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Title White Spot Lesions Due to Orthodontic Treatment
Clinical Question In patients with a previous treatment involving fixed orthodontic appliances, is there an increased risk of white spot lesions compared to patients with no history of orthodontic treatment?
Clinical Bottom Line Fixed orthodontic appliances such as orthodontic brackets and bands greatly increase the risk of developing white spots lesions due to increased plaque retention. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 2816842Ogaard/198951 orthodontically-treated (23 M, 28 F) and 47 non-treated (28 M, 19 F) 19-year-oldsCase-Control Study
Key resultsWhile it seems that orthodontic therapy does not cause cavitated carious lesions, there were significantly more white spot lesions on the facial surfaces of teeth in patients receiving orthodontic therapy with brackets and bands, even 5 years post-treatment. Only 4% of patients who received orthodontic therapy presented with no white spot lesions, compared to 15% of untreated subjects. While the majority of subjects in both groups had at least one white spot lesion, the number of teeth with a white spot lesion in the orthodontically-treated patients was significantly greater – the majority of non-treated patients presented with less than 4 surface lesions while the majority of treated patients presented with 4-10 white spots (p < 0.01). In addition, some teeth were more susceptible to white spot lesions than others (first molars, max lateral incisors, man canines and premolars), with over 25% of these teeth presenting with white spots in treated patients.
Evidence Search #25 Search ("Orthodontics"[Mesh]) AND "Dental Caries"[Mesh] Limits: Meta-Analysis, Randomized Controlled Trial, Review 21:44:00 163 #20 Search ("Tooth Demineralization"[Mesh]) AND "Orthodontic Brackets"[Mesh] Limits: Meta-Analysis, Randomized Controlled Trial, Review 21:38:07 55
Comments on
The Evidence
This was a case-control (retrospective) study comparing the incidence of carious lesions in patients with a history of orthodontic treatment with that of untreated patients. The two subject groups were not evaluated for the incidence of carious lesions before treatment. All subjects chosen for study were evaluated (>80% completion rate) and treated the same; however, the article does not mention if researchers were blinded to orthodontic treatment history. Recall bias and competing interests on the part of the PI seem unlikely.
Applicability This evidence is applicable to the PICO question and gives a good idea of what the patient can expect from orthodontic treatment in terms of both the structural integrity of treated enamel surfaces as well as esthetic concerns with the white spot lesions. The results present special importance to patients with oral hygiene concerns, since clinicians may be inclined to delay orthodontic treatment until good hygiene habits have been established.
Specialty/Discipline (Orthodontics) (Dental Hygiene)
Keywords White spot lesions, orthodontics, brackets, bands
ID# 810
Date of submission: 03/24/2011spacer
E-mail reyesrn@livemail.uthscsa.edu
Author Ryan Noel Reyes
Co-author(s) e-mail
Faculty mentor/Co-author Peter T. Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail GAKUNGA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
Comments and Evidence-Based Updates on the CAT
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by Teresa Nguyen, Abdulaziz A. Alblaihess (San Antonio, TX & Riyadh) on 06/25/2014
A PubMed search on this topic was completed on June 2014 and found a more recent publication: Richter 2011 (PMID 21536209). This case series study conducted on 350 orthodontic patients support the conclusion that orthodontic treatment is associated with increased white spot lesions. However, Richter et al also notes a negative correlation between the number of new white spot lesions and the frequency of oral hygiene discussions given. This suggests that poor oral hygiene instructions may be a contributing factor.

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