Management of white spot lesions induced during orthodontic treatment with multibracket appliance: a national-based survey

Abstract

Objectives The study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence. Materials and methods The survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05). Results A prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents’ assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL. Conclusions WSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT. Clinical relevance. The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications.

Evaluation of Information Reliability and Quality of Youtube™ Videos About White Spot Lesions

“…Fixed orthodontic treatments are frequently applied with the effect of increasing aesthetic concerns. 22 White spot lesions (WSLs) are a common side effect seen in fixed orthodontic treatments due to co-factors, such as a long treatment process, inadequate oral hygiene, and failure to change eating and drinking habits. 23 Demineralization occurs in the enamel under the influence of acidogenic bacteria in the dental plaque, and WSLs can be formed as a result of the dissolution of the hydroxyapatite crystals.…”

“…23 Demineralization occurs in the enamel under the influence of acidogenic bacteria in the dental plaque, and WSLs can be formed as a result of the dissolution of the hydroxyapatite crystals. 22 WSL is noticed by the patient when the WSL areas appear more opaque due to the difference in light reflection properties between the lesion area and the adjacent healthy enamel tissue. 24 After debonding process, although some spontaneous regression can be seen in WSLs with brushing and hygiene habits, some WSLs may not improve easily depending on the severity of the lesion and may affect the patient's satisfaction with the tooth appearance.…”

Demineralisationsprophylaxe bei festsitzenden kieferorthopädischen Apparaturen

“…Dazu gehört der häufige Konsum von zuckerhaltigen Nahrungsmitteln oder Getränken. Daher erstaunt es, dass laut einer aktuellen Fragebogenstudie unter deutschen Kieferorthopäden nur 53% der Teilnehmer immer oder meistens Ernährungsempfehlungen vor MB-Therapie geben 7 . Zu beachten ist auch, dass Jugendliche ein höheres Risiko für die Entstehung von WSL haben als Erwachsene 6 .…”

“…Hierfür werden fließfähige Kompositmaterialien verwendet. Die Glattflächenversiegelung kann dabei vor oder nach dem Kleben der Brackets aufgetragen werden 7 . Um die Zahnhartsubstanz zu schützen, muss die Materialschicht intakt sein.…”

Interventions Prior and During the Orthodontic Treatment for Orthodontically Induced White Spot Lesions

“…Some of the studies have focused on the bonding 167 of brackets to the tooth surface [6,7], some described the differences between the buccal and lingual brackets, their impact to caries development [8]. However, the prevention of orthodontically induced tooth demineralization using topical agents in the form of rinses, varnishes or gels remains the easiest and most accessible way for the patients to avoid white spot lesions [9]. Interventions applied prior and during orthodontic treatment might prevent cavitation and subsequent invasive procedures.…”