Prevention of incipient carious lesions with various interventions during fixed and removable orthodontic treatment. A systematic review and meta-analysis

Abstract

To systematically review and quantify the effectiveness of interventions in reducing caries development during orthodontic treatment and evaluate the quality of evidence for the development of clinical guidelines. Materials and methods: A comprehensive literature search of the Cochrane, EMBASE and MEDLINE databases was conducted to identify eligible randomised controlled trials (RCTs). The risk of bias was assessed using the Cochrane risk of bias (RoB 2) tool. In order to facilitate the development of clinical guidelines, the quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: A total of 18 RCTs were included in the qualitative synthesis, of which 10 had a high risk of bias, and eight had minor concerns. Three RCTs that investigated the efficacy of fluoride interventions during fixed orthodontic treatment were included in the quantitative synthesis. The pooled effect size resulted in a risk reduction of 0.23 (95% CI: -0.35, -0.11, p < 0.001) in the intervention group compared to controls. The GRADE evaluation identified the evidence as moderate due to the limited number of RCTs and moderate heterogeneity (I-squared statistic of 49.3%). Conclusions: Although fluoride is the most effective evidence-based preventive intervention during orthodontic treatment, large RCTs are required to provide high quality evidence. Further studies are needed to evaluate the caries preventive effects of oral hygiene programs, chlorhexidine, CPP-ACP and other interventions.

Therapeutic properties of glass‐ionomer cements: Their application to orthodontic treatment

“…The exposure to fluoride via regular mouth rinses and or fluoridated toothpastes has been shown to be an effective preventive measure during orthodontic treatment. 12 In addition, the application of casein phosphopeptide-amorphous calcium phosphate (CCP-ACP) in combination with Sodium Fluoride gel, can help to reduce enamel demineralisation and promote remineralisation of early lesions. 13 Regrettably, patient compliance in following instructions in these preventive measures is a limiting factor in successful caries prevention.…”

“…However, new carious lesions can develop in as little as four weeks 11 and as the interval between orthodontic appointments can be up to eight weeks, may remain undetected by the practitioner. The exposure to fluoride via regular mouth rinses and or fluoridated toothpastes has been shown to be an effective preventive measure during orthodontic treatment 12 . In addition, the application of casein phosphopeptide‐amorphous calcium phosphate (CCP‐ACP) in combination with Sodium Fluoride gel, can help to reduce enamel demineralisation and promote remineralisation of early lesions 13 .…”

Caries prevention during removable orthodontic treatment: a scoping review protocol

“…5,6 Nevertheless, removable orthodontic treatment has an increased risk of dental caries as an adverse effect. 7 According to Mathews et al the incidence of white spot lesion development is 1.2% during removable orthodontic treatment. Although this incidence is far lower than those with fixed orthodontic appliances (26%), removable appliances are capable of changing the microbial flora of the oral cavity, which may result in dental caries.…”

“…Although this incidence is far lower than those with fixed orthodontic appliances (26%), removable appliances are capable of changing the microbial flora of the oral cavity, which may result in dental caries. 7,8 Lucchese et al reported that past studies have proven that there is an increase in S. mutans and Lactobacillus spp in patients using removable orthodontic appliances. 9 This may be caused by removable appliances covering all or part of tooth surfaces which affects the flushing effect of saliva, creates niches for cariogenic microorganisms to develop and persist, and leads to an ecological shift.…”

“…9 This may be caused by removable appliances covering all or part of tooth surfaces which affects the flushing effect of saliva, creates niches for cariogenic microorganisms to develop and persist, and leads to an ecological shift. 7,8 Therefore, caries prevention is important for oral health during removable orthodontic treatment.…”