01 September 2020

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Fluoride varnish and chlorhexidine gel on white spots in fixed orthodontic patients

Giulia Palandrani

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Plaque accumulation which can lead to whitespot  formation and gingival inflammation represent a significant challenge to excellence in clinical orthodontics. Dental caries is one of the most important oral cavity diseases, which initially appears as a white spot lesion (WSL) due to the loss of mineral content. After bracket placement, whitespost  can be identified within 1 month although it takes at least 6 months before caries becomes notable.[ 

Good plaque control is very difficult in patients with fixed orthodontic appliances. To improve mechanical plaque removal, incorporation of a chemotherapeutic agent such as an antibacterial mouth rinse into the oral hygiene regimen can be helpful.

Chlorhexidine (CHX)  is the most potentially documented antimicrobial agent against mutans streptococci (MS) and dental caries. CHX varnishes establish the most persistent reduction in MS, followed by gels and mouthwashes

Topical application of fluoride varnish at least around anterior teeth is suggested in high risk patients, for example, for orthodontic patients at every orthodontic adjustment appointment.

Materials and methods
This clinical trial included 40 patients (20 females and 20 males), who were treated in the Department of Orthodontics of Dental School, Isfahan University of Medical Sciences.
Before the beginning of examination, all of the selected volunteers were instructed on toothbrushing technique (bass technique) and flossing
The materials used were CHX varnish  0.2%, Periokin, Spain), sodium fluoride varnish alcohol free (5%, Pascal, America) and 70% Wt% sorbitol solution for placebo group. They were applied in every 3 months.

Results
After using fluoride  and CHX  for 9 months, GI ( gingival index) decreases significantly (P < 0.05) while the changes in placebo and control groups were not statistically significant.
A significant decrease in plaque was observed when comparing CHX with control (P = 0.00) and CHX with placebo (P = 0.03).
CHX effectiveness in WSL reduction was also significant compared to control group (P = 0.001) and placebo group (P = 0.009). Furthermore, decrease in WSLs was significantly more in CHX group compared to fluoride group (P = 0.001). 

Discussion
Several studies in the literature are in agreement with the results of our study, confirming that CHX and fluoride varnishes can decrease dental plaque and WSLs of orthodontic patients when added to routine oral hygiene treatment (brushing + flossing).
Statistically significant decrease of WSLs was registered in the participants of CHX and fluoride groups in all three follow ups but not in the control or placebo groups. No significant differences were observed between the CHX and fluoride groups for demineralization
Early detection of WSLs during orthodontic treatment is also very important as it would allow clinicians to implement preventive measures to control the demineralization process before progression of the lesions.

Conclusion
Adding CHX and fluoride to daily oral hygiene program reduces bacterial plaque accumulation and improves GI. Orthodontists are recommended to enhance their patients’ oral hygiene by requiring the use of CHX and fluoride in addition to daily brushing.

for additional Informations :  The effect of fluoride varnish and chlorhexidine gel on white spots and gingival and plaque indices in fixed orthodontic patients: A placebo controlled study.