Prevention and treatment of white spot lesions during and after fixed orthodontic treatment: A systematic literature review.

Objective: The aim of the study is to evaluate the effectiveness of fluoride and casein topical preparations in the prevention of white spot lesions during and after fixed orthodontic treatment.

Material and methods: Information search for controlled studies on humans published in the English language between 2008 and 2013 was conducted in Medline via PubMed, ScienceDirect, and Oxford University Press: Oxford journals and The Cochrane Library, as well as the Web search Google Scholar. 177 articles were reviewed; eleven clinical studies fulfilled all inclusion criteria.

Results: In the clinical studies it was concluded that high-concentration fluoride supplements are effective in reducing white spot lesions. Results of the studies showed the same usefulness of fluoride varnish, MI Paste, and usual oral hygiene using 1100 ppm of fluoride toothpaste. Effect on the prevention and treatment of white spot lesions of oral hygiene with toothpaste containing 1450 ppm of fluoride in orthodontic patients was evaluated. The positive effect of casein phosphopeptide-amorphous calcium phosphate in white spot lesions treatment was found. Otherwise in some clinical studies use of casein derivates during fixed orthodontics for white spot lesions treatment was not effective.

Conclusions: More clinical studies conducted during last five years yielded significantly positive results about the effectiveness of fluoride and caseine supplements in ameliorating white spot lesions during and after fixed orthodontic treatment. For a higher-risk patient group, additional supplements such as high-concentrated fluoride varnish, chewing sticks, or casein derivates, are required. A good oral hygiene regimen using high-fluoride toothpaste is as effective as fluoride or casein derivates in the prevention of new white spot lesions formation.