A review on preventive measures and treatment of white spot lesions in patients with fixed orthodontic appliances
Journal of Dental School, Shahid Beheshti University of Medical Sciences,
Vol. 33 No. 1 (2015),
11 March 2019
,
Page 106-117
https://doi.org/10.22037/jds.v33i1.24765
Abstract
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.
- Demineralization
- Fixed orthodontic appliances
- Fluoride
- Prevention
- White spot lesions
How to Cite
References
Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM, et al. Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Am J Orthod Dentofacial Orthop 2013; 143: 31-41.
Rogers S, Chadwick B, Treasure E. Fluoride-containing orthodontic adhesives and decalcification in patients with fixed appliances: a systematic review. Am J Orthod Dentofacial Orthop 2010; 138: 390-391.
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: 188-194.
Sudjalim TR, Woods MG, Manton DJ. Prevention of white spot lesions in orthodontic practice: a contemporary review. Aust Dent J 2006; 51: 284-289.
Liu J, Bian Z, Fan M, He H, Nie M, Fan B, Peng B, Chen Z. Typing of mutans streptococci by arbitrarily primed PCR in patients undergoing orthodontic treatment. Caries Res 2004; 38: 523- 529.
Manfred L, Covell DA, Crowe JJ, Tufekci E, Mitchell JC. A novel biomimetic orthodontic bonding agent helps prevent white spot lesions adjacent to brackets. Angle Orthod 2013; 83: 97- 103
Benson PE, Parkin N, Millett DT, Dyer FE, Vine S, Shah A. Fluorides for the prevention of white spots on teeth during fixed brace treatment. Cochrane Database Syst Rev 2004; 3: CD003809.
Guzmán-Armstrong S, Chalmers J, Warren JJ. Ask us. White spot lesions: prevention and treatment. Am J Orthod Dentofacial Orthop 2010; 138: 690-696.
Derks A, Kuijpers-Jagtman AM, Frencken JE, Van't Hof MA, Katsaros C. Caries preventive measures used in orthodontic practices: an evidence-based decision? Am J Orthod Dentofacial Orthop 2007; 132: 165-170.
Shungin D, Olsson AI, Persson M. Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment. Am J Orthod Dentofacial Orthop 2010; 138: 136.e1-8; discussion 136-137.
Chen H, Liu X, Dai J, Jiang Z, Guo T, Ding Y. Effect of remineralizing agents on white spot lesions after orthodontic treatment: a systematic review. Am J Orthod Dentofacial Orthop 2013; 143: 376-382.
Demito CF, Rodrigues GV, Ramos AL, Bowman SJ. Efficacy of a fluoride varnish in preventing white-spot lesions as measured with laser fluorescence. J Clin Orthod 2011; 45: 25-29.
Benson PE, Shah AA, Millett DT, Dyer F, Parkin N, Vine RS. Fluorides, orthodontics and demineralization: a systematic review. J Orthod 2005; 32: 102-114.
Noble J, Cassolato S, Karaikos N, Wiltshire WA. Point of care. Preventive and interceptive measures for improving and maintaining good oral hygiene and cariogenic control in orthodontic patients. J Can Dent Assoc. 2009; 75: 441-443.
Maxfield BJ, Hamdan AM, Tüfekçi E, Shroff B, Best AM, Lindauer SJ. Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists. Am J Orthod Dentofacial Orthop 2012; 141: 337-344.
Rose LF, Mealey B, Genco R. Periodontics: Medicine, Surgery and Implants. 1st Ed. USA:
St.Louis: The C.V. Mosby Publishing Co.2004; Chaps 13,16, 18: 426-472, 557-575, 589-631.
O Haris N, Garcia-Godoy F, Nielsen Nathe C. Primary oreventive dentistry. 7th Ed. New Jersey: Pearson Education Inc 2008; Chap 8, 9: 121-140, 153-155.
Alexander SA, Ripa LW. Effects of self-applied topical fluoride preparations in orthodontic patients. Angle Orthod 2000; 70: 424-430.
Baysan A, Lynch E, Ellwood R, Davies R, Petersson L, Borsboom P. Reversal of primary root caries using dentifrices containing 5,000 and 1,100 ppm fluoride. Caries Res 2001; 35: 41-46.
Bizhang M, Chun YH, Winterfeld MT, Altenburger MJ, Raab WH, Zimmer S. Effect of a 5000 ppm fluoride toothpaste and a 250 ppm fluoride mouth rinse on the demineralization of dentin surfaces. BMC Res Notes 2009; 2: 147.
Nalbantgil D, Oztoprak MO, Cakan DG, Bozkurt K, Arun T. Prevention of demineralization around orthodontic brackets using two different fluoride varnishes. Eur J Dent 2013; 7: 41-47.
Shafi I. Fluoride varnish reduces white spot lesions during orthodontic treatment. Evid Based Dent 2008; 9: 81.
Ferreira JM, Aragão AK, Rosa AD, Sampaio FC, Menezes VA. Therapeutic effect of two fluoride varnishes on white spot lesions: a randomized clinical trial. Braz Oral Res 2009; 23: 446- 451.
Alavi S, Farahi A. Effect of fluoride on friction between bracket and wire. Dent Res J (Isfahan) 2011; 8: S37-42.
Walker MP, White RJ, Kula KS. Effect of fluoride prophylactic agents on the mechanical properties of nickel-titanium-based orthodontic wires. Am J Orthod Dentofacial Orthop 2005; 127: 662-669.
Alaghemand H, Esmaeili B, Firouz P, Soltani MH, Rouhaninasab M, Nazhvani AD, Bijani A. A comparative study of preventive effect of chlorhexidine 0.12% and nano zinc oxide particles on the distraction of collagen scaffolding of the hybrid layer by two immunohistochemistry and microleakage tests. DMRJournal 2014; 2: 33-38.
Nayak PA, Nayak UA, Mythili R.Effect of Manuka honey, chlorhexidine gluconate and xylitol on the clinical levels of dental plaque. Contemp Clin Dent 2010; 1: 214-217.
Ribeiro LG, Hashizume LN, Maltz M. The effect of different formulations of chlorhexidine in reducing levels of mutans streptococci in the oral cavity: A systematic review of the literature. J Dent 2007; 35: 359-370.
Zhang Q, van Palenstein Helderman WH, van't Hof MA, Truin GJ. Chlorhexidine varnish for preventing dental caries in children, adolescents and young adults: a systematic review. Eur J Oral Sci 2006; 114: 449-455.
Mohire NC, Yadav AV. Chitosan-based polyherbal toothpaste: as novel oral hygiene product. Indian J Dent Res 2010; 21: 380-384.
Koide SS. Chitin-Chitosan: properties, benefits and risks. Nutrition research 1998; 18: 1091- 1101.
Arnaud TM, de Barros Neto B, Diniz FB. Chitosan effect on dental enamel de-remineralization: an in vitro evaluation. J Dent 2010; 38: 848-852.
Pannuti CM, Mattos JP, Ranoya PN, Jesus AM, Lotufo RF, Romito GA. Clinical effect of a herbal dentifrice on the control of plaque and gingivitis: a double blind study. Pesqui Odontol Bras 2003; 17: 314-318.
Uysal T, Akkurt MD, Amasyali M, Ozcan S, Yagci A, Basak F, et al. Does a chitosan-containing dentifrice prevent demineralization around orthodontic brackets? Angle Orthod 2011; 81: 319- 325.
Urez A, Boynuegria D, Őzcan G, Karaduman B, Uc D, Senel S, et al. Two percent chitosan mouthwash: A microbiological and clinical coamparative study. J Dent Sci 2012; 7: 342-349.
Bergstrand F, Twetman S. A review on prevention and treatment of post-orthodontic white spot lesions - evidence-based methods and emerging technologies. Open Dent J 2011; 5: 158-162.
Trahan L. Xylitol: a review of its action on mutans streptococci and dental plaque--its clinical significance. Int Dent J 1995; 45: 77-92.
Bahador A, Lesan S, Kashi N. Effect of xylitol on cariogenic and beneficial oral streptococci: a randomized, double-blind crossover trial. Iran J Microbiol 2012; 4: 75-81.
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: 240-244.
Takahashi K, Fukazawa M, Motohira H, Ochiai K, Nishikawa H, Miyata T.A pilot study on antiplaque effects of mastic chewing gum in the oral cavity. J Periodontol. 2003; 74: 501-505.
Aksoy A, Duran N, Koksal F. In vitro and in vivo antimicrobial effects of mastic chewing gum against Streptococcus mutans and mutans streptococci. Arch Oral Biol 2006; 51: 476-481.
Aksoy A, Duran N, Toroglu S, Koksal F.Short-term effect of mastic gum on salivary concentrations of cariogenic bacteria in orthodontic patients. Angle Orthod 2007; 77: 124-128.
Biria M, Malekafzali B, Kamel V. Comparison of the effect of Xylitol gum- and mastic chewing on the remineralization rate of caries-like lesions. Journal of Dentistry, Tehran University of Medical Sciences 2009; 6: 6-10.
Goswami M, Saha S, Chaitra TR J. Latest developments in non-fluoridated remineralizing technologies. J Indian Soc Pedod Prev Dent 2012; 30: 2-6.
Ghafournia M, Haj Norooz Ali Tehrani M. Casein phosphopeptides in oral and dental health. Journal of Isfahan Dental School 2008; 4: 211.
Reynolds EC. Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: a review. Spec Care Dentist 1998;18: 8-16.
Mayne RJ, Cochrane NJ, Cai F, Woods MG, Reynolds EC. In-vitro study of the effect of casein phosphopeptide amorphous calcium fluoride phosphate on iatrogenic damage to enamel during orthodontic adhesive removal. Am J Orthod Dentofacial Orthop 2011; 139: 543-551.
Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM, et al. Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Am J Orthod Dentofacial Orthop 2013;143: 31-41.
Brown ML, Davis HB, Tufekci E, Crowe JJ, Covell DA, Mitchell JC. Ion release from a novel orthodontic resin bonding agent for the reduction and/or prevention of white spot lesions. An in vitro study. Angle Orthod 2011; 81: 1014-1020.
Yuan P, Shen X, Liu J, Hou Y, Zhu M, Huang J, et al. Effects of dentifrice containing hydroxyapatite on dentinal tubules occlusion and aqueous hexavalent chromium cations sorbtion:a preliminary study. PloS ONE 2012;7: e45283.
Huang SB, Gao SS, Cheng L, Yu HY. Combined effect of nanohydroxyapatite and Gella chinesis on remineralization of initial enamel in vitro. J Dent 2010; 38: 811-819.
Huang SB, Gao SS, Yu HY. Effect of nanohydroxyapatite concentration on remineralization of initial enamel lesion in vitro. Biomed Mater 2009; 4: 034104.
Moslemi M, Fekrazad R, Tadayon N, Ghorbani M, Torabzadeh H, Shadkar MM. Effects of ER,Cr:YSGG laser irradiation and fluoride treatment on acid resistance of the enamel. Pediatr Dent 2009; 31: 409-413.
Altinok B, Tanboga I, Peker S, Eren F, Bakkal M, Peker F.The effect of laser-activated Acidulated Phosphate Fluoride on enamel submitted to erosive solution only: an in vitro preliminary evaluation. Eur J Paediatr Dent 2011; 12: 13-16.
Hicks J, Flaitz C, Ellis R, Westerman G, Powell L. Primary tooth enamel surface topography with in vitro argon laser irradiation alone and combined fluoride and argon laser treatment: scanning electon microscopic study. Pediatr Dent 2003; 25: 491-496.
Srivastava K, Tikku T, Khanna R, Sachan K. Risk factors and management of white spot lesions in orthodontics. J Orthod Sci 2013; 2: 43-49.
Blankenau RJ, Powell G, Ellis RW, Westerman GH. In vivo caries-like lesion prevention with argon laser: pilot study. J Clin Laser Med Surg 1999; 17: 241-243.
Fekrazad R, Ebrahimpour L. Evaluation of acquired acid resistance of enamel surrounding orthodontic brackets irradiated by laser and fluoride application. Lasers Med Sci 2013 Apr 30. [Epub ahead of print]
Rios D, Magalhães AC, Machado MA, da Silva SM, Lizarelli Rde F, Bagnato VS, et al. In vitro evaluation of enamel erosion after Nd:YAG laser irradiation and fluoride application. Photomed Laser Surg 2009; 27: 743-747.
Anaraki SN, Serajzadeh M, Fekrazad R.Effects of laser-assisted fluoride therapy with a CO2 laser and Er, Cr:YSGG laser on enamel demineralization. Pediatr Dent 2012; 34: 92-96.
Liu Y, Hsu CY, Teo CM, Teoh SH. Potential mechanism for the laser-fluoride effect on enamel demineralization. J Dent Res 2013; 92: 71-75.
Sobral MA, Lachowski KM, de Rossi W, Braga SR, Ramalho KM. Effect of Nd:YAG laser and acidulated phosphate fluoride on bovine and human enamel submitted to erosion/abrasion or erosion only: an in vitro preliminary study. Photomed Laser Surg 2009; 27: 709-713.
Proffit WR, Fields JrHW, Sarver D M. Contemporary Orthodontics. 5th Ed. USA: The C.V.
Mosby Co. 2013; Chap 10: 368-369.
Shungin D, Olsson AI, Persson M. Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment. Am J Orthod Dentofacial Orthop 2010; 138: 136.e1-8; discussion 136-7.
Kobavashi LY, Ash JrMM. A clinical evaluation of an electric toothbrush used by orthodontic patients. Angle Orthod 1964; 34: 209-219.
Boyd RL, Murray P, Robertson PB. Effect of rotary electric tooth- brush versus manual toothbrush on periodontal status during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989; 96: 342-347.
Robinson PG, Deacon SA, Deery C, Heanue M, Walmsley AD, Worthington HV, et al. Manual versus powered tooth brushing for oral health. Cochrane Database Syst Rev 2005 Apr 18; (2):CD002281.
Heintze SD, Jost-Brinkmann PG, Loundos J. Effectiveness of three different types of electric toothbrushes compared with a manual technique in orthodontic patients. Am J Orthod Dentofacial Orthop 1996; 110: 630-638.
Erbe C, Klukowska M, Tsaknaki I, Timm H, Grender J, Wehrbein H. Efficacy of 3 toothbrush treatments on plaque removal in orthodontic patients assessed with digital plaque imaging: a randomized controlled trial. Am J Orthod Dentofacial Orthop 2013; 143: 760-766.
Al-Mulla A, Karlsson L, Kharsa S, Kjellberg H, Birkhed D. Combination of high-fluoride toothpaste and no post-brushing water rinsing on enamel demineralization using an in-situ caries model with orthodontic bands. Acta Odontol Scand 2010; 68: 323-328.
Nordström A, Birkhed D. Effect of a third application of toothpastes (1450 and 5000 ppm F), including a ‘massage'method on fluoride retention and pH drop in plaque. Acta Odontol Scand 2013; 71: 50-56.
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: 138-144.
Gontijo L, Cruz Rde A, Brandão PR. Dental enamel around fixed orthodontic appliances after fluoride varnish application. Braz Dent J 2007; 18: 49-53.
Demito CF, Vivaldi-Rodrigues G, Ramos AL, Bowman SJ. The efficacy of a fluoride varnish in reducing enamel demineralization adjacent to orthodontic brackets: an in vitro study. Orthod Craniofac Res 2004; 7: 205-210.
Ellis PE, Benson PE. Potential hazards of orthodontic treatment–what your patient should know. Dental Update 2002; 29: 492-496.
O'Reilly MM, Featherstone JD.Demineralization and remineralization around orthodontic appliances: an in vivo study. Am J Orthod Dentofacial Orthop 1987; 92: 33-40.
Ogaard B, Rølla G, Arends J, ten Cate JM. Orthodontic appliances and enamel demineralization. Part 2.Prevention and treatment of lesions. Am J Orthod Dentofacial Orthop 1988; 94: 123-128.
Geiger AM, Gorelick L, Gwinnett AJ, Griswold PG. The effect of a fluoride program on white spot formation during orthodontic treatment. Am J Orthod Dentofacial Orthop 1988; 93: 29-37.
Mattick CR, Mitchell L, Chadwick SM, Wright J. Fluoride-releasing elastomeric modules reduce decalcification: a randomized controlled trial. J Orthod 2001; 28: 217-219.
Wiltshire WA. In vitro and in vivo fluoride release from orthodontic elastomeric ligature ties. Am J Orthod Dentofacial Orthop 1999; 115: 288-292.
Banks PA, Chadwick SM, Asher-McDade C, Wright JL. Fluoride-releasing elastomerics--a prospective controlled clinical trial. Eur J Orthod 2000; 22: 401-407.
Benson PE, Shah AA, Campbell IF. Fluoridated elastomers: effect on disclosed plaque. J Orthod 2004; 31: 41-46.
Miura KK, Ito IY, Enoki C, Elias AM, Matsumoto MA. Anticariogenic effect of fluoride- releasing elastomers in orthodontic patients. Braz Oral Res 2007; 21: 228-233.
Wilczyńska-Borawska M, Rodakowska E, Lewkowski A, Baginska J, Wilczko M. Chitosan in the chewing gum, an innovative caries prevention method? Initial in vitro study. Health Med 2012; 6: 3957-3960.
Hayashi Y, Ohara N, Ganno T, Ishizaki H, Yanagiguchi K. Chitosan-containing gum chewing accelerates antibacterial effect with an increase in salivary secretion. J Dent 2007; 35: 871-874.
Chen CY, Chung YC. Antibacterial effect of water-soluble chitosan on representative dental pathogens Streptococcus mutans and Lactobacilli brevis. J Appl Oral Sci 2012; 20: 620-627.
Hayashi Y, Ohara N, Ganno T, Yamaguchi K, Ishizaki T, Nakamura T, et al. Chewing chitosan- containing gum effectively inhibits the growth of cariogenic bacteria. Arch Oral Biol 2007; 52: 290-294.
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: 140- 143.
Wu G, Liu X, Hou Y. Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images. Angle Orthod 2010; 80: 933-938.
Xiaojun D, Jing L, Xuehua G, Hong R, Youcheng Y, Zhangyu G, Sun J. Effects of CPP-ACP paste on the shear bond strength of orthodontic brackets. Angle Orthod 2009; 79: 945-950.
Walsh LJ. Contemporary technologies for remineralisation therapies: A review. International Dentistry SA 2009; 11: 6-16.
Ballard RW, Haqan JL, Phaup AN, Sarkar N, Townsend JA, Armbruster PC. Evaluation of 3 commercially available materials for resolution of white spot lesions. Am J Orthod Dentofacial Orthop 2013; 143: 78-84.
Vahid Golpayegani M, Sohrabi A, Biria M, Ansari G. Remineralization effect of topical NovaMin versus Sodium Fluoride (1.1%) on caries-like lesions in permanent teeth. J Dent (Tehran) 2012; 9: 68-75.
Sharma N, Roy S, Kakar A, Greenspan DC, Scott R. A clinical study comparing oral formulations containing 7.5% calcium sodium phosphosilicate (NovaMin), 5% potassium nitrate, and 0.4% stannous fluoride for the management of dentin hypersensitivity. J Clin Dent 2010; 21: 88-92.
Wefel JS. NovaMin: likely clinical success. Adv Dent Res 2009; 21: 40-43.
Tai BJ, Bian Z, Jiang H, Greenspan DC, Zhong J, Clark AE, Du MQ. Anti-gingivitis effect of a dentifrice containing bioactive glass (Novamin) particulate. J Clin Periodontol 2006; 33: 86-91.
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