Treatment of Orthodontic White Spots: Etiology of Orthodontic White Spot Lesions and Interventional Fluoride Varnish Treatment: A Randomized Control Trial

Abstract

Fixed orthodontic appliances harbor plaque and perpetuate the formation of early non-cavitated carious lesions. However, not all patients with poor hygiene develop them. It has been established that fluoride varnish can be used to promote enamel remineralization. The study aimed to assess the efficacy of fluoride varnish in remineralizing early non-cavitated lesions among orthodontic patients. A second goal of this study was to elucidate if BMI and obesity increased susceptibility to development of white spot lesions. A randomized control trial was conducted among 25 patients attending the Orthodontic clinic at Temple University. Patients were ages 11-18 and had fixed orthodontic appliances for a minimum of three months. Eleven were randomly assigned to a test group (Enamel Pro® Varnish fluoride varnish application to white spot lesions every two months) and 14 randomly assigned to a control group (reinforcement of oral hygiene instructions). Data collection was completed every two months over a six-month time period. White spot lesion size was measured using the International Caries Detection and Assessment System (ICDAS). Oral hygiene was assessed using Plaque Index (PI) and S. mutans levels were measured using Stripmutans plaque/salivary tests (Dentocult®). Both the control and experimental group had non-significant decreases in non-cavitated carious lesion count. The control group displayed significant increases in Stripmutans salivary scores (p0.05). PI scores decreased in the control group and increased in the experimental group (p>0.05). There was no correlation between BMI and lesion count in the control or experimental group (p>0.05). A 5% sodium fluoride varnish containing Amorphous Calcium Phosphate (Enamel Pro® Varnish) fluoride varnish application was not efficacious in reducing early non-cavitated carious lesions when compared to reinforcing oral hygiene. There is no correlation with BMI and white spot susceptibility.