Fixed orthodontic appliances are commonly used in contemporary orthodontic treatment and can be associated with the development of white spot lesions on the teeth. These lesions can be detrimental to both the aesthetics and health of the teeth so prevention is better than cure and patient selection is critical. This paper discusses predictors of development in addition to methods to help prevent white spot lesions during fixed appliance therapy. Recommendations for oral hygiene regimes during fixed orthodontic appliance treatment are given, the development of white spot lesions (WSLs) described and ways to predict their occurrence identified.
Clinical Relevance: Most general dental practitioners will have patients who are considering orthodontic treatment or are wearing fixed orthodontic appliances and so are at increased risk of developing WSLs. It is therefore important they are aware of predictors and ways to prevent WSLs.
Article
Fixed appliances are the mainstay of contemporary orthodontic treatment as they allow three-dimensional control of tooth position.1 One of the risks associated with fixed appliance treatment is demineralization, which often presents as a white spot lesion (WSL).2 WSL development is disappointing for both patient and practitioner as the aesthetics and the health of the teeth are compromised. The reported prevalence of WSLs in post-orthodontic treatment patients ranges from 2–96%,3 and this considerable variation is thought to be due to difficulties in distinguishing between pre-existing WSLs, WSLs occurring during orthodontic treatment, and opaque enamel lesions caused by other factors.2
White spot lesions occur as a consequence of repeated episodes of mineral loss from the enamel into the surrounding saliva and plaque. The mineral is initially lost from the enamel surface, however, subsurface minerals serve to maintain the integrity of the surface layer, resulting in a subsurface lesion. The process is dynamic, with periods of demineralization and remineralization occurring, depending on the changing conditions of the oral environment.4 Whilst the surface layer remains intact, there is still the possibility of arrest or reversal of a lesion. However, if demineralization exceeds remineralization over a prolonged period of time, a critical point is reached where the surface layer cannot be maintained and cavitation occurs.5
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