Assessment of White Spot Lesion and Enamel Demineralization in Orthodontic Patients With Fixed Brackets—A Clinical Appraisal Using Fluoride Mouth Rinse, Fluoride Varnish Containing CPP-ACP, and CPP-ACFP

Abstract

Objectives: To systematically review the effectiveness of 5% sodium fluoride varnish (FV) in the treatment of orthodontically-induced white spot lesions (WSLs). Methods: A literature search of three independent databases (Medline, Cochrane Library and Web of Science) was performed from inception to November 2020. This systematic review included randomised/quasi-randomised clinical trials (RCTs) that used FV for patients who had at least one WSL as a result of fixed orthodontic treatment. Exclusion criteria were split-mouth study designs or studies that failed to report WSLs as the outcome variable or studies with less than 3 months follow-up. An Inverse-Variance fixed-effect method was performed for continuous variables. Changes in the mean difference (MD) for the DIAGNOdent (DD) scores following FV application were calculated at the 95% confidence interval (CI). Results: Three of the four included studies showed significant improvement in the remineralisation of WSL after treatment with FV in comparison to control subjects. Three studies were conducted on patients after fixed orthodontic treatment and one study was conducted during treatment. The studies included a total of 284 participants with the majority in the age range of 10 to 25 years. The distribution of the participants was approximately equal in the FV and control group. When compared with the control group, there was a statistically significant reduction in the mean DD readings for the FV group at the 3-month (MD=-3.43; 95% CI:-4.72 to-2.15; p < 0.001) and at the 6-month (MD =-4.47; 95% CI:-4.72 to-2.15; p < 0.001) follow-up visit. Conclusions: Although few studies have shown the effectiveness of FV application in the treatment of orthodontically-induced WSLs, the limited number of robust clinical trials, makes it difficult to draw a definitive conclusion.