. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) software version 17.0 and paired t-tests were done. Results: Data of total of 97 subjects (45 females (46.39%) and 52 males (54.63%), mean age: 17.70±5.72 years) undergoing orthodontic treatment with self-ligation brackets was included in the study. The overall prevalence percent of WSLs in the study was 71.13%. The prevalence of WSLs among females was 70.5% and in males, it was 73%. There was no statistical significance for association between gender and severity of WSLs and there was a statistical significance for association of age group and severity of WSLs in upper lateral incisors and canines (p&lt;0.05). Conclusion: The most commonly involved teeth were upper central incisors and second premolars, and the overall WSLs incidence in subjects undergoing passive self-ligation therapy was 71.9 %. No influence of the gender was noted and severe lesions were commonly noted in maxillary lateral incisors of young individuals.

Prevalence of white spot lesions and risk factors associated with the COVID-19 pandemic

BackgroundThe objective of this study was to investigate the impact of the COVID-19 pandemic on the prevalence and persistence of white spot lesions (WSLs) among patients treated with traditional braces.MethodsA group of 434 consecutively finished cases who had pretreatment and post-treatment digital photographs taken were included in this study. Each set of photographs was evaluated by two investigators to determine prepandemic and postlockdown WSLs, in addition to changes in oral hygiene (OH) and other risk factors.ResultsThere was a statistically significant difference in the development of WSLs pre–COVID-19 lockdown (PRL) versus post–COVID-19 lockdown (POL) (P < 0.001). The overall prevalence for the development of WSLs increased to 52.8% POL. For patients with good pretreatment OH, the risk of developing WSLs POL (42.0%) was two times greater than the rate in PRL (20.1%). For patients whose OH worsened during treatment, 81.2% of POL patients developed WSL compared with 69.6% of PRL patients. The incidence of WSLs was statistically greater in the maxillary anterior region POL than PRL, whereas the incidence in the mandibular anterior region did not reach statistical significance. The distribution of WSLs was greater POL for each tooth irrespective of the arch.ConclusionsBecause of the COVID-19 pandemic, the prevalence of visible WSLs increased from 29.5% to 52.8%. Patients whose hygiene worsened during orthodontic treatment are at an increased risk of developing WSLs.

Management of white spot lesions induced during orthodontic treatment with multibracket appliance: a national-based survey

ObjectivesThe study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence.Materials and methodsThe survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05).ResultsA prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents’ assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL.ConclusionsWSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT.Clinical relevance.The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications.

Prevalence of white spot lesions during clear aligner therapy: a systematic review

Abstract Objectives: To determine if an association exists between the prevalence of white spot lesions (WSLs) and orthodontic treatment using clear aligners. Methods: Electronic databases were searched with no restrictions on year. Article selection criteria included human clear aligner studies conducted during the permanent dentition and with a full description of the applied technique and oral hygiene status. Results: The search strategy resulted in a total of 4177 articles. After title and abstract screening, 156 relevant articles were identified from which five remained after the application of the exclusion criteria. The articles were mostly classified as having a low risk of bias. Conclusions: Clear aligner therapy induces a lower development rate of new WSLs than orthodontic treatment by fixed appliances. In patients who have poor oral hygiene and/or existing WSLs, clear aligner treatment could be recommended.

Evaluation of the preventive effect of two concentrations of xylitol varnish versus fluoride varnish on enamel demineralization around orthodontic brackets: a randomized controlled trial.

The highly prevalent white spot lesions around orthodontic brackets necessitate introducing preventive materials without relying on patient compliance. To evaluate the antidemineralizing effect of two concentrations of xylitol varnish. Triple-blind, four-arm, parallel-group, single-center, randomized controlled clinical trial. A total of 120 orthodontic patients were randomly assigned to four groups (n = 30), using a computer-generated randomized block list. The treatment groups were: 10% xylitol, 20% xylitol, 5% fluoride, and placebo. Tooth demineralization was measured with DIAGNOdent at T1 (before treatment), followed by varnish application. At T2 (third month), the varnish was re-applied, and at the third (T2) and sixth (T3) months, and after treatment (T4), the demineralization was measured. The white spot lesion frequency was assessed visually after treatment. The participants, the clinician, and data assessors were all blinded to group assignments. A total of 115 patients underwent per-protocol analyses. At T2, the mean DIAGNOdent numbers in the fluoride and 10% xylitol groups were significantly lower than the placebo group (P = 0.00), with a mean difference of 0.63 (95% CI, 0.15-1.10) and 0.5 (95% CI, 0.04-0.95), respectively. At T3, the fluoride and 10% xylitol groups had significantly lower mineral loss than the placebo group (P=0.046) with a mean difference of 0.52 (95% CI, 0.14-0.89) in the fluoride and 0.45 (95% CI, 0.03-0.86) in the 10% xylitol groups, respectively. However, at T4, only the mean for the 10% xylitol group was significantly different (P=0.049) from the placebo group, with a mean difference of 1.18 (95% CI, 0.42-1.93). Visual assessment showed that after treatment, the prevalence of white spot lesions in the fluoride (P=0.03) and 10% xylitol (P=0.00) groups was less than the placebo group with the odds ratio of 0.67 (95% CI, 0.46-0.96) and 0.43 (95% CI, 0.28-0.64), respectively. The 10% xylitol varnish short-term effects on caries control were significantly greater than 20% xylitol varnish and placebo but similar to fluoride varnish. However, the 10% xylitol long-term effect was almost better than fluoride varnish. The protocol was registered at IRCT.ir under the code IRCT20180913041032N1.

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

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.

Prevalence of White Spot Lesions in Patients Treated with Fixed Orthodontic Appliances

Prevalence of White Spot Lesions in Patients Treated with Fixed Orthodontic Appliances

White spots on tooth enamel in mixed dentition

Aim: To determine the prevalence, etiological factors of white spots on enamel and to evaluate the treatment by microabrasion technique in schoolchildren. Method: A study was developed in children between the ages of 6 and 12 of both genders, enrolled in 3 municipal public schools. Oral examination of the children was carried out, and for those children in whom white spot lesions were found, dental treatment was provided by the microabrasion technique in the incisors and/ or first permanent molars to prevent the evolution to a caries lesion with cavitation, since the enamel structure was damaged. Results: The most affected age was 10 years with 27.8% (n = 5). In relation to the enamel surface area affected by white patches, the majority had 1% - 24% of the enamel reached. The possible etiological factors of white patches were systemic infections, trauma or caries with pulp involvement in a deciduous tooth. The treatment was effective in 16 children and for the remaining two the restorative treatment was performed. Conclusion: The prevalence of white spot lesions found in enamel was 3.95%, with a higher prevalence in females. The permanent right upper central incisor was the most affected. The treatment proved to be effective in most children possibly because the lesion is located more superficially in the enamel.KeywordsDental enamel; Enamel hypoplasia; Tooth demineralization; Enamel microabrasion.

The lingual enamel morphology and bracket shear bond strength influenced by Nd:YAG laser and aluminum oxide sandblasting preconditioning.

This study aimed to investigate the influence of Nd:YAG laser and aluminum oxide sandblasting on the shear bond strength (SBS) of lingual brackets and to optically analyze the behavior of the enamel morphology. Thirty-five bovines' incisors teeth were divided into 5 groups (n = 7), according to the surface preconditioning: G1, control group; G2, Nd:YAG laser; G3, laser + aluminum oxide sandblasting (Al2O3); G4, Al2O3; and G5, Al2O3 + laser. All groups had lingual brackets bonded and shear debonded after 72 h. SBS values were analyzed, and the enamel morphology was evaluated by optical coherence tomography (OCT) and scanning electron microscope (SEM), before and after preconditioning surface. The optical attenuation coefficient (α) analysis was obtained from OCT images. Data analysis used the ANOVA test, followed by post hoc Tukey, Kruskal Wallis, and post hoc Dunn tests (significance of 5%). The SBS values presented similarly among groups, but the value of α showed statistical difference (p-value = 0.0124) between G3 and G5 with the others. Optical analyses indicated a melting on the enamel that suffered laser irradiation for G2 and G5 and crystal surface disorganization for G4. Sandblasting partially removes the melting of the laser effect (G3). The sandblasting is a dispensable step for bonding lingual brackets, and the melting of the enamel after laser irradiation does not compromise the bracket adhesive resistance. The Nd:YAG laser became an interesting tool to prevent caries and decrease prevalence of white spot lesions in orthodontic treatments, without systemic effects in patients with genetic high risks of caries.

Prevalence of White Spot Lesions in 3-year-old Children Visiting a Private Dental College: An Observational Study

Prevalence of White Spot Lesions in 3-year-old Children Visiting a Private Dental College: An Observational Study

The Prevalence of White Spot Lesions During Orthodontic Treatment With Fixed Appliances

The Prevalence of White Spot Lesions During Orthodontic Treatment With Fixed Appliances

Prevalence of White Spot Lesion during Orthodontic Treatment with Fixed Appliance

Background: White spot lesions (enamel demineralization) is one of the most common and a significant risk associated with orthodontic treatment.&#x0D; Objective: To determine the prevalence of white spot lesion during fixed orthodontic treatment.&#x0D; 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.&#x0D; 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% &amp; 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.&#x0D; 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.&#x0D; Update Dent. Coll. j: 2019; 9 (2): 40-42

Clinical and Salivary Findings in Patients with Metal and Crystalline Conventional and Self-Ligating Orthodontic Brackets.

AimData regarding different types of orthodontic brackets and ligation and various clinical and salivary findings are scarce. Therefore, the aim of this study was to compare clinical and salivary findings in patients with different types of fixed orthodontic appliances.Subjects and methodsDecayed, missing and filled teeth index (DMFT) and plaque index, salivary flow rate, salivary pH and prevalence of white spot lesions were determined in 83 patients with different types of orthodontic brackets and ligation (metal passive self-ligating brackets, conventional metal brackets, mono-crystal brackets and polycrystalline active self-ligating brackets), before and six months after the beginning of fixed orthodontic treatment. The patients were recruited in a private dental office, in the period of two years. The group comprised 83 patients (mean age: 15.14 ± 1.66 years), including 52 women (mean age: 15.08 ± 1.68) and 31 men (15.24 ± 1.64). Statistical analysis was performed by use of dependent and independent samples t-test as well as one way ANOVA, Wilcoxon signed rank test and the Kruskal Wallis test. P-values below 0.05 (p<0.05) were considered significant.ResultsDMFT and salivary flow have shown a significant increase, while salivary pH has shown a significant decrease in the observed time interval, in all patients irrespective of type of brackets and ligation. Among patients with different bracket material, no significant differences were found in any of the observed parameters.ConclusionAlthough salivary flow rate is increased in patients with fixed orthodontic appliances which can have caries-protective effect, DMFT also increases and salivary pH decreases six months after the beginning of the treatment independently of bracket material or ligation type. All patients should receive instructions for precise oral hygiene and dietary habits before the beginning of fixed orthodontic therapy and at every dental check-up.

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

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. 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. 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). 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.

White spot lesions in orthodontic patients: An expert opinion

Formation of white spot lesions (WSLs) has remained a common occurrence during fixed orthodontic treatments, particularly in patients with poor oral hygiene. Such lesions, if not addressed, may progress to caries, thereby leading to poor aesthetics and patient dissatisfaction. Given the complexities and the alarming rise in the prevalence of WSLs in orthodontic patients, there is a need to develop a set of recommendations based on the Indian scenario to address unmet patient needs in managing WSLs. This paper is an outcome of expert group discussion convened with the primary objective to discuss the knowledge–practice gaps in the field of orthodontics, to understand the prevailing clinical practice patterns in managing WSLs in Indian settings, and to facilitate information exchange among subject matter experts. In brief, patient education and motivation regarding the importance of maintaining good dietary compliance and excellent oral hygiene are the cornerstones for the prevention and management of WSLs. Moreover, identification and management of various risk factors could prove beneficial. Noninvasive treatment of early or active WSLs by means of remineralizing agents could ensure better prognosis and could help prevent WSL progression.

A Survey of Pediatric Dentists on the Treatment Timing and Modalities for White Spot Lesions in the United States.

The purpose of this study was to estimate the prevalence of white spot lesions (WSLs) in various practice settings and patient populations, and to gather information about the treatment timing and modalities used by pediatric dentists in the United States. A fourteen question, multiple choice, electronic survey was developed and distributed to 6,092 active American Academy of Pediatric Dentistry (AAPD) members. A total of 625 active members responded, garnering a 9.7% response rate. Before treatment, there were significantly more WSLs reported in Corporate practice than Multi-Doctor Practice (P=0.002), and significantly more WSLs in Academics/Hospital-Based Practices than in Multi-Doctor Practices (P=0.002). For WSLs after treatment, there were significantly more WSLs in Academic/Hospital-Based practices than in single-practitioner settings (P=0.003). Approximately 38% of pediatric dentists preferred to treat WSLs before, during or after orthodontic treatment, while 23% treat only before and 20% treat only after treatment. The three most common treatment modalities for WSLs, were prescription fluoride toothpaste (5000 ppm), fluoride varnish, and fluoride rinse. Approximately 47% of respondents reported they were "very comfortable" treating WSLs and 31.0% felt "comfortable." The prevalence of WSLs differed across types of practice. There is no agreement among pediatric dentist as to timing and treatment modalities for WSLs.