Prevalence of white spot lesion formation during orthodontic treatment

Abstract

Purpose: To quantify the prevalence of white spot lesions (WSLs) on the anterior teeth and, secondarily, to evaluate risk factors and predictors.

Materials and methods: Digital photographs and records of 885 randomly chosen patients were evaluated before and after treatment. Chart information included gender, age, as well as banding and debanding dates. Fluorosis and oral hygiene before and after treatment were also evaluated. Preexisting and posttreatment WSLs were recorded and compared for all 12 anterior teeth. Risk ratios (RR) and absolute risk (AR) were calculated to determine the likelihood and risk of WSL formation.

Results: Overall, 23.4% of the patients developed at least one WSL during their course of treatment. Maxillary anterior teeth were affected more than mandibular teeth. The maxillary laterals and canines and the mandibular canines were the most susceptible. There was no significant difference in WSLs between genders. Fluorosis, treatment time in excess of 36 months, poor pretreatment hygiene, hygiene changes during treatment, and preexisting WSLs were all significantly (P < .05) related to the development of WSLs. The highest risk of developing WSLs was associated with preexisting WSLs (RR = 3.40), followed by declines in oral hygiene during treatment (RR = 3.12) and poor pretreatment oral hygiene (RR = 2.83).

Conclusions: Nearly 25% of the patients developed WSLs while in treatment, depending on fluorosis, treatment time, preexisting WSLs, and oral hygiene. Orthodontists need to be mindful of these risk factors when making treatment decisions.

Figure 1.

Pretreatment photo depicting fluorosis. Fluorosis was defined as significant when it extended beyond the incisal edges and was evident on more than one tooth.

Figure 2.

(A) Pretreatment photo showing WSLs that did not change during treatment and thus were not counted (yellow arrows). (B) Posttreatment photo showing unchanged WSLs (yellow arrows) and WSLs that developed during treatment (blue arrows) and thus were counted.

Figure 3.

(A) Pretreatment photo demonstrating preexisting WSLs (yellow arrows). (B) Posttreatment photo demonstrating preexisting WSLs that worsened during treatment and thus were counted (green arrows), as well as new WSLs (blue arrows).