Spot Lesions In Patients Research Articles

Efficacy of F-ACP-Containing Dental Mousse in the Remineralization of White Spot Lesions after Fixed Orthodontic Therapy: A Randomized Clinical Trial.

Fixed appliance (FA) therapy predisposes patients to white spot lesions (WSLs). The F-ACP complex (amorphous calcium phosphate nanoparticles enriched with carbonate and fluorine and coated with citrate) has been effective for in vitro enamel remineralization. The aim of this study was to evaluate the efficacy of the F-ACP complex in remineralizing WSLs after FA therapy. One hundred and six adolescents (aged 12-20 years) were randomized into study and control groups after FA therapy. Patients in the study group were advised to use dental mousse containing F-ACP applied within Essix retainers for six months. The presence of WSLs was recorded at baseline (T0), 3 months (T1), and 6 months (T2) according to the International Caries Detection and Assessment System (ICDAS). Visual Plaque Index (VPI) and Gingival Bleeding Index (GBI) were recorded. Among 106 study participants, 91 (52 and 39 in study and control groups, respectively) completed the study. The results showed that the ICDAS score was significantly lower (p < 0.001) in the study group than in the control group between T0 and T2. The application of mousse containing the F-ACP complex inside Essix retainers for six months is effective in remineralizing white spot lesions in patients after FA therapy without side effects.

Evaluation of surface-modified orthodontic brackets with silver nanoparticles and its influence on bacterial inhibition – An in vitro study

: Compared to other fixed orthodontic appliances, orthodontic brackets have a substantial impact on enamel demineralization. This demineralization is a result of organic acid production by various microorganisms, primarily from Streptococcus mutans and Lactobacillus acidophilus. Preventing white spot lesions and caries during orthodontic treatment presents a considerable challenge for clinicians. Silver exhibits broad-spectrum antimicrobial activity against various microorganisms, including Gram-positive and Gram-negative bacteria, certain viruses, fungi, protozoa, and antibiotic-resistant strains. As such, the purpose of this research is to investigate the antibacterial properties of orthodontic brackets coated with silver nanoparticles against Streptococcus mutans and Lactobacillus acidophilus. The study involved 80 stainless steel orthodontic brackets, which were divided into four groups, each containing 20 brackets. In each group, there were uncoated brackets serving as the control group, and the experimental group consisted of brackets coated with silver dioxide. Coating was done by physical vapor deposition with the help of RF Magnetron sputtering unit. Surface morphology and material composition was analyzed by SEM and EDS unit. Afterward, the brackets underwent microbiological tests to evaluate their antibacterial efficacy against Streptococcus mutans and Lactobacillus acidophilus.The study found that silver nanoparticle-coated stainless-steel brackets exhibited effective antibacterial properties against both Streptococcus mutans and Lactobacillus acidophilus when compared to the uncoated brackets. Silver nano particle coated SS brackets showed increased anti-bacterial effect towards S. mutans than L acidophilus.Using silver nanoparticles to coat orthodontic brackets represents an innovative and effective approach to prevent the formation of white spot lesions in patients receiving fixed orthodontic treatment. The antimicrobial properties of silver nanoparticles can combat bacteria like Streptococcus mutans and Lactobacillus acidophilus, responsible for enamel demineralization and the occurrence of white spot lesions. This advancement in bracket technology has the potential to significantly reduce the risk of enamel damage and improve overall oral health outcomes for orthodontic patients.

Microbiome and metabolome associated with white spot lesions in patients treated with clear aligners.

White spot lesions (WSLs) have long been a noteworthy complication during orthodontic treatment. Recently, an increasing number of orthodontists have found that adolescents undergoing orthodontic treatment with clear aligners are at a higher risk of developing WSLs. The oral microbiota and metabolites are considered the etiologic and regulatory factors of WSLs, but the specific impact of clear aligners on the oral microbiota and metabolites is unknown. This study investigated the differences in the salivary microbiome and metabolome between adolescents with and without WSLs treated with clear aligners. Fifty-five adolescents (aged 11-18) with Invisalign appliances, 27 with and 28 without WSLs, were included. Saliva samples were analyzed using 16S rRNA gene sequencing and ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS); the data were further integrated for Spearman correlation analysis. The relative abundances of 14 taxa, including Actinobacteria, Actinomycetales, Rothia, Micrococcaceae, Subdoligranulum, Capnocytophaga, Azospira, Olsenella, Lachnoanaerobaculum, and Abiotrophia, were significantly higher in the WSL group than in the control group. Metabolomic analysis identified 27 potential biomarkers, and most were amino acids, including proline and glycine. The metabolites were implicated in 6 metabolic pathways, including alanine, aspartate and glutamate metabolism; glycine, serine and threonine metabolism; and aminoacyl-tRNA biosynthesis. There was a correlation between the salivary microbial and metabolomic datasets, reflecting the impact of clear aligners on the metabolic activity of the oral flora. A concordant increase in the levels of Lachnoanaerobaculum, Rothia, Subdoligranulum and some amino acids had predictive value for WSL development. In summary, when adolescents undergo long-term clear aligner therapy with poor oral hygiene habits, clear aligners can disrupt the balance of the oral microecosystem and lead to oral microbiota dysbiosis, thereby increasing the risk of developing WSLs. Our findings might contribute to the understanding of the pathogenesis of WSLs and provide candidate biomarkers for the diagnosis and treatment of WSLs associated with clear aligners.

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.

Preventive Effect of Professional Fluoride Supplements on Enamel Demineralization in Patients Undergoing Fixed Orthodontic Treatment: A Systematic Review and Meta-Analysis.

The current study aimed to systematically review the randomized clinical trials assessing the preventive effect of professional fluoride interventions on enamel demineralization in patients undergoing fixed orthodontic treatment. The electronic search was performed in PubMed and Cochrane library in September 2021. No restriction was set on the publication date. Randomized clinical trials assessing the preventive effect of fluoride varnish, gel, mouthwash, and high-fluoride toothpaste on white spot lesions compared to the control group by clinical or radiographic methods in more than 10 patients were included. A total of 7 articles consisting of 1418 participants were included. In 4 articles, fluoride varnish (contained a range of 1000-50 000 ppm fluoride) was applied multiple times (4-20 times) in test groups. Their results indicated that the test groups significantly had lesser new white spot lesions or advanced white spot lesions. One study used fluoride varnish only once at the beginning of treatment and reported no significant difference in white spot lesions compared to the control group. Application of high-fluoride toothpaste as well as fluoride mouthwash, also, showed significantly lower white spot lesions. Three studies were included in the meta-analysis and revealed that the relative risk of white spot lesions was 0.64 (95% CI = 0.40 to 0.89; P < .01) in favor of fluoride varnish. Multiple applications (4-20 times) of fluoride varnish or daily use of fluoride mouthwash or high-fluoride toothpaste seem to reduce white spot lesions in patients undergoing orthodontic treatment. However, single use of fluoride varnish was not effective. Further research is needed to establish the required number of fluoride applications for the prevention of white spot lesions during orthodontic treatment.

DIAGNOdent pen quantification of the synergy of NovaMin® in fluoride toothpaste to remineralize white spot lesions in patients with fixed orthodontic appliances: A double-blind, randomized, controlled clinical trial

White spot lesions (WSLs) are a real problem in patients with fixed orthodontic appliances with inadequate hygiene and eating habits. This study aimed at evaluating the synergic effects of NovaMin in fluoride toothpaste on remineralization of WSLs in patients with fixed orthodontic appliances. In the present double-blind, randomized, controlled, parallel, clinical trial, Patients with a minimum of 1 WSL on the buccal surface of the anterior teeth and the first premolar on both arches were recruited between 12 February 2021 and 12 April 2021 at the Faculty of Dentistry of X. They were randomly divided into 2 groups, the control group receiving fluoride toothpaste (Sensodyne® Rapid Relief, England), and the study group receiving the fluoride-containing toothpaste and NovaMin (Sensodyne® Repair and Protect, England). A DIAGNOdent pen (KAVO Dental Corporation, Germany) was used to score the WSLs at baseline and then after the usage for 1 and 3months. The primary outcome measures were the difference in DIAGNOdent score in patients with fixed orthodontic appliances that used fluoride toothpaste and NovaMin/fluoride toothpaste. The secondary outcome measures were the intragroup comparison of the DIAGNOdent score in patients with fixed orthodontic appliances that used fluoride toothpaste and NovaMin/fluoride toothpaste. The type of toothpaste used was blinded for the participants, examiner, and data analyser. A sample size comprising 38 patients (19 patients in each group) was determined. In each group, statistical analysis was conducted on 18 patients. A patient in each group refused to contribute to the study. In both groups (P<0.001), the DIAGNOdent reading of the WSLs decreased significantly after 1 and at 3months, though no significant difference was found between the two groups at different intervals. Each patient had no adverse effects. In this 3-month follow-up study, NovaMin/fluoride toothpaste provided a slight improvement in WSL remineralisation, but not significant compared to fluoride toothpaste. NovaMin therefore did not have a significant synergistic effect. Both types of toothpaste can improve WSLs in orthodontic patients. IRCT20140215016582N5.

Comparative Efficacy of MI Paste Plus and Fluoride Varnish Remineralizing Agents for Preventing White Spot Lesions in Patients on Fixed Orthodontic Treatment: A Clinical Trial

Background: White spot lesions (WSLs), as the initial form of dental caries, develop due to subsurface enamel demineralization. They have a relatively high prevalence in orthodontic patients. Several materials are used to prevent WSLs, and various studies have assessed their efficacy during orthodontic treatment. Objectives: This study aimed to compare the efficacy of fluoride varnish and MI Paste Plus for preventing WSLs during orthodontic treatment. Methods: This clinical trial evaluated 60 patients in three groups of control, fluoride varnish, and MI Paste Plus for six months. The presence/absence of WSLs was clinically evaluated at baseline and two, four, and six months after the intervention using the International Caries Detection and Assessment System. The patients’ saliva pH was measured at baseline and six months after the intervention. Results: The difference in the WSLs score was significant between the MI Paste Plus and control groups (P &lt; 0.05). However, despite the slightly lower frequency of WSLs in the varnish group, the difference between the varnish and control groups was not significant (P &gt; 0.05). The MI Paste Plus group results were superior to those in the varnish group but not significantly. The saliva pH did not change significantly after the intervention compared to the baseline. Conclusions: MI Paste Plus caused a significant WSLs reduction in orthodontic patients but had no significant effect on the saliva pH.

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

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.

Effectiveness of MI Varnish in Preventing White Spot Lesions during Orthodontic Treatment -In Vivo Study

Objective: The objective was to evaluate the efficacy of MI varnish in preventing white spot lesions in patients with fixed orthodontic therapy. Method The study was performed where 100 patients undergoing orthodontics treatment were allocated randomly to 2 subgroups with differing frequencies of MI varnish application. Degree of mineralisation was measured on the vestibular surfaces of 12 teeth (6 varnish &amp; 6 unvarnished controls) Measurement were taken at 4 sites using camera EOS 750D and then subjected to statistical analysis. Results: The statistical analysis showed difference in the degree of demineralization between treated and untreated teeth, and was statistically significant in terms of time point, frequency of application or specific tooth site. Conclusion: Periodic application of MI varnish can offer some protection against white spot lesions and it is not statistically significant degree if patients have excellent oral hygiene. Additional protection is conferred by applying the product every 3 months compared with every 6 months.

Effect of nanosilver mouthwash on prevention of white spot lesions in patients undergoing fixed orthodontic treatment - a randomized double-blind clinical trial

Background/purposeThe formation of white spot lesions (WSLs) around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, marking the result of a successfully completed treatment. This double-blind, randomized clinical trial study aims to investigate the varying effects of nano-silver, chlorhexidine (CHX) or fluoride mouthwashes on WSLs. Materials and methodsDouble-blind prospective randomized clinical trial, comprised of forty-two patients with mild to moderate crowding, were recruited for this study. Randomization and allocation to trial group were carried out by computer system in college of dentistry, university of Sulaimani from January 2020 to September 2020. The patients were divided into three groups (14 per group) according to the type of mouthwash used during the treatment (nano-silver, CHX or fluoride), using block randomization. The clinical examination for the presence of WSLs was recorded through visual examination of the upper and lower anterior teeth using the International Caries Detection and Assessment System (ICDAS II) score before bonding and at 30, 90 and 180 days after bonding of the upper and lower arches. ResultsThe total number of patients was 42 (16 males and 26 females) with a mean age of 23.02 ± 3.841 (18–37) years old, distributed into three groups of 14 patients. There is significant difference in white spot lesions formation between the three groups; the mean of WSLs in nanosilver group is lower than CHX and fluoride group in 90 and 180 days of follow-up (P < 0.05). ConclusionNano-silver mouthwash is more effective than CHX and fluoride mouthwash in reducing WSLs during orthodontic treatment.

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

Effect of fluoride dentifrices on white spot lesions during orthodontic treatment: A randomized trial.

To determine the effect of Clinpro 5000, Clinpro Tooth Crème, and MI-Paste Plus on the formation of white spot lesions in patients undergoing orthodontic treatment. Three prospective groups with 40 patients undergoing orthodontic treatment in each group were evaluated (total recruitment = 120 subjects). The selected product was brushed on for 2 minutes twice daily for 4 months. Subjects were reviewed for 4 months on a monthly basis. The Enamel Decalcification Index (EDI) was used to determine the number of white spot lesions per surface at each visit. 100 subjects (35 using Clinpro 5000, 32 using Clinpro Tooth Crème, and 33 using MI Paste Plus) completed the study. The data lend strong support for Clinpro 5000 providing superior protection against enamel decalcification when compared to Clinpro Crème, and mixed support when compared to MI Paste Plus. The use of Clinpro 5000, Clinpro Crème, and MI paste Plus all have a reduction effect on white spot lesions when compared to studies reported previously. Clinpro 5000 has a marginally better effect than the two other test pastes. The results of this study can be used by clinicians when deciding the effectiveness of using fluoride dentifrice products to prevent white spot lesions in their orthodontic practice (ClinicalTrials.gov ID: NCT03440996).

Evaluation of the Efficacy of Various Topical Fluorides on Enamel Demineralization Adjacent to Orthodontic Brackets: An In Vitro Study

White spot lesions (WSLs) occur frequently after fixed orthodontic treatment. This in vitro study was undertaken to compare the efficacy of 2.26% fluoride varnish, 1.23% APF gel, 0.21% fluoride toothpaste and 0.04% sodium fluoride mouthwashes in preventing enamel demineralization around orthodontic brackets in extracted premolars. The sample for this study included 100 premolars free of caries and enamel cracks. They were divided into five groups of 20 samples each. Group 1 (FV): light-curable Fluoride varnish (Clinpro™ XT 3M ESPE, Pymble, New South Wales, Australia), group 2 (FG): 1.23% APF gel (Patterson NE. International, USA), group 3 (FTP): 0.21% w/w sodium fluoride toothpaste with tri-calcium phosphate (Clinpro™ Tooth Crème, 3M ESPE, Australia), group 4 (FMW): sodium fluoride 0.044% (w/v) mouthwash (Colgate® Phos-Flur® Ortho Defense Rinse, Colgate-Palmolive, NY) and group 5 (C): control. The samples were subjected to laboratory pH cycling. The demineralization changes in the enamel were assessed before the start of the experiment and after 14 days. There was a significant change in the mean Diagnodent score value (p <0.001) in all groups from day 1-day 14. The mean values were significantly different among groups at day 1 (p = 0.002), day 14 (p = 0.001) and also the change from Day 1 to Day 14 was significantly different among Groups (p = 0.001). The least change in the mean value from baseline to 14 days was seen in group 1 (FV) followed by group 3 (FTP), group 2 (FG), and group 4 (FMW) and then the group 5 (C). All the topical fluorides tested were able to reduce the demineralization when compared to the control group under similar testing conditions, but to varying degrees. light-curable fluoride varnish outperformed all the topical fluorides followed by 0.21% w/w dodium fluoride toothpaste with tri-calcium phosphate, 1.23% Acidulated phosphate fluoride gel and sodium fluoride 0.044% (w/v) mouthwash. The control group where no topical fluoride was applied showed the least resistance to demineralization. Within the limitations of this study, routine application of light cured fluoride varnish (Clinpro) can be recommended to prevent enamel demineralization to prevent white spot lesions in patients receiving orthodontic treatment.

Preventing and Arresting the Appearance of White Spot Lesions around the Bracket by applying Fluoride Varnish: A Systematic Review

Introduction: White spot lesions are the first clinical sign of dental caries, and they occur frequently in patients with orthodontic appliances. Currently, there are no systematic reviews that have evaluated fluoride varnish compared with other methods to prevent or arrest the development of dental caries. The aim of this systematic review (SR) was to evaluate the effectiveness of the use of fluoride varnish compared with other methods to prevent or arrest initial lesions of caries in patients with corrective orthodontics. Methods: A search was conducted for articles in the MEDLINE, EMBASE and Google Scholar databases. This SR included randomized clinical trials and prospective interventional studies that used fluoride varnish for the prevention and/or arrest of white spot lesions in orthodontic treatment or during the 3-month period after removal of orthodontic fixed appliances. To assess the risk of bias in the studies, we used the Cochrane collaboration tool. Results: The search strategy showed 115 possible eligible articles, and we included 10 articles in this SR. The reviewed studies showed high and moderate methodological quality. Four studies out of 10 agreed that fluoride varnish is as effective as the advised and guided oral hygiene technique. Overall, most of the included studies did not show significant advantages to fluoride varnish application in terms of preventing the development of white spots around orthodontic brackets when the patients were submitted to regular professional oral hygiene control. Conclusions: Fluoride varnish is an effective material to prevent and arrest white spot lesions in patients with orthodontic treatment.

Fluoride-Releasing Materials to Prevent White Spot Lesions around Orthodontic Brackets: A Systematic Review.

The relation between orthodontic fixed appliances use and enamel demineralization is well established. Different preventive approaches have been suggested to this problem, but controversy remains about which is the best. The aim of this study was to perform a systematic review of clinical trials that investigated the effectiveness of materials containing fluorides to lute brackets or cover the bonding interface in order to inhibit the development and progression of white spot lesions. The null hypothesis was that fluoride materials do not affect the incidence of white spot lesions around brackets. A MEDLINE search was conducted for randomized clinical trials evaluating the development of white spot lesions in patients using fixed orthodontic appliances, followed by meta-analysis comparing the results for patients for whom dental materials containing fluorides were used (experimental group) to those for whom these materials were not used (control group). The pooled relative risk of developing white spot lesions for the experimental group was 0.42 (95% confidence interval: 0.25 to 0.72); hence, when fluoride-releasing materials are used, the patient has 58% less risk of white spot lesion development. Regarding white spot lesion extent, the pooled mean difference between the experimental and control groups was not statistically significant (-0.12; 95% confidence interval: -0.29 to 0.04). In conclusion, the results of the present systematic review suggest that fluoride-releasing materials can reduce the risk of white spot lesions around brackets. However, when white spot lesions had already occurred, there is no evidence that fluoride-releasing materials reduce the extent of these lesions.

A review on preventive measures and treatment of white spot lesions in patients with fixed orthodontic appliances

Objective: One complication of fixed orthodontic treatment in patients with poor oral hygiene is development of demineralized enamel lesions compromising esthetics. This study aimed to review preventive measures and treatment of white spot lesions (WSLs) in patients with fixed orthodontic appliances. Review of Literature: In this review study, PubMed and Google Scholar databases were searched for articles published during 1964-2013 using the keywords “white spot lesions”, “demineralization”, “mastic gum”, “casein phosphopeptide amorphous calcium phosphate or CPP-ACP”, “chitosan” and “orthodontics”; 96 articles were evaluated. Conclusion: White spot lesions can be prevented by conventional plaque control and adjunct measures such as the use of fluoride-containing compounds, chlorhexidine (CHX), xylitol gums, chitosan compounds and laser. Low-concentration fluoride, CPP-ACP compounds and laser help remineralize these lesions. If not treated, bleaching, microabrasion and tooth restoration are the final solutions.

Clinical Survey of White Spot Lesions in Patients Treated at Asahi University Hospital Pediatric Dentistry Department

Clinical Survey of White Spot Lesions in Patients Treated at Asahi University Hospital Pediatric Dentistry Department

Factors Affecting the Formation, Severity and Location of White Spot Lesions during Orthodontic Treatment with Fixed Appliances.

ABSTRACTObjectivesThe purpose of the present study was to investigate factors affecting the formation, severity and location of white spot lesions in patients completing fixed appliance therapy.Material and MethodsA total of 45 patients (19 males and 26 females, mean age 15.81 years, standard deviation 2.89 years) attending consecutively Aberdeen Dental Hospital (ADH) between January and June 2013 to have their fixed appliances removed were given a questionnaire to elicit information regarding their dental care and diet. They were then examined clinically as well as their pre-treatment photographs to record treatment data and white spot lesion (WSL) location and severity using a modified version of Universal Visual Scale for Smooth Surfaces (UniViSS Smooth). Absolute risk (AR) and risk ratios (RR) were also calculated.ResultsThe incidence of at least one WSL observed in patients was 42%, with males displaying a higher incidence than females. The highest incidence of WSLs was recorded on the maxillary canines and lateral incisors, and on the maxillary and mandibular premolars and first molars. The gingival areas of the maxillary and mandibular teeth were the most affected surfaces. Significant (P < 0.05) relationships were found between the presence of WSLs and the following factors: poor oral hygiene (OH), males, increased treatment length, lack of use of fluoride supplements, use of carbonated soft drinks and/or fruit juices and the use of sugary foods. Poor OH posed the highest risk of developing WSL (RR = 8.55).Conclusions42% of patients have developed white spot lesions during fixed appliance therapy. Various contributing risk factors were identified with the greatest risk posed by a poor oral hygiene.

Effectiveness of Pit and Fissure Sealants in Reducing White Spot Lesions during Orthodontic Treatment

A pilot investigation was performed to test the null hypothesis that highly filled (58%) resin sealants do not prevent white spot lesions in patients undergoing active orthodontic treatment. A split-mouth design was applied to 60 healthy patients, with the sealant randomly allocated to either the right or the left side of each jaw. The sealant was applied to the incisors and canines from the gingival surface of the bracket to the free gingival margin. The contralateral teeth had the same type of bracket with no sealant. Sealants were placed on the experimental teeth 2 weeks to 3 months after initial bonding and were removed after 15 to 18 months. Intraoral photographs, visual assessments, and DIAGNOdent (KaVo Dental Corporation, Lake Zurich, Ill) measurements were used to assess white spot lesions after sealant removal. Six lesions on the teeth with sealants were identified visually, compared with 22 lesions on the teeth without sealants. The teeth without sealants had 3.8 times the number of white spot lesions than were noted on the sealed teeth. These sealants showed no visible signs of discoloration. The DIAGNOdent measured statistically significant differences between sealed and unsealed teeth in the maxilla (P < .001) and in the mandible (P = .010). DIAGNOdent measurements also showed a difference between sealed and unsealed teeth after the 28 teeth with visible lesions were excluded. The hypothesis was rejected. Ultraseal XT Plus clear sealant (Ultradent Products, South Jordon, Utah) produced a significant reduction in enamel demineralization during fixed orthodontic treatment and should be considered for use by clinicians to minimize white spot lesions.