Preventing and Arresting the Appearance of White Spot Lesions around the Bracket by applying Fluoride Varnish: A Systematic Review

Abstract

Introduction: White spot lesions are the first clinical sign of dental caries, and they occur frequently in patients with orthodontic appliances. Currently, there are no systematic reviews that have evaluated fluoride varnish compared with other methods to prevent or arrest the development of dental caries. The aim of this systematic review (SR) was to evaluate the effectiveness of the use of fluoride varnish compared with other methods to prevent or arrest initial lesions of caries in patients with corrective orthodontics. Methods: A search was conducted for articles in the MEDLINE, EMBASE and Google Scholar databases. This SR included randomized clinical trials and prospective interventional studies that used fluoride varnish for the prevention and/or arrest of white spot lesions in orthodontic treatment or during the 3-month period after removal of orthodontic fixed appliances. To assess the risk of bias in the studies, we used the Cochrane collaboration tool. Results: The search strategy showed 115 possible eligible articles, and we included 10 articles in this SR. The reviewed studies showed high and moderate methodological quality. Four studies out of 10 agreed that fluoride varnish is as effective as the advised and guided oral hygiene technique. Overall, most of the included studies did not show significant advantages to fluoride varnish application in terms of preventing the development of white spots around orthodontic brackets when the patients were submitted to regular professional oral hygiene control. Conclusions: Fluoride varnish is an effective material to prevent and arrest white spot lesions in patients with orthodontic treatment.

Prevention of demineralization during multi‐bracketed fixed orthodontic treatment: An overview of systematic reviews

“…Eighteen reviews 12,13,14,15,16,17,21,26,28,30,32,33,34,35,36,38,39,40 (including three Cochrane reviews) focused on the role of any form of fluorides (professionally applied, selfapplied, or fluoride-releasing materials), and two other reviews 22,25 focused on the role of fluorides with calcium phosphopeptide-amorphous calcium phosphate (CPP-ACP). Three reviews 30,32,34 focused specifically on the role of fluoride varnishes, whereas one review focused on the role of professionally applied topical fluorides.…”

“…Four of the reviews 35,36,37,39 had "moderate" overall confidence in the review and another four reviews (5 published papers) were assessed to have "low" overall confidence in the review. 11,12,13,29,34 Majority of the reviews were, however, assessed to have "critically low" overall confidence in the review. 16,17,18,19,20,21,22,23,24,25,26,27,28,30,31,32,33,38,40 The detailed assessment of the risk of bias of included reviews using the AMSTAR-2 tool is presented in Figure 3.…”

Novel Orthodontic Cement Comprising Unique Imidazolium-Based Polymerizable Antibacterial Monomers

“…The mean prevented portion based on six clinical trials was 42.5% with a range from 4% to 73% [ 23 ]. These studies provided convincing support for routine professional applications of fluoride varnish around the bracket base during orthodontic treatment [ 24 , 25 , 26 , 27 , 28 ].…”

“…Given the extensive prevalence of WSLs occurring during orthodontic treatments, various strategies have been utilized to prevent or mediate demineralization and occurrence of WSL formation. The use of fluoride via various forms, i.e., mouth rinse, gel, topical varnish, toothpaste, etc., has been the predominant remedy applied and studied [ 7 , 14 , 23 , 24 ]. Fluoride ions have been well documented to enhance remineralization of enamel and mitigate mineral loss during acid dissolution, by replacing the hydroxyl groups in hydroxyapatite and forming more acid-resistant fluorapatite [ 25 ].…”

Effect of different white-spot lesion treatment on orthodontic shear strength and enamel morphology: In vitro study

“…[2] The presence of WSLs is strongly influenced by the level of oral hygiene, sex, orthodontic treatment length, flour intake, and diet. [3] In WSLs, a decrease in orthodontic bracket bonding strength occurs, which will cause the bracket to fall off more easily during the course of treatment. It may be caused by the poor quality of enamel surfaces and lack of resin tag that makes it possible for mechanical attachment between composite bonding material and enamel surface to occur.…”