Is it possible to completely eliminate new white spot lesions during orthodontic treatment?

Urszula Kozak

Abstract


Introduction: Orthodontists prevent and treat dental, occlusal, and facial abnormalities and improve aesthetics. Despite this, orthodontists continue to struggle with the persistent problem of impaired oral hygiene during orthodontic treatment. Although patient awareness is growing, new white spot lesions (WSLs) after the insertion of fixed appliances are still observed. The aim of the study was to evaluate the relationship between oral hygiene status and the development of new WSLs in orthodontically treated teenagers undergoing a regular oral hygiene regimen and motivation.
Materials and methods: A group of 144 teenagers aged 12–18 years was examined. Participants were divided into 2 groups – orthodontically treated and control. Oral hygiene status, based on the approximal plaque index (API), and the number of WSLs were measured at 3 time points: baseline (0), 1 month from baseline (1), and 6 months from baseline (2).
Results: The API values in the group treated with fixed appliances increased over time, indicating that the oral hygiene of orthodontic patients deteriorated over time. The distribution of the API after 6 months differed significantly between the group with new decalcifications and the group without new decalcifications (p < 0.05).
Conclusions: Despite intense oral hygiene instructions, motivation, and fluoride prevention, there remains a group of patients with disturbed oral hygiene that significantly influences the development of new WSLs after 6 months of fixed appliance therapy. There is a need for intense oral hygiene education and motivation in early childhood to develop proper oral hygiene habits for a lifetime, as a 6-month period proved to be insufficient for some patients.

Keywords


caries; fixed appliances; oral hygiene; orthodontic treatment; white spot lesions; WSL prevention

Full Text:

PDF

References


Kilian M, Chapple ILC, Hannig M, Marsh PD, Meuric V, Pedersen AML, et al. The oral microbiome – an update for oral healthcare professionals. Br Dent J 2016;221(10):657-66. doi: 10.1038/sj.bdj.2016.865.

Lin D, Yang L, Wen L, Lu H, Chen Q, Wang Z. Crosstalk between the oral microbiota, mucosal immunity, and the epithelial barrier regulates oral mucosal disease pathogenesis. Mucosal Immunol 2021;14(6):1247-58. doi: 10.1038/s41385-021-00413-7.

Chimenos-Küstner E, Giovannoni ML, Schemel-Suárez M. Dysbiosis as a determinant factor of systemic and oral pathology: importance of microbiome. Med Clin (Barc) 2017;149(7):305-9. doi: 10.1016/j.medcli.2017.05.036.

Zaura E, ten Cate JM. Towards understanding oral health. Caries Res 2015;49 Suppl 1:55-61. doi: 10.1159/000377733.

Marsh PD, Head DA, Devine DA. Prospects of oral disease control in the future – an opinion. J Oral Microbiol 2014;6:26176. doi: 10.3402/jom.v6.26176.

Wu J, Peters BA, Dominianni C, Zhang Y, Pei Z, Yang L, et al. Cigarette smoking and the oral microbiome in a large study of American adults. ISME J 2016;10(10):2435-46.

Uzuner FD, Kaygisiz E, Cankaya ZT. Effect of the bracket types on microbial colonization and periodontal status. Angle Orthod 2014;84(6):1062-7. doi: 10.2319/111813-844.1.

Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod 2011;81(2):206-10.

Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics. J Esthet Restor Dent 2013;25(2):85-95.

Fontana M. Enhancing fluoride: Clinical human studies of alternatives or boosters for caries management. Caries Res 2016;50 Suppl 1:22-37.

Bishara SE, Ostby AW. White spot lesions: Formation, prevention, and treatment. Semin Orthod 2008;14(3):174-82.

Julien KC, Buschang PH, Campbell PM. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod 2013;83(4):641-7.

Sangamesh B, Kallury A. Iatrogenic effects of orthodontic treatment – Review on white spot lesions. Int J Sci Eng Res 2011;2:2-16.

Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2010;(1):CD007868. doi: 10.1002/14651858.CD007868.pub2.

Khoroushi M, Kachuie M. Prevention and treatment of white spot lesions in orthodontic patients. Contemp Clin Dent 2017;8(1):11-9. doi: 10.4103/ccd.ccd_216_17.

Mylonopoulou IM, Pepelassi E, Madianos P, Halazonetis DJ. A randomized, 3-month, parallel-group clinical trial to compare the efficacy of electric 3-dimensional toothbrushes vs manual toothbrushes in maintaining oral health in patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2021;160(5):648-58. doi: 10.1016/j.ajodo.2021.02.016.

Rigau-Gay MM, Claver-Garrido E, Benet M, Lusilla-Palacios P, Ustrell-Torrent JM. Effectiveness of motivational interviewing to improve oral hygiene in orthodontic patients: A randomized controlled trial. J Health Psychol 2020;25(13-14):2362-73. doi: 10.1177/1359105318793719.

Zabokova-Bilbilova E, Popovska L, Kapusevska B, Stefanovska E. White spot lesions: prevention and management during the orthodontic treatment. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2014;35(2):161-8. doi: 10.2478/prilozi-2014-0021.

Benson PE, Pender N, Higham SM. Quantifying enamel demineralization from teeth with orthodontic brackets – a comparison of two methods. Part 2: validity. Eur J Orthod 2003;25(2):159-65. doi: 10.1093/ejo/25.2.159.

Alexander SA, Ripa LW. Effects of self-applied topical fluoride preparations in orthodontic patients. Angle Orthod 2000;70(6):424-30. doi: 10.1043/0003-3219(2000)070<0424:EOSATF>2.0.CO;2.

Blinkhorn AS, Holloway PJ, Davies TG. Combined effects of a fluoride dentifrice and mouthrinse on the incidence of dental caries. Community Dent Oral Epidemiol 1983;11(1):7-11. doi: 10.1111/j.1600-0528.1983.tb01347.x.

Chapman JA, Roberts WE, Eckert GJ, Kula KS, González-Cabezas C. Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2010;138(2):188-94. doi: 10.1016/j.ajodo.2008.10.019.

Kirschneck C, Christl JJ, Reicheneder C, Proff P. Efficacy of fluoride varnish for preventing white spot lesions and gingivitis during orthodontic treatment with fixed appliances – a prospective randomized controlled trial. Clin Oral Investig 2016;20(9):2371-8. doi: 10.1007/s00784-016-1730-6.

Vivaldi-Rodrigues G, Demito CF, Bowman SJ, Ramos AL. The effectiveness of a fluoride varnish in preventing the development of white spot lesions. World J Orthod 2006;7(2):138-44.

Benson PE, Parkin N, Dyer F, Millett DT, Furness S, Germain P. Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment. Cochrane Database Syst Rev 2013;12(12):CD003809. doi: 10.1002/14651858.CD003809.pub3.

Jenatschke F, Elsenberger E, Welte HD, Schlagenhauf U. Influence of repeated chlorhexidine varnish applications on mutans streptococci counts and caries increment in patients treated with fixed orthodontic appliances. J Orofac Orthop 2001;62(1):36-45. doi: 10.1007/pl00001917.

Madléna M, Vitalyos G, Márton S, Nagy G. Effect of chlorhexidine varnish on bacterial levels in plaque and saliva during orthodontic treatment. J Clin Dent 2000;11(2):42-6.

Ali A, Ismail H, Amin K. Effect of nanosilver mouthwash on prevention of white spot lesions in patients undergoing fixed orthodontic treatment – a randomized double-blind clinical trial. J Dent Sci 2022;17(1):249-55. doi: 10.1016/j.jds.2021.03.016.

Twetman S. Are we ready for caries prevention through bacteriotherapy? Braz Oral Res 2012;26 Suppl 1:64-70. doi: 10.1590/s1806-83242012000700010.

Parčina Amižić I, Cigić L, Gavić L, Radić M, Biočina Lukenda D, Tonkić M, et al. Antimicrobial efficacy of probiotic-containing toothpastes: an in vitro evaluation. Med Glas (Zenica) 2017;14(1):139-44. doi: 10.17392/870-16.

Fontana M, González-Cabezas C. Are we ready for definitive clinical guidelines on xylitol/polyol use? Adv Dent Res 2012;24(2):123-8.

Sengun A, Sari Z, Ramoglu SI, Malkoç S, Duran I. Evaluation of the dental plaque pH recovery effect of a xylitol lozenge on patients with fixed orthodontic appliances. Angle Orthod 2004;74(2):240-4.

Karandish M. The efficiency of laser application on the enamel surface: A systematic review. J Lasers Med Sci 2014;5(3):108-14.

Fox JL, Yu D, Otsuka M, Higuchi WI, Wong J, Powell GL. Initial dissolution rate studies on dental enamel after CO2 laser irradiation. J Dent Res 1992;71(7):1389-98.

Elaut J, Wehrbein H. The effects of argon laser curing of a resin adhesive on bracket retention and enamel decalcification: a prospective clinical trial. Eur J Orthod 2004;26(5):553-60.

Reynolds EC. Casein phosphopeptide – amorphous calcium phosphate: The scientific evidence. Adv Dent Res 2009;21(1):25-9.

Robertson MA, Kau CH, English JD, Lee RP, Powers J, Nguyen JT. MI Paste Plus to prevent demineralization in orthodontic patients: A prospective randomized controlled trial. Am J Orthod Dentofacial Orthop 2011;140(5):660-8.

He WD, Liu YZ, Xu YY, Chen D. Study on application of CPP-ACP on tooth mineralization during orthodontic treatment with fixed appliance. Shanghai Kou Qiang Yi Xue 2010;19(2):140-3.

Iijima Y, Cai F, Shen P, Walker G, Reynolds C, Reynolds EC. Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. Caries Res 2004;38(6):551-6.

Paschoal MA, Moura CM, Jeremias F, Souza JF, Bagnato VS, Giusti JS, Santos-Pinto L. Longitudinal effect of curcumin-photodynamic antimicrobial chemotherapy in adolescents during fixed orthodontic treatment: a single-blind randomized clinical trial study. Lasers Med Sci 2015;30(8):2059-65. doi: 10.1007/s10103-014-1700-7.

Olek M, Machorowska-Pieniążek A, Stós W, Kalukin J, Bartusik-Aebisher D, Aebisher D, et al. Photodynamic therapy in orthodontics: a literature review. Pharmaceutics 2021;13(5):720. doi: 10.3390/pharmaceutics13050720.

Ryu HS, Bae IH, Lee KG, Hwang HS, Lee KH, Koh JT, et al. Antibacterial effect of silver-platinum coating for orthodontic appliances. Angle Orthod 2012;82(1):151-7. doi: 10.2319/021411-111.1.

Shah AG, Shetty PC, Ramachandra CS, Bhat NS, Laxmikanth SM. In vitro assessment of photocatalytic titanium oxide surface modified stainless steel orthodontic brackets for antiadherent and antibacterial properties against Lactobacillus acidophilus. Angle Orthod 2011;81(6):1028-35.

Chun MJ, Shim E, Kho EH, Park KJ, Jung J, Kim JM, et al. Surface modification of orthodontic wires with photocatalytic titanium oxide for its antiadherent and antibacterial properties. Angle Orthod 2007;77(3):483-8.

Xia Y, Zhang FM, Xie H, Gu N. Nanoparticle-reinforced resin-based dental composites. J Dent 2008;36(6):450-5.

Yagci A, Seker ED, Demirsoy KK, Ramoglu SI. Do total or partial etching procedures effect the rate of white spot lesion formation? A single-center, randomized, controlled clinical trial. Angle Orthod 2019;89(1):16-24.

Burbank BD, Slater M, Kava A, Doyle J, McHale WA, Latta MA, et al. Ion release, fluoride charge of and adhesion of an orthodontic cement paste containing microcapsules. J Dent 2016;45:32-8.

Lazar L, Vlasa A, Beresescu L, Bud A, Lazar AP, Matei L, et al. White spot lesions (WSLs) – post-orthodontic occurrence, management and treatment alternatives: a narrative review. J Clin Med 2023;12(5):1908. doi: 10.3390/jcm12051908.

Alabdullah MM, Nabawia A, Ajaj MA, Saltaji H. Effect of fluoride-releasing resin composite in white spot lesions prevention: A single-centre, split-mouth, randomized controlled trial. Eur J Orthod 2017;39(6):634-40.

Mitchell L. An investigation into the effect of a fluoride releasing adhesive on the prevalence of enamel surface changes associated with directly bonded orthodontic attachments. Br J Orthod 1992;19(3):207-14. doi: 10.1179/bjo.19.3.207.

Caruso S, Caruso S, Pellegrino M, Skafi R, Nota A, Tecco S. A knowledge-based algorithm for automatic monitoring of orthodontic treatment: the dental monitoring system. Two cases. Sensors (Basel) 2021;21(5):1856.

Scheerman JFM, van Empelen P, van Loveren C, van Meijel B. A mobile app (WhiteTeeth) to promote good oral health behavior among dutch adolescents with fixed orthodontic appliances: intervention mapping approach. JMIR Mhealth Uhealth 2018;6(8):e163. doi: 10.2196/mhealth.9626.




DOI: https://doi.org/10.21164/pomjlifesci.1091

Copyright (c) 2025 Ursazula Kozak

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/