Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review

Abstract

Summary Background Fluoride varnish (FV) is an established technology for primary and secondary caries prevention. Objective The aim of this review was to evaluate the preventive effect of FV on development of white spot lesions (WSL) when regularly applied during orthodontic treatment with fixed appliances. Search methods We searched PubMed, Scopus and Google Scholar up to October 2022 using predetermined keywords. Selection criteria We included randomized controlled trials of a duration of minimum 12 months and at least quarterly FV applications. Data collection and analysis Based on abstracts, we retrieved full-text papers, extracted key outcome data, and assessed risk of bias. Primary outcome was prevalence of WSLs on subject level after debonding. We conducted a narrative synthesis and pooled comparable outcome data in a random effects model. Results We included seven studies covering 666 patients and assessed four publications with low or moderate risk of bias and three with high. The prevalence of WSLs at debonding varied between 12 and 55%. All studies presented results in favour for the FV intervention, one reached statistical significance on subject level. Five studies provided data for a meta-analysis. The pooled risk ratio was 0.64 [95% CI: 0.42, 0.98], indicating a statistically significant preventive effect. Certainty of evidence was graded as very low after reducing for risk of bias, inconsistency and imprecision. Limitations We pooled data on subject level and did not consider lesion severity on tooth level. Conclusions and implications Even if the certainty of evidence was very low, it was shown that FV can prevent development of WSL when regularly applied during orthodontic treatment. Larger investigations reporting a core outcome set are required to increase the certainty of evidence. Registration PROSPERO database (CRD42022370062).

Metal leakage from orthodontic appliances chemically alters enamel surface during experimental in vitro simulated treatment

“…Fluoride (0.0047 mmol NaF 99+% (Acros Organics, Thermo Scientific Chemical, Delphi, India)), was added to the remineralization solution as it plays a crucial role in both enamel remineralization and metal corrosion 24 , 25 , 33 . The solutions were prepared using deionized water with a conductivity of 5 µS/cm produced by a R5Uv device (Hydrolab, Straszyn, Poland).…”

“…The proportions of remineralization and demineralization time were determined by taking into account the abiotic nature of the experiment (lack of enzymes and organic constituents protecting the enamel against dissolution) 42 . The pH cycle has been designed to prevent excessive demineralization of the enamel on the one hand and to maintain the acid shock occurring in the oral cavity, which causes leakage of metals from the appliance on the other hand 25 , 29 . Daily changes in the concentration of Ca in the experimental solutions resulting from element release (demineralization) or uptake (remineralization) were balanced (Supplementary Fig.…”

“…It has been believed that the direct cause of the formation of plaque and caries in orthodontic patients are the difficulties in maintaining proper hygiene around the brackets and the accumulation of bacteria there 24 . Fluoride therapy and frequent orthodontic control have been proposed to address this problem 25 , 26 . It has also been reported that certain white spots in orthodontic patients endure for over six weeks 22 and that fluoride therapy is inefficient on long-existing lesions of this nature 27 .…”