Predicting Improvement of Post-Orthodontic White Spot Lesions

Abstract

Introduction: It is well known that patients undergoing orthodontic treatment are at greater risk for developing white spot lesions (WSL). Although prevention of WSLs is always the goal, they continue to be a common sequela in patients undergoing orthodontics. For this reason, understanding the patterns of WSL improvement is of great importance to both the patient and the provider. Previous studies have shown some lesions exhibiting significant improvement, while other lesions show limited to no improvement. Our study sought to identify specific patient and tooth-related factors that are most predictive for improvement. Methods: Patients aged 12-20 years, who had at least 1 WSL that developed during orthodontic treatment, were recruited from private dental and orthodontic offices. They all had their braces removed less than 2 months prior to enrollment into the study. Photos were taken at enrollment and 8 weeks later. Paired photographs from the 2 time points were blindly assessed for improvement in appearance by a panel of 5 dental professionals, and by 2 sets of evaluators for changes in surface area and appearance at the individual tooth level. Results: One hundred and one subjects were included in this study. Patient age, brushing frequency, and larger percent surface area affected were associated with increased improvement of lesions. Central incisors showed greater improvement when compared to lateral incisors. Increased time since appliance removal and increased length of orthodontic treatment were associated with decreased improvement. Gender, oral hygiene status, retainer type, location of the lesion (gingival, middle, incisal), presence of staining, and lesion diffuseness were not found to be predictive for improvement. Conclusions: Of the various patient and tooth-related factors examined; age, time since appliance removal, length of orthodontic treatment, tooth type (central vs. lateral incisor), WSL surface area, and brushing frequency had significant associations with WSL improvement.