Effect of fluoride on preventing orthodontics treatments-induced white spot lesions: an umbrella meta-analysis

Abstract

Purpose: Orthodontic treatments have been associated with certain drawbacks, including an increased risk of dental plaque, demineralization of teeth, and tooth discoloration. Localized enamel porosities that result from tooth demineralization are known as white spot lesions (WSL), which can lead to caries development. The results of the published meta-analysis are inconsistent in some aspects. Therefore, this meta-analysis of meta-analyses was conducted to provide a clear conclusion on the effect of fluoride therapy on orthodontics-induced WSLs. Methods: To identify relevant studies, scientific databases like Web of Science, PubMed, Scopus, Cochrane Central Library, and EMBASE were searched until February 2023. Meta-analysis studies investigating the effect of fluoride in preventing orthodontics treatments-induced white spot lesions. A random-effects model was employed to evaluate the pooled results. Sensitivity and subgroup analyses were conducted. The quality of the included meta-analyses was assessed using the AMSTAR2 questionnaire. Results: A total of 7 studies were incorporated in the analysis involving 7963 participants with a mean age of 16.94 years. The random-effects analysis demonstrated that fluoride interventions significantly reduced the incidence of white spot lesions (ES = −0.39; 95%CI:-0.63,-0.15,p = 0.001;I2 = 77%, p = 0.002). In addition, the forest plot presented evidence that topical fluoride reduced the risk of white spot lesions by 40% (ES = 0.60; 95%CI:0.35,0.86, p = 0.001;I2 = 85%, p = 0.001). Conclusion: Fluoride interventions are effective in reducing the occurrence of white spot lesions during orthodontic treatment. Topical fluoride interventions were found to be particularly effective, especially in smaller and moderate-quality studies. The findings have significant clinical implications and highlight the importance of preventive measures in orthodontic care.