Enamel Demineralization during Fixed Orthodontic Treatment - Incidence and Correlation to Various Oral-hygiene Parameters.

OBJECTIVE

To investigate the incidence of white spot lesions (WSLs) around brackets and molar bands during orthodontic therapy, and establish whether a correlation to indices of dental and gingival health, fluoride application and oral hygiene could be demonstrated.

PATIENTS AND

METHODS

Fifty-three patients with fixed orthodontic appliances were included at random in this study at the Department of Orthodontics of Erlangen-Nuremberg University. Dental health (DMFS), plaque index, papillary bleeding index, sulcus probing depth (SPD), gingival recession (GR), clinical attachment level (as sum of SPD and GR), oral hygiene, and fluoride use were evaluated. WSLs were graded from intraoral photographs taken before and after treatment.

RESULTS

97.5% of teeth before and 73.6% after treatment were free of WSLs. Of all teeth, 24.9% developed new WSLs or a rise in their number. New or more numerous WSLs were more common in upper and lower premolars (34.4%) and front teeth (28.1%) than molars (11.8%). WSL incidence during therapy correlated with clinical attachment level, and the oral hygiene and fluoride-use scores.

CONCLUSIONS

Despite improvements in materials and preventive efforts, orthodontic treatment continues to carry the considerable risk of enamel demineralization. Each patient's prophylactic efforts, including fluoride use, are of paramount importance in preventing WSLs.