Management of White Spot Lesions

Abstract

It has been reported that white spot lesions (WSLs) can be seen as a result of prolonged plaque accumulation on the affected surface of the teeth. They are more often associated with fixed orthodontic treatment and defined as "the presence of clinically detectable, localized areas of enamel demineralization." These lesions are managed in the first step by establishing a good oral hygiene to enhance remineralization, and prophylaxis with products mostly containing fluoride, calcium, or phosphate. The aim of this chapter is to outline the risk factors and preventive measures of WSLs, and the currently used methods to manage it based on the latest evidence.A review of the literature has shown that WSLs develop as a result of prolonged "undisturbed" plaque accumulation on the affected teeth surface, commonly due to inadequate oral hygiene [4][5][6][7][8][9]. Under these conditions, acids diffuse into the enamel and the demineralization continues in the subsurface enamel, then the intact enamel surface collapses and becomes cavitated [10]. It has been shown that these lesions can appear within 4 weeks [11].The concept of caries process was explained with a model; it was initiated by fluctuations in pH caused by the bacteria that are always metabolically active in the biofilm or dental plaque. These fluctuations may cause erratic loss and gain of mineral ("demineralization" and "remineralization") [12]. As a total result of these continuous demineralization and remineralization processes of enamel that occur episodically based on the presence of cariogenic bacteria in dental plaque and the availability of refined carbohydrates for fermentation to organic acids [13], dissolution of the dental hard tissues develops and a caries lesion forms [14].In the first stage of the enamel defect there is a lower mineral distribution and also a lower interprismatic mineral content in the surface layer [15]. It has been proposed that further dissolution of the outer 10-30 microns of enamel is prevented relatively by several metabolic formations. The protective roles of salivary proline-rich proteins and other salivary inhibitors like statherin have also been emphasized [16]. But they cannot penetrate the deeper parts of the enamel due to their macromolecule structures; so their stabilizing role is limited for the surface enamel [17]. The white-spot lesion's shape is determined by the distribution pattern of the biofilm and the direction of the enamel prisms [18].The presence of fixed orthodontic appliances causes an increasing number of plue retention sites as a result of the presence of brackets, bands, wires, and other applications, which makes the cleaning of teeth more difficult [4,5,7,9,10,[19][20][21][22].When the orthodontic bands are removed and the feasibility of tooth cleaning is provided, it results a reduced porosity of the deeper parts of lesions (Figure 1). The return of fluids to supersaturation condition causes a shift in equilibrium and reprecipitation of minerals at the sites of demineralization. As a result of this...

Evaluation of the remineralizing effect of biomimetic self-assembling peptides in post-orthodontic white spot lesions compared to fluoride-based delivery systems: randomized controlled trial

“…However, the most significant disadvantage of this device is that it can produce false-positive results when plaque and calculus are present. So it is critical to clean the tooth surface before using DIAGNOdent [ 24 ].…”

THE EFFECT OF MISWAK & ITS PROTOCOL OF PLACEMENT, ON THE STRUCTURE, MINERAL CONTENT OF CHEMICAL AND LASER ASSISTED BLEACHED WHITE SPOT

“…Break for the nasty restoration sequence and escape cavity formation (17) White spot lesions (WSLs), described as "white dullness," happen because of subsurface enamel mineral loss that is positioned on smooth external of teeth. The reason of its dull look is the deviations in light dashing that change the visual assets of the demineralized enamel (18) Currently bleaching is an informal, traditional technique to increase beautiful look in comparison with other processes such as plating or capping (19) . It should be considered that the bleaching manner only improves the beautiful look with a hide effect on WSLs and does not treat the lesion (1) Whitening of living teeth can be commonly fragmented into dual theories; the application of lesser concentrations of carbamide peroxide (CP) on specially constructed trays by the patient and the application of greater concentrations of hydrogen peroxide (HP) in a dental visit (20) .…”

Protocol for the development of a Core Outcome Set for trials on the prevention and treatment of Orthodontically induced enamel White Spot Lesions (COS-OWSL)

“…Despite the high prevalence of orthodontically induced WSLs, the methods used for detecting WSLs varied in previous research [ 13 ]. Many tools can be used to detect WSLs, including traditional visual inspection, photograph and radiograph, transillumination, and fluorescence methods [ 14 ]. For example, direct visual inspection, the simplest and most cost-effective detection method of WSLs, has been frequently adopted in routine practice, but the specific approach and criteria used in visual inspection are rarely consistent across different investigators and clinical settings [ 13 , 15 ].…”