A Review on Prevention and Treatment of Post-Orthodontic White Spot Lesions - Evidence-Based Methods and Emerging Technologies

Private Practice, Stockholm, Sweden.
The Open Dentistry Journal 09/2011; 5(1):158-62. DOI: 10.2174/1874210601105010158
Source: PubMed

ABSTRACT The aim of this paper was to update the evidence for primary and secondary prevention (treatment) of white spot lesions (WSL) adjacent to fixed orthodontic appliances.
A search for relevant human clinical trials published in English between 2004 and March 2011 retrieved 25 publications that fulfilled the inclusion criteria. The papers were assessed for prevented fraction and/or absolute risk reduction when possible.
The findings consolidated the use of topical fluorides in addition to fluoride toothpaste as the best evidence-based way to avoid WSL. The mean prevented fraction based on 6 trials was 42.5% with a range from -4% to 73%. The recent papers provided the strongest support for regular professional applications of fluoride varnish around the bracket base during the course of orthodontic treatment. For the treatment of post-orthodontic WSL, home-care applications of a remineralizing cream, based on casein phosphopeptide-stabilized amorphous calcium phosphate, as adjunct to fluoride toothpaste could be beneficial but the findings were equivocal. For emerging technologies such as sugar alcohols and probiotics, still only studies with surrogate endpoints are available. Thus, further well-designed studies with standardized regimes and endpoints are needed before guidelines on the non-fluoride technologies can be recommended.

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    ABSTRACT: Abstract Objective. To investigate the effect of daily intake of fluoridated milk on enamel demineralization adjacent to fixed orthodontic brackets assessed with quantitative light-induced fluorescence (QLF). Materials and methods. Sixty-four healthy adolescents (13-18 years) undergoing orthodontic treatment with fixed appliances were enrolled and randomly allocated to a randomized controlled trial with two parallel groups. The intervention group was instructed to drink one glass of milk (∼ 200 ml) supplemented with fluoride (5 ppm) once daily and the subjects of the control group to drink the same amount of milk without fluoride. The intervention period was 12 weeks and the end-point was mineral gain or loss in enamel, assessed by QLF on two selected sites from each individual. The attrition rate was 12.5% and 112 sites were included in the final evaluation. Results. There was no statistically significant difference between the groups concerning fluorescence (ΔF) values and lesion area (A mm(2)) at baseline. After 12 weeks, a significant decrease (p < 0.05) in ΔF was registered in the fluoridated milk group and a significant increase in the non-fluoride control group (p < 0.05). The mean reduction in the test group was somewhat lower (14%) than the increase in the control group (18%), but individual variations were evident. Only minor alterations of lesion area were recorded over the 12-week period and no statistically significant differences compared with baseline were found in any of the groups. Conclusion. Daily intake of fluoridated milk may aid remineralization of white spot lesions adjacent to fixed orthodontic appliances.
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