Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Nov 17;2019(11):CD003809.
doi: 10.1002/14651858.CD003809.pub4.

Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment

Philip E Benson  1 , Nicola Parkin  1 , Fiona Dyer  1 , Declan T Millett  2 , Peter Germain  3
Affiliations
Meta-Analysis

Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment

Philip E Benson et al. Cochrane Database Syst Rev. .

Abstract

Background: Early dental decay or demineralised lesions (DLs, also known as white spot lesions) can appear on teeth during fixed orthodontic (brace) treatment. Fluoride reduces decay in susceptible individuals, including orthodontic patients. This review compared various forms of topical fluoride to prevent the development of DLs during orthodontic treatment. This is the second update of the Cochrane Review first published in 2004 and previously updated in 2013.

Objectives: The primary objective was to evaluate whether topical fluoride reduces the proportion of orthodontic patients with new DLs after fixed appliances. The secondary objectives were to examine the effectiveness of different modes of topical fluoride delivery in reducing the proportions of orthodontic patients with new DLs, as well as the severity of lesions, in terms of number, size and colour. Participant-assessed outcomes, such as perception of DLs, and oral health-related quality of life data were to be included, as would reports of adverse effects.

Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 1 February 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 1 February 2019), MEDLINE Ovid (1946 to 1 February 2019), and Embase Ovid (1980 to 1 February 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection criteria: Parallel-group, randomised controlled trials comparing the use of a fluoride-containing product versus a placebo, no treatment or a different type of fluoride treatment, in which the outcome of enamel demineralisation was assessed at the start and at the end of orthodontic treatment.

Data collection and analysis: At least two review authors independently, in duplicate, conducted risk of bias assessments and extracted data. Authors of trials were contacted to obtain missing data or to ask for clarification of aspects of trial methodology. Cochrane's statistical guidelines were followed.

Main results: This update includes 10 studies and contains data from nine studies, comparing eight interventions, involving 1798 randomised participants (1580 analysed). One report contained insufficient information and the authors have been contacted. We assessed two studies as at low risk of bias, six at unclear risk of bias, and two at high risk of bias. Two placebo (non-fluoride) controlled studies, at low risk of bias, investigated the professional application of varnish (7700 or 10,000 parts per million (ppm) fluoride (F)), every six weeks and found insufficient evidence of a difference regarding its effectiveness in preventing new DLs (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.14 to 1.93; 405 participants; low-certainty evidence). One placebo (non-fluoride) controlled study, at unclear risk of bias, provides a low level of certainty that fluoride foam (12,300 ppm F), professionally applied every two months, may reduce the incidence of new DLs (12% versus 49%) after fixed orthodontic treatment (RR 0.26, 95% CI 0.11 to 0.57; 95 participants). One study, at unclear risk of bias, also provides a low level of certainty that use of a high-concentration fluoride toothpaste (5000 ppm F) by patients may reduce the incidence of new DLs (18% versus 27%) compared with a conventional fluoride toothpaste (1450 ppm F) (RR 0.68, 95% CI 0.46 to 1.00; 380 participants). There was no evidence for a difference in the proportions of orthodontic patients with new DLs on the teeth after treatment with fixed orthodontic appliances for the following comparisons: - an amine fluoride and stannous fluoride toothpaste/mouthrinse combination versus a sodium fluoride toothpaste/mouthrinse, - an amine fluoride gel versus a non-fluoride placebo applied by participants at home once a week and by professional application every three months, - resin-modified glass ionomer cement versus light-cured composite resin for bonding orthodontic brackets, - a 250 ppm F mouthrinse versus 0 ppm F placebo mouthrinse, - the use of an intraoral fluoride-releasing glass bead device attached to the brace versus a daily fluoride mouthrinse. The last two comparisons involved studies that were assessed at high risk of bias, because a substantial number of participants were lost to follow-up. Unfortunately, although the internal validity and hence the quality of the studies has improved since the first version of the review, they have compared different interventions; therefore, the findings are only considered to provide low level of certainty, because none has been replicated by follow-up studies, in different settings, to confirm external validity. A patient-reported outcome, such as concern about the aesthetics of any DLs, was still not included as an outcome in any study. Reports of adverse effects from topical fluoride applications were rare and unlikely to be significant. One study involving fluoride-containing glass beads reported numerous breakages.

Authors' conclusions: This review found a low level of certainty that 12,300 ppm F foam applied by a professional every 6 to 8 weeks throughout fixed orthodontic treatment, might be effective in reducing the proportion of orthodontic patients with new DLs. In addition, there is a low level of certainty that the patient use of a high fluoride toothpaste (5000 ppm F) throughout orthodontic treatment, might be more effective than a conventional fluoride toothpaste. These two comparisons were based on single studies. There was insufficient evidence of a difference regarding the professional application of fluoride varnish (7700 or 10,000 ppm F). Further adequately powered, randomised controlled trials are required to increase the certainty of these findings and to determine the best means of preventing DLs in patients undergoing fixed orthodontic treatment. The most accurate means of assessing adherence with the use of fluoride products by patients and any possible adverse effects also need to be considered. Future studies should follow up participants beyond the end of orthodontic treatment to determine the effect of DLs on patient satisfaction with treatment.

PubMed Disclaimer

Conflict of interest statement

Three of the review authors (Philip Benson, Declan Millett and Fiona Dyer) were authors for one of the included studies (Benson 2019). The evaluation of this study, including data extraction and methodological quality assessments, was reviewed and confirmed by two authors not involved in this study (Nicola Parkin and Peter Germain).

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Study flow diagram.
1.1
1.1. Analysis
Comparison 1 Professionally‐applied F varnish versus non‐F (placebo) varnish, Outcome 1 Number of participants with new DLs.
1.2
1.2. Analysis
Comparison 1 Professionally‐applied F varnish versus non‐F (placebo) varnish, Outcome 2 Number of participants with more severe DLs (scores 3 or 4 versus scores 1 or 2).
2.1
2.1. Analysis
Comparison 2 12,500 ppm F (NaF/olaflur/dectaflur) gel versus 0 ppm F placebo gel, Outcome 1 Number of participants with new DLs.
3.1
3.1. Analysis
Comparison 3 12,300 ppm F APF foam versus 0 ppm F placebo foam, Outcome 1 Number of participants with new DLs.
4.1
4.1. Analysis
Comparison 4 5000 ppm F toothpaste versus 1450 ppm F toothpaste, Outcome 1 Number of participants with new DLs.
5.1
5.1. Analysis
Comparison 5 250 ppm F mouthrinse (100 ppm AmF/150 ppm NaF) versus 0 ppm F placebo mouthrinse, Outcome 1 Number of participants with new DLs.
6.1
6.1. Analysis
Comparison 6 1400 ppm/250 ppm F (AmF/SnF) versus 1400 ppm/250 ppm F (NaF) toothpaste/mouthrinse combinations, Outcome 1 White spot index.
6.2
6.2. Analysis
Comparison 6 1400 ppm/250 ppm F (AmF/SnF) versus 1400 ppm/250 ppm F (NaF) toothpaste/mouthrinse combinations, Outcome 2 Visible plaque index.
6.3
6.3. Analysis
Comparison 6 1400 ppm/250 ppm F (AmF/SnF) versus 1400 ppm/250 ppm F (NaF) toothpaste/mouthrinse combinations, Outcome 3 Gingival bleeding index.
7.1
7.1. Analysis
Comparison 7 Resin‐modified glass ionomer cement (RM‐GIC) versus light‐cured composite resin (LCC), Outcome 1 Number of participants with new DLs.
7.2
7.2. Analysis
Comparison 7 Resin‐modified glass ionomer cement (RM‐GIC) versus light‐cured composite resin (LCC), Outcome 2 Number of participants with more severe DLs of aesthetic concern.
8.1
8.1. Analysis
Comparison 8 Intraoral F‐releasing glass bead device versus F mouthrinse only, Outcome 1 Number of participants with new DLs.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Benson 2019 {published data only}
    1. Benson PE, Alexander‐Abt J, Cotter S, Dyer FMV, Fenesha F, Patel A, et al. Resin‐modified glass ionomer cement vs composite for orthodontic bonding: a multicenter, single‐blind, randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics 2019;155(1):10‐8. - PubMed
He 2010 {published data only}
    1. He WD, Liu YZ, Xu YY, Chen D. Study on application of CPP‐ACP on tooth mineralization during orthodontic treatment with fixed appliance. Shanghai Kou Qiang Yi Xue 2010;19(2):140‐3. - PubMed
Jiang 2013 {published data only}
    1. Jiang H, Hua F, Yao L, Tai B, Du M. Effect of 1.23% acidulated phosphate fluoride foam on white spot lesions in orthodontic patients: a randomised trial. Pediatric Dentistry 2013;35(3):275‐8. - PubMed
Jost‐Brinkman 2017 {published and unpublished data}
    1. Jost‐Brinkman PG, Redlich M, Klasser M, Egger‐Heigold B. Prevention of incipient carious lesions (white spot lesions) in patients with fixed orthodontic appliances following the application of elmex® gel. GCP Study Report 2017.
Luther 2005 {published and unpublished data}
    1. Luther F, Tobin M, Robertson AJ, Toumba KJ. Fluoride‐releasing glass beads in orthodontic treatment to reduce decay: a randomized, controlled clinical trial. World Journal of Orthodontics Supplement 2005;6(5):166‐7.
Ogaard 2006 {published and unpublished data}
    1. Ogaard B, Alm AA, Larsson E, Adolfsson U. A prospective, randomized clinical study on the effects of an amine fluoride/stannous fluoride toothpaste/mouthrinse on plaque, gingivitis and initial caries lesion development in orthodontic patients. European Journal of Orthodontics 2006;28(1):8‐12. - PubMed
Sonesson 2014 {published data only}
    1. Sonesson M, Twetman S, Bondemark L. Effectiveness of high‐fluoride toothpaste on enamel demineralization during orthodontic treatment ‐ a multicenter randomized controlled trial. European Journal of Orthodontics 2014;36(6):678‐82. - PubMed
Sonesson 2019 {published and unpublished data}
    1. Sonesson M, Brechter A, Abdulraheem S, Lindman R, Twetman S. Fluoride varnish for the prevention of white spot lesions during orthodontic treatment with fixed appliances: a randomized controlled trial. European Journal of Orthodontics 2019 Jun 14 [Epub ahead of print]. [DOI: 10.1093/ejo/cjz045] - DOI - PubMed
Stecksén‐Blicks 2007 {published and unpublished data}
    1. Stecksén‐Blicks C, Renfors G, Oscarson ND, Bergstrand F, Twetman S. Caries‐preventive effectiveness of fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances. Caries Research 2007;41(6):455‐9. - PubMed
van der Kaaij 2015 {published data only}
    1. Kaaij NCW, Veen MH, Kaaij MAE, Cate JM. A prospective, randomized placebo‐controlled clinical trial on the effects of a fluoride rinse on white spot lesion development and bleeding in orthodontic patients. European Journal of Oral Sciences 2015;123(3):186‐93. - PMC - PubMed

References to studies excluded from this review

Alexander 2000 {published data only}
    1. Alexander SA, Ripa LW. Effects of self‐applied topical fluoride preparations in orthodontic patients. Angle Orthodontist 2000;70(6):424‐30. - PubMed
Al Mulla 2010 {published data only}
    1. Al Mulla AH, Al Kharsa S, Birkhed D. Modified fluoride toothpaste technique reduces caries in orthodontic patients: a longitudinal, randomized clinical trial. American Journal of Orthodontics and Dentofacial Orthopedics 2010;138(3):285‐91. - PubMed
Alwi 1994 {published data only}
    1. Alwi NBH, Creanor SL. The influence of fluoride‐releasing composites on the development of white‐spot lesions near orthodontic brackets: an in vivo investigation (Research Reports 1993: Abstract). British Journal of Orthodontics 1994;21(1):118.
Banks 1997 {published data only}
    1. Banks PA, Burn A, O'Brien K. A clinical evaluation of the effectiveness of including fluoride into an orthodontic bonding adhesive. European Journal of Orthodontics 1997;19(4):391‐5. [MEDLINE: ] - PubMed
Banks 2000 {published data only}
    1. Banks PA, Chadwick SM, Asher‐McDade C, Wright JL. Fluoride‐releasing elastomerics ‐ a prospective controlled clinical trial. European Journal of Orthodontics 2000;22(4):401‐7. [MEDLINE: ] - PubMed
Blanco 1988 {published data only}
    1. Blanco Parra R. Evaluation of the presence of white spots following orthodontic treatment. Revista Iberoamericana de Ortodoncia 1988;8(1):31‐8. - PubMed
Boyd 1992 {published data only}
    1. Boyd RL. Two‐year longitudinal study of a peroxide‐fluoride rinse on decalcification in adolescent orthodontic patients. Journal of Clinical Dentistry 1992;3(3):83‐7. [MEDLINE: ] - PubMed
Boyd 1993 {published data only}
    1. Boyd RL. Comparison of three self‐applied topical fluoride preparations for control of decalcification. Angle Orthodontist 1993;63(1):25‐30. [MEDLINE: ] - PubMed
Boyles 2007 {published data only}
    1. Bagby MD, Boyles GAC, Martin C, Kao E, Ngan P. Effects of fluoride varnishes on enamel decalcification around orthodontic appliances. American Association of Dental Research poster abstract; 2008 March 31‐April 5; Dallas (TX).
    1. Boyles GA. Effects of Fluoride Varnishes and Adhesives on Bond Strength and Preventing Enamel Decalcification Around Orthodontic Appliances: an In Vitro and In Vivo Study [Masters thesis]. Morgantown, West Virginia (USA): West Virginia University, 2007.
Buyukyilmaz 1994 {published data only}
    1. Buyukyilmaz T, Tangugsorn V, Ogaard B, Arends J, Ruben J, Rolla G. The effect of titanium tetrafluoride (TiF4) application around orthodontic brackets. American Journal of Orthodontics and Dentofacial Orthopedics 1994;105(3):293‐6. [MEDLINE: ] - PubMed
    1. Buyukyilmaz T, Tangugsorn V, Ogaard B, Arends J, Ruben J, Rolla G. The effect of titanium tetrafluoride (TiF4) application around orthodontic brackets. European Journal of Orthodontics 1993;15(4):334. - PubMed
Chung 1998 {published and unpublished data}
    1. Chung CK, Millett DT, Creanor SL. Cariostatic ability of resin‐modified glass ionomer cements for orthodontic bonding. European Journal of Orthodontics 1996;18(5):513.
    1. Chung CK, Millett DT, Creanor SL, Gilmour WH, Foye RH. Fluoride release and cariostatic ability of a compomer and a resin‐modified glass ionomer cement used for orthodontic bonding. Journal of Dentistry 1998;26(5‐6):533‐8. - PubMed
Czochrowska 1998 {published data only}
    1. Czochrowska E, Ogaard B, Duschner H, Ruben J, Arends J. Cariostatic effect of a light‐cured, resin‐reinforced glass‐ionomer for bonding orthodontic brackets in vivo. A combined study using microradiography and confocal laser scanning microscopy. Journal of Orofacial Orthopedics 1998;59(5):265‐73. [MEDLINE: ] - PubMed
D'Agostino 1988 {published data only}
    1. D'Agostino RB, Cancro LP, Fischman S. Effects of anticaries dentifrices on orthodontic subjects. Compendium of Continuing Education in Dentistry 1988;11:S384‐9. - PubMed
Demito 2011 {published and unpublished data}
    1. Demito CF, Rodrigues GV, Ramos AL, Bowman SJ. Efficacy of a fluoride varnish in preventing white‐spot lesions as measured with laser fluorescence. Journal of Clinical Orthodontics 2011;45(1):25‐9. - PubMed
Dénes 1988 {published data only}
    1. Dénes J, Gábris K. Results of a 3‐year Elmex program during orthodontic treatment with fixed appliances. ZWR 1988;97(10):863‐8. - PubMed
Dénes 1989 {published data only}
    1. Dénes J, Domokos G, Gábris K, Juhász G, Nagy B, Radóczi B, et al. Results of the use of amine‐fluoride preparations in orthodontic practice. Fogorvosi Szemle 1989;82(9):257‐61. - PubMed
Dénes 1991 {published data only}
    1. Dénes J, Gábris K. Results of a 3‐year oral hygiene programme, including amine fluoride products, in patients treated with fixed orthodontic appliances. European Journal of Orthodontics 1991;13(2):129‐33. - PubMed
Dyer 1982 {published data only}
    1. Dyer JR, Shannon IL. MFP versus stannous fluoride mouthrinses for prevention of decalcification in orthodontic patients. ASDC Journal of Dentistry for Children 1982;49(1):19‐21. [MEDLINE: ] - PubMed
Enerbäck 2019 {published data only}
    1. Enerbäck H, Möller M, Nylén C, Ödman Bresin C, Östman Ros I, Westerlund A. Effects of orthodontic treatment and different fluoride regimens on numbers of cariogenic bacteria and caries risk: a randomized controlled trial. European Journal of Orthodontics 2019;41(1):59‐66. [DOI: 10.1093/ejo/cjy025] - DOI - PubMed
Farhadian 2008 {published and unpublished data}
    1. Farhadian N, Miresmaeili A, Eslami B, Mehrabi S. Effect of fluoride varnish on enamel demineralization around brackets: an in‐vivo study. American Journal of Orthodontics and Dentofacial Orthopedics 2008;133(4 Suppl):S95‐8. - PubMed
Fricker 1985 {published data only}
    1. Fricker JP, McLachlan MD. Clinical studies of glass ionomer cements. Part I‐A twelve month clinical study comparing zinc phosphate cement to glass ionomer. Australian Orthodontic Journal 1985;9(1):179‐80. - PubMed
Fricker 1987 {published data only}
    1. Fricker JP, McLachlan MD. Clinical studies on glass ionomer cements. Part 2‐A two year clinical study comparing glass ionomer cement with zinc phosphate cement. Australian Orthodontic Journal 1987;10(1):12‐4. - PubMed
Gaworski 1999 {published data only}
    1. Gaworski M, Weinstein M, Borislow AJ, Braitman LE. Decalcification and bond failure: a comparison of a glass ionomer and a composite resin bonding system in vivo. American Journal of Orthodontics and Dentofacial Orthopedics 1999;116(5):518‐21. [MEDLINE: ] - PubMed
Geiger 1988 {published data only}
    1. Geiger AM, Gorelick L, Gwinnett AJ, Griswold PG. The effect of a fluoride program on white spot formation during orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics 1988;93(1):29‐37. - PubMed
Geiger 1992 {published data only}
    1. Geiger AM, Gorelick L, Gwinnett AJ, Benson BJ. Reducing white spot lesions in orthodontic populations with fluoride rinsing. American Journal of Orthodontics and Dentofacial Orthopedics 1992;101(5):403‐7. - PubMed
Gillgrass 2001 {published and unpublished data}
    1. Gillgrass TJ, Benington PC, Millett DT, Newell J, Gilmour WH. Modified composite or conventional glass ionomer for band cementation? A comparative clinical trial. American Journal of Orthodontics and Dentofacial Orthopedics 2001;120(1):49‐53. - PubMed
Gorton 2003 {published data only}
    1. Gorton J, Featherstone JD. In vivo inhibition of demineralization around orthodontic brackets. American Journal of Orthodontics and Dentofacial Orthopedics 2003;123(1):10‐4. - PubMed
Hirschfield 1978 {published data only}
    1. Hirschfield RE. Control of decalcification by use of fluoride mouthrinse. ASDC Journal of Dentistry for Children 1978;45(6):458‐60. - PubMed
Leizer 2010 {published and unpublished data}
    1. Leizer C, Weinstein M, Borislow AJ, Braitman LE. Efficacy of a filled‐resin sealant in preventing decalcification during orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics 2010;137(6):796‐800. - PubMed
Maijer 1988 {published data only}
    1. Maijer R, Smith DC. A comparison between zinc phosphate and glass ionomer cement in orthodontics. American Journal of Orthodontics and Dentofacial Orthopedics 1988;93(4):273‐9. [MEDLINE: ] - PubMed
Marcusson 1997 {published and unpublished data}
    1. Marcusson A, Norevall LI, Persson M. White spot reduction when using glass ionomer cement for bonding in orthodontics: a longitudinal and comparative study. European Journal of Orthodontics 1997;19(3):233‐42. [MEDLINE: ] - PubMed
Marini 1999 {published data only}
    1. Marini I, Pelliccioni GA, Vecchiet F, Alessandri Bonetti G, Checchi L. A retentive system for intra‐oral fluoride release during orthodontic treatment. European Journal of Orthodontics 1999;21(6):695‐701. [MEDLINE: ] - PubMed
Mattick 2001 {published data only (unpublished sought but not used)}
    1. Mattick CR, Mitchell L, Chadwick SM, Wright J. Fluoride‐releasing elastomeric modules reduce decalcification: a randomized controlled trial. Journal of Orthodontics 2001;28(3):217‐9. - PubMed
Millett 1999 {published data only}
    1. Millett DT, Nunn JH, Welbury RR, Gordon PH. Decalcification in relation to brackets bonded with glass ionomer cement or a resin adhesive. Angle Orthodontist 1999;69(1):65‐70. [MEDLINE: ] - PubMed
Millett 2000 {published and unpublished data}
    1. Millett DT, McCluskey LA, McAuley F, Creanor SL, Newell J, Love J. A comparative clinical trial of a compomer and a resin adhesive for orthodontic bonding. Angle Orthodontist 2000;70(3):233‐40. [MEDLINE: ] - PubMed
Mitchell 1992 {published data only}
    1. Mitchell L. An investigation into the effect of a fluoride releasing adhesive on the prevalence of enamel surface changes associated with directly bonded orthodontic attachments. British Journal of Orthodontics 1992;19(3):207‐14. [MEDLINE: ] - PubMed
Neumann 1976 {published data only}
    1. Neumann HF. A clinical evaluation of decalcification under orthodontic bands following pretreatment with acidulated phosphate‐fluorides and adhesive plastic coatings. American Journal of Orthodontics 1976;69(6):698‐9. [MEDLINE: ]
O'Reilly 1987 {published data only}
    1. O'Reilly MM, Featherstone JD. Demineralization and remineralization around orthodontic appliances: an in vivo study. American Journal of Orthodontics and Dentofacial Orthopedics 1987;92(1):33‐40. [MEDLINE: ] - PubMed
Ogaard 1986 {published and unpublished data}
    1. Ogaard B, Arends J, Schuthof J, Rolla G, Ekstrand J, Oliveby A. Action of fluoride on initiation of early enamel caries in vivo. A microradiographical investigation. Caries Research 1986;20(3):270‐7. [MEDLINE: ] - PubMed
Ogaard 1992 {published data only}
    1. Ogaard B, Rezk‐Lega F, Ruben J, Arends J. Cariostatic effect and fluoride release from a visible light‐curing adhesive for bonding of orthodontic brackets. American Journal of Orthodontics and Dentofacial Orthopedics 1992;101(4):303‐7. [MEDLINE: ] - PubMed
Ogaard 1996 {published data only}
    1. Ogaard B, Duschner H, Ruben J, Arends J. Microradiography and confocal laser scanning microscopy applied to enamel lesions formed in vivo with and without fluoride varnish treatment. European Journal of Oral Sciences 1996;104(4 Pt 1):378‐83. - PubMed
Ogaard 1997 {published data only}
    1. Ogaard B, Larsson E, Glans R, Henriksson T, Birkhed D. Antimicrobial effect of a chlorhexidine‐thymol varnish (Cervitec) in orthodontic patients. A prospective, randomized clinical trial. Journal of Orofacial Orthopedics 1997;58(4):206‐13. [MEDLINE: ] - PubMed
Ogaard 2001 {published data only}
    1. Ogaard B, Larsson E, Henriksson T, Birkhed D, Bishara SE. Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics 2001;120(1):28‐35. - PubMed
Pascotto 2004 {published data only}
    1. Pascotto RC, Navarro MF, Capelozza Filho L, Cury JA. In vivo effect of a resin‐modified glass ionomer cement on enamel demineralization around orthodontic brackets. American Journal of Orthodontics and Dentofacial Orthopedics 2004;125(1):36‐41. [MEDLINE: ] - PubMed
Robertson 2011 {published data only}
    1. Johnson D. MI Paste Plus research. American Journal of Orthodontics and Dentofacial Orthopedics 2012;141(5):526. [PUBMED: 22554734] - PubMed
    1. Robertson MA, Kau CH, English JD, Lee RP, Powers J, Nguyen JT. MI Paste Plus to prevent demineralization in orthodontic patients: a prospective randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics 2011;140(5):660‐8. - PubMed
Salzmann 1976 {published data only}
    1. Salzmann JA. A clinical evaluation of decalcification under orthodontic bands following pretreatment with acidulated phosphate‐fluorides and adhesive plastic coatings. American Journal of Orthodontics 1976;69(6):698.
Shan 2008 {published and unpublished data}
    1. Shan LH, Cui ZQ, Shen QH, Gao Q, Qiu ZX. Application of light‐cure resin‐modified glass ionomer cement in orthodontic practice. Journal of Clinical Rehabilitative Tissue Engineering Research 2008;12(6):1149‐52.
Shannon 1978 {published data only}
    1. Shannon IL, Clair JR, Pratt GA, West DC. Stannous fluoride versus sodium fluoride in preventive treatment of orthodontic patients. Australian Orthodontic Journal 1978;5(1):18‐24.
Shannon 1979 {published data only}
    1. Shannon IL, West DC. Prevention of decalcification in orthodontic patients by daily self‐treatment with 0.4% SnF2 gel. Pediatric Dentistry 1979;1(2):101‐2. [MEDLINE: ] - PubMed
Sköld‐Larsson 2013 {published data only}
    1. Sköld‐Larsson K, Sollenius O, Karlsson L, Petersson LG, Twetman S. Effect of fluoridated milk on enamel demineralization adjacent to fixed orthodontic appliances. Acta Odontologica Scandinavica 2013;71(3‐4):464‐8. - PubMed
Sonis 1989 {published data only}
    1. Sonis AL, Snell W. An evaluation of a fluoride‐releasing, visible light‐activated bonding system for orthodontic bracket placement. American Journal of Orthodontics and Dentofacial Orthopedics 1989;95(4):306‐11. - PubMed
Trimpeneers 1996 {published data only}
    1. Trimpeneers LM, Dermaut LR. A clinical evaluation of the effectiveness of a fluoride‐releasing visible light‐activated bonding system to reduce demineralization around orthodontic brackets. American Journal of Orthodontics and Dentofacial Orthopedics 1996;110(2):218‐22. [MEDLINE: ] - PubMed
Turner 1993 {published data only (unpublished sought but not used)}
    1. Turner PJ. The clinical evaluation of a fluoride‐containing orthodontic bonding material. Journal of Orthodontics 1993;20(4):307‐13. - PubMed
Twetman 1997 {published data only}
    1. Twetman S, McWilliam JS, Hallgren A, Oliveby A. Cariostatic effect of glass ionomer retained orthodontic appliances. An in vivo study. Swedish Dental Journal 1997;21(5):169‐75. - PubMed
Ullsfoss 1994 {published data only}
    1. Ullsfoss BN, Ogaard B, Arends J, Ruben J, Rolla G, Afseth J. Effect of a combined chlorhexidine and NaF mouthrinse: an in vivo human caries model study. Scandinavian Journal of Dental Research 1994;102(2):109‐12. [MEDLINE: ] - PubMed
Underwood 1989 {published data only}
    1. Underwood ML, Rawls HR, Zimmerman BF. Clinical evaluation of a fluoride‐exchanging resin as an orthodontic adhesive. American Journal of Orthodontics and Dentofacial Orthopedics 1989;96(2):93‐9. [MEDLINE: ] - PubMed
van der Linden 1998 {published data only}
    1. Linden RP, Dermaut LR. White spot formation under orthodontic bands cemented with glass ionomer with or without Fluor Protector. European Journal of Orthodontics 1998;20(3):219‐24. - PubMed
Vivaldi‐Rodrigues 2006 {published and unpublished data}
    1. Vivaldi‐Rodrigues G, Demito CF, Bowman SJ, Ramos AL. The effectiveness of a fluoride varnish in preventing development of white spot lesions. World Journal of Orthodontics 2006;7:138‐44. - PubMed
Wenderoth 1999 {published data only}
    1. Wenderoth CJ, Weinstein M, Borislow AJ. Effectiveness of a fluoride‐releasing sealant in reducing decalcification during orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics 1999;116(6):629‐34. [MEDLINE: ] - PubMed

References to ongoing studies

DRKS00012533 {published and unpublished data}
    1. DRKS00012533. Efficacy of the fluoride varnish enamelast for preventing white‐spot lesions and gingivitis in fixed orthodontic treatment of patients with low to moderate caries risk ‐ a randomized controlled trial. drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00... (first received 8 June 2017).
DRKS00012540 {published and unpublished data}
    1. DRKS00012540. Efficacy of Fluor‐Protector S fluoride varnish for preventing white‐spot lesions and gingivitis in fixed orthodontic treatment of patients with high risk of caries ‐ a randomized controlled trial. drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00... (first received 8 June 2017).
IRCT2016122531558N1 {published and unpublished data}
    1. IRCT2016122531558N1. Effect of preventive agents on oral health in orthodontic patients [A clinical trial of comparing the effect of fluoride varnish and chlorhexidine gel on white spots and gingival indexes in orthodontic patients]. en.irct.ir/trial/24800 (first received 24 June 2017).

Additional references

Angmar‐Mansson 1996
    1. Angmar‐Mansson B, al‐Khateeb S, Tranaeus S. Monitoring the caries process. Optical methods for clinical diagnosis and quantification of enamel caries. European Journal of Oral Science 1996;104(4 Pt 2):480‐5. - PubMed
Benson 2010
    1. Benson PE. Fluoride‐containing materials and the prevention of demineralization during orthodontic treatment – which research method should we now use?. Seminars in Orthodontics 2010;16(4):293‐301.
Chadwick 2005
    1. Chadwick BL, Roy J, Knox J, Treasure ET. The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: a systematic review. American Journal of Orthodontics and Dentofacial Orthopedics 2005;128(5):601‐6. - PubMed
Derks 2004
    1. Derks A, Katsaros C, Frencken JE, van't Hof MA, Kuijpers‐Jagtman AM. Caries‐inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. Caries Research 2004;38(5):413‐20. - PubMed
Enaia 2011
    1. Enaia M, Bock N, Ruf S. White‐spot lesions during multibracket appliance treatment: a challenge for clinical excellence. American Journal of Orthodontics and Dentofacial Orthopedics 2011;140(1):e17‐e24. - PubMed
GRADEpro GDT 2015 [Computer program]
    1. Hamilton (ON): McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 15 March 2019. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Höchli 2017
    1. Höchli D, Hersberger‐Zurfluh M, Papageorgiou SN, Eliades T. Interventions for orthodontically induced white spot lesions: a systematic review and meta‐analysis. European Journal of Orthodontics 2017;39(1):122‐33. - PubMed
Kerbusch 2012
    1. Kerbusch AE, Kuijpers‐Jagtman AM, Mulder J, Sanden WJ. Methods used for prevention of white spot lesion development during orthodontic treatment with fixed appliances. Acta Odontologica Scandinavica 2012; Vol. 70, issue 6:564‐8. - PubMed
Lapenaite 2016
    1. Lapenaite E, Lopatiene K, Ragauskaite A. Prevention and treatment of white spot lesions during and after fixed orthodontic treatment: a systematic literature review. Stomatologija 2016;18:3‐8. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Lopatiene 2016
    1. Lopatiene K, Borisovaite M, Lapenaite E. Prevention and treatment of white spot lesions during and after treatment with fixed orthodontic appliances: a systematic literature review. Journal of Oral Maxillofacial Research 2016;7(2):e1. - PMC - PubMed
Lynch 2006
    1. Lynch RJ, Mony U, Cate JM. The effect of fluoride at plaque fluid concentrations on enamel de‐ and remineralisation at low pH. Caries Research 2006;40(6):522‐9. - PubMed
Marinho 2003a
    1. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 1. [DOI: 10.1002/14651858.CD002278] - DOI - PMC - PubMed
Marinho 2003b
    1. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD002782] - DOI - PMC - PubMed
Marinho 2004
    1. Marinho VCC, Higgins JPT, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD002781.pub2] - DOI - PMC - PubMed
Marinho 2016
    1. Marinho VCC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2016, Issue 7. [DOI: 10.1002/14651858.CD002284.pub2] - DOI - PMC - PubMed
Maxfield 2012
    1. Maxfield BJ, Hamdan AM, Tufekci E, Shroff B, Best AM, Lindauer SJ. Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists. American Journal of Orthodontics and Dentofacial Orthopedics 2012;141(3):337‐44. - PubMed
McCarney 2007
    1. McCarney R, Warner J, Iliffe S, Haselen R, Griffin M, Fisher P. The Hawthorne Effect: a randomised, controlled trial. BMC Medical Research Methodology 2007;7:30. - PMC - PubMed
Naranjo 2006
    1. Naranjo AA, Triviño ML, Jaramillo A, Betancourth M, Botero JE. Changes in the subgingival microbiota and periodontal parameters before and 3 months after bracket placement. American Journal of Orthodontics and Dentofacial Orthopedics 2006;30(3):275.e17‐275.e22. - PubMed
Nascimento 2016
    1. Nascimento PL, Fernandes MT, Figueiredo FE, Faria‐E‐Silva AL. Fluoride‐releasing materials to prevent white spot lesions around orthodontic brackets: a systematic review. Brazilian Dental Journal 2017;27(1):101‐7. - PubMed
Ogaard 1989
    1. Ogaard B. Prevalence of white spot lesions in 19‐year‐olds: a study on untreated and orthodontically treated persons 5 years after treatment. American Journal of Orthodontics and Dentofacial Orthopedics 1989;96(5):423‐7. - PubMed
Pandis 2013
    1. Pandis N, Walsh T, Polychronopoulou A, Katsaros C, Eliades T. Split‐mouth designs in orthodontics: an overview with applications to orthodontic clinical trials. European Journal of Orthodontics 2013;35(6):783‐9. [DOI: 10.1093/ejo/cjs108] - DOI - PubMed
Rahimi 2017
    1. Rahimi F, Sadeghi M, Mozaffari HR. Efficacy of fluoride varnish for prevention of white spot lesions during orthodontic treatment with fixed appliances: a systematic review study. Biomedical Research and Therapy 2017;4(8):1513‐26.
Rogers 2010
    1. Rogers S, Chadwick B, Treasure E. Fluoride‐containing orthodontic adhesives and decalcification in patients with fixed appliances: a systematic review. American Journal of Orthodontics and Dentofacial Orthopedics 2010;390:e1‐8. - PubMed
Rücker 2008
    1. Rücker G, Schwarzer G, Carpenter J. Arcsine test for publication bias in meta‐analyses with binary outcomes. Statistics in Medicine 2008;27:746‐63. - PubMed
Sardana 2019a
    1. Sardana D, Zhang J, Ekambaram M, Yang Y, McGrath CP, Yiu CKY. Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: a systematic review and meta‐analysis. Journal of Dentistry 2019;82(1):1‐10. [DOI: 10.1016/j.jdent.2018.12.006] - DOI - PubMed
Sardana 2019b
    1. Sardana D, Manchanda S, Ekambaram M, Yang Y, McGrath CP, Yiu CKY. Effectiveness of self‐applied topical fluorides against enamel white spot lesions from multibracketed fixed orthodontic treatment: a systematic review. European Journal of Orthodontics 2019 Apr 9 [Epub ahead of print]. [DOI: 10.1093/ejo/cjz015] - DOI - PubMed
Tasios 2019
    1. Tasios T, Papageorgiou SN, Papadopoulos MA, Tsapas A, Haidich AB. Prevention of orthodontic enamel demineralization: a systematic review with meta‐analyses. Orthodontics and Craniofacial Research 2019 May 13 [Epub ahead of print]. [DOI: 10.1111/ocr.12322] - DOI - PubMed
ten Cate 2013
    1. Cate JM. Contemporary perspective on the use of fluoride products in caries prevention. British Dental Journal 2013;214(4):161‐7. - PubMed
Tufekci 2011
    1. Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthodontist 2011;81(2):206‐10. - PMC - PubMed
Wang 2013
    1. Wang M, Guo Y, Jiang H. Effectiveness of topical fluoride on prevention of enamel demineralization in China: a systematic review. Chinese Journal of Evidence‐Based Medicine 2013;13(7):875‐84.

References to other published versions of this review

Benson 2002
    1. Benson PE, Parkin N, Millett DT, Dyer FE, Vine S, Shah A. Fluorides for the prevention of white spots on teeth during fixed brace treatment. Cochrane Database of Systematic Reviews 2002, Issue 3. [DOI: 10.1002/14651858.CD003809] - DOI - PubMed
Benson 2004
    1. Benson PE, Parkin N, Millett DT, Dyer F, Vine S, Shah A. Fluorides for the prevention of white spots on teeth during fixed brace treatment. Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD003809.pub2] - DOI - PubMed
Benson 2013
    1. Benson PE, Parkin N, Dyer F, Millett DT, Furness S, Germain P. Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment. Cochrane Database of Systematic Reviews 2013, Issue 12. [DOI: 10.1002/14651858.CD003809.pub3] - DOI - PubMed

Publication types

MeSH terms