23 October 2023

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How to prevent the appearance of white spots during orthodontic treatments

Lara Figini

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White spots (WS) frequently appear during orthodontic therapy with fixed appliances and usually appear in the gingival and vestibular parts of the teeth: the most affected by these lesions are the canines and the upper lateral incisors. The areas of WS are characterized by the loss of mineralization of the enamel and clinically appear more or less extensive, chalk white or brown in colour, porous and rough to the touch; it is a phenomenon linked to the different diffusion of light compared to normally mineralized enamel. These lesions are irreversible and if left untreated they evolve into tooth decay.

The incidence of WS is closely related to oral hygiene maneuvers and should always be detected by orthodontists in the initial stages. The impact of WS on patients' oral health and on the aesthetics of the smile can be very significant, hence the importance of their prevention which is mainly based on the correct selection of the patient candidate for orthodontics.

Materials and methods

In an Italian systematic review, published in the International Journal of Environmental Research and Public Health in April 2023, the authors conducted a bibliographic search of studies on the topic via the PubMed, Scopus and Web of Science databases, selecting articles only in English published from January 2018 to January 2023. The keywords used were “WS” and “fixed orthodontics*”, using "AND" as the Boolean operator. Sixteen studies in total were included for qualitative analysis.

Results

From the literature search, the authors identified a total of 1015 relevant studies. Subsequent elimination of duplicates (456) resulted in the inclusion of 559 articles. Of these, 483 were excluded: 62 because reviews and 421 because the authors judged them to be off topic.

After applying the eligibility criteria, 16 studies were included in the final review.

Conclusions

From the data of this review it can be concluded that prevention begins with maintaining correct oral hygiene, regular use of fluoride toothpastes, mouthwashes, gels, varnishes and sealants. The laser in combination with fluoride helps prevent the onset of WS and assists the repair processes of the initial lesions.