MALOCCLUSION SEVERITY AND ENAMEL DECALCIFICATION RELATIONSHIPS IN FIXED ORTHODONTIC TREATMENT

Abstract

Objectives: Orthodontic patients treated with traditional metal braces exhibit an increased risk of forming enamel decalcifications known as white spot lesions (WSLs) on facial surfaces of teeth. This is due to the increased surface area around which plaque can adhere with brackets bonded. It is not currently known whether malocclusion complexity contributes to WSL formation. The Salzmann Index (SI) is a set of criteria that quantifies malocclusion complexity. In Pennsylvania, it is used in patients under 21 years to determine eligibility for orthodontic Medicaid insurance coverage. This study aims to determine if SI score impacts the incidence of WSLs among patients treated with traditional braces. Methods: 200 subjects between 10-18 years who completed >12 months of orthodontic treatment with metal braces were compared for SI scores and oral hygiene (OH). Pre-treatment OH was obtained from clinical exam forms. Pre- and post- intraoral photos of facial surfaces of upper and lower anterior dentition segments were analyzed. Presence and severity of WSLs, and mid- and post-treatment OH were determined by amount of tooth surface with lesion involvement, and localized vs. generalized gingival swelling, redness, and plaque, respectively. Hygiene and WSL’s were scored on 3-point scales. Statistical analysis was performed for each variable using R2 values. Results: There was a significant difference in WSLs pre- versus post-treatment (p<0.001). Higher SI score, average overall OH, and pre-treatment WSLs were all significant predictors of post-treatment WSLs (p=.007, p=.014, p=.000, respectively). Salzmann Index score and OH showed moderate level correlation to WSLs (R2=0.22 for both), while pre-treatment WSLs showed low level correlation (R2=0.07). Duration of treatment was not a significant predictor of post-treatment WSLs (p=.654). Conclusion: Findings suggest that patients with higher SI scores may be advised on greater predilection to WSL development regardless of treatment duration. Those with poor pre-treatment OH may benefit from greater reinforcement and monitoring of OH. Placement of orthodontic sealants on facial tooth surfaces prior to bonding fixed appliances should be considered to increase prevention of WSLs.