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| Title |
The Use of Selenium-Coating Enamel Sealants May Reduce the Incidence or Severity of Enamel Demineralization and White Spot Lesions in Patients Undergoing Fixed Orthodontic Treatment |
| Clinical Question |
In patients undergoing fixed orthodontic treatment, does the use of selenium-containing enamel sealants reduce the incidence or severity of enamel demineralization and white spot lesions? |
| Clinical Bottom Line |
For patients undergoing fixed orthodontic treatment, current in vitro evidence suggests that selenium-containing sealants and bonding materials may reduce the incidence or severity of enamel demineralization and white spot lesions. Amaechi (2021) demonstrated that selenium-based primers and sealants prevented lesion formation on extracted teeth, while Krasniqi (2020) showed that selenium-containing orthodontic materials significantly inhibited S. mutans growth, the primary bacterium responsible for initiating these lesions. Although these findings are promising, both studies were conducted under laboratory conditions and did not account for the variability of real-world oral environments. Therefore, selenium-based materials appear to have preventive potential, but high-quality in vivo clinical studies are needed to establish their efficacy and long-term benefits in orthodontic patients. |
| 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) 33748508 | Amaechi 2021 | 53 sound extracted human molars and premolars | Laboratory study | | Key results | The control group (teeth with no primer or sealant applied) had a significantly higher mean lesion depth (109.47 +/- 34.22 μm) and mineral loss (2251.07 +/- 514.26 vol%μm) compared with the other groups (p < 0.001). The only groups that developed white spot lesions were the control group and the group treated with only Leopard Light primer. The other groups, in which the teeth were treated with various primers and/or sealants, including the organoselenium-containing DenteShield™, did not develop white spot lesions. There was no difference in the absence of white spot lesions between the groups treated with selenium-based primer, sealant, or both in combination. | | #2) 31959737 | Krasniqi 2020 | Laboratory test of 2 bacterial strains: S. mutans & L. acidophilus | Laboratory study | | Key results | Fluoride-containing orthodontic materials showed the greatest antimicrobial activity, producing inhibition zones of ~ 9 +/- 2.6 mm that were significantly larger than the control (p < 0.001) and effective against both Streptococcus and Lactobacillus acidophilus. Selenium-containing materials had a moderate effect (inhibition zones of ~4 +/- 4.9 mm; p < 0.001 vs. control), being highly effective against S. mutans but showing almost no inhibition of L. acidophilus. Materials without antimicrobial agents had minimal inhibition and were not significantly different from the control (p > 0.05). | |
| Evidence Search |
(orthodontic OR "fixed appliance" OR brackets) AND ("selenium sealant" OR DenteShield OR "selenium-containing sealant") AND ("white spot lesions" OR "enamel demineralization") |
Comments on
The Evidence |
Both Amaechi (2021) and Krasniqi (2020) conducted in vitro studies that provide early evidence but have limited clinical relevance. Amaechi’s study used extracted teeth and a controlled setup to test selenium-based sealants, showing good internal validity through standardized methods but some bias risk due to a lack of blinding and materials provided by the manufacturer. Krasniqi’s study tested selenium- and fluoride-containing orthodontic materials against S. mutans and L. acidophilus, reporting significant results (F = 52.081; p < 0.001) but no mention of blinding or calibration, which could affect reliability. Both studies were well designed for lab work but cannot fully mimic real-world conditions like saliva flow and long-term wear. Amaechi noted support from SelenBio, Inc., while Krasniqi reported only departmental funding, suggesting limited financial bias. Overall, the studies show promise for selenium’s antibacterial and enamel-protective potential, but clinical trials are needed to confirm these findings. |
| Applicability |
The development of white spot lesions and enamel demineralization is a known risk of fixed orthodontic treatment. This is due to orthodontic brackets increasing the surface area available for plaque accumulation, as well as contributing to a decrease in oral pH during treatment. Preventive measures, such as the use of selenium-based primers or sealants prior to orthodontic bonding, may help reduce the incidence of white spot lesions. This approach may be particularly beneficial for patients who struggle with oral hygiene compliance or who are at high risk for dental caries. Further research is needed. |
| Specialty/Discipline |
(Orthodontics) |
| Keywords |
orthodontic, selenium-containing sealant, white spot lesions
|
| ID# |
3590 |
| Date of submission: |
10/15/2025 |
| E-mail |
misras@livemail.uthscsa.edu |
| Author |
Shreya Misra, DDS |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Shaza Abass, BDS, MS, PhD |
| Faculty mentor/Co-author e-mail |
abass@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?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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