Demineralized white spot lesions: An unmet challenge for orthodontists

Matthew J. Miller, Shira Bernstein, Stephanie L. Colaiacovo, Olivier Nicolay, George J. Cisneros

Research output: Contribution to journalArticle

Abstract

White spot lesions (WSLs) are an all too common negative outcome of orthodontic treatment: a disheartening truth in an esthetically driven profession. WSLs are areas of enamel demineralization 100-150-μm deep, with an intact porous surface layer, which can progress until a complete inward collapse of the surface occurs. Their un-esthetic opaque appearance is potentially reversible, but irreversible once cavitated. Clinically detectable WSLs can occur as early as 1 month after fixed appliance placement. It is estimated that 50% of patients develop WSLs in at least one tooth by the end of orthodontic treatment. Although orthodontists have recognized this issue, the problem still persists. An immediate application of fluoride to a white spot lesion will cause a rapid surface remineralization, leaving deeper layers demineralized, so prevention of lesion progression is necessary for an ideal esthetic outcome. Aside from excellent oral hygiene, fluoride varnish, MI Paste, and smooth surface sealants are currently the primary methods of WSL prevention. There is an existing body of research related to the use of topical fluoride and calcium-phosphate pastes to prevent demineralization during orthodontic treatment, including at-home topical treatments. However, the self-reported compliance rate is approximately 50%. Professional fluoride varnish is thought to have the advantages of reducing demineralization without being technique sensitive. Other methods of WSL prevention are available, such as placement of sealants on facial surfaces of teeth, but preliminary research has shown conflicting results on their effectiveness. Regression of WSLs after treatment is attributed to gradual surface abrasion of tooth structure. Research has shown no improvement in WSLs when comparing non-invasive treatment methods such as MI Paste to routine oral hygiene practice. Success has been shown in treating arrested WSLs with a resin infiltration technique, but this is most useful on a small scale.

Original languageEnglish (US)
JournalSeminars in Orthodontics
DOIs
StateAccepted/In press - 2016

Fingerprint

Dental Caries
Topical Fluorides
Ointments
Orthodontics
Oral Hygiene
Esthetics
Tooth
Tooth Abrasion
Dental Enamel
Fluorides
Phosphates
Calcium

ASJC Scopus subject areas

  • Orthodontics

Cite this

Demineralized white spot lesions : An unmet challenge for orthodontists. / Miller, Matthew J.; Bernstein, Shira; Colaiacovo, Stephanie L.; Nicolay, Olivier; Cisneros, George J.

In: Seminars in Orthodontics, 2016.

Research output: Contribution to journalArticle

Miller, Matthew J.; Bernstein, Shira; Colaiacovo, Stephanie L.; Nicolay, Olivier; Cisneros, George J. / Demineralized white spot lesions : An unmet challenge for orthodontists.

In: Seminars in Orthodontics, 2016.

Research output: Contribution to journalArticle

@article{c0b67e413ca84b4b8d52e473cfcd7dfe,
title = "Demineralized white spot lesions: An unmet challenge for orthodontists",
abstract = "White spot lesions (WSLs) are an all too common negative outcome of orthodontic treatment: a disheartening truth in an esthetically driven profession. WSLs are areas of enamel demineralization 100-150-μm deep, with an intact porous surface layer, which can progress until a complete inward collapse of the surface occurs. Their un-esthetic opaque appearance is potentially reversible, but irreversible once cavitated. Clinically detectable WSLs can occur as early as 1 month after fixed appliance placement. It is estimated that 50% of patients develop WSLs in at least one tooth by the end of orthodontic treatment. Although orthodontists have recognized this issue, the problem still persists. An immediate application of fluoride to a white spot lesion will cause a rapid surface remineralization, leaving deeper layers demineralized, so prevention of lesion progression is necessary for an ideal esthetic outcome. Aside from excellent oral hygiene, fluoride varnish, MI Paste, and smooth surface sealants are currently the primary methods of WSL prevention. There is an existing body of research related to the use of topical fluoride and calcium-phosphate pastes to prevent demineralization during orthodontic treatment, including at-home topical treatments. However, the self-reported compliance rate is approximately 50%. Professional fluoride varnish is thought to have the advantages of reducing demineralization without being technique sensitive. Other methods of WSL prevention are available, such as placement of sealants on facial surfaces of teeth, but preliminary research has shown conflicting results on their effectiveness. Regression of WSLs after treatment is attributed to gradual surface abrasion of tooth structure. Research has shown no improvement in WSLs when comparing non-invasive treatment methods such as MI Paste to routine oral hygiene practice. Success has been shown in treating arrested WSLs with a resin infiltration technique, but this is most useful on a small scale.",
author = "Miller, {Matthew J.} and Shira Bernstein and Colaiacovo, {Stephanie L.} and Olivier Nicolay and Cisneros, {George J.}",
year = "2016",
doi = "10.1053/j.sodo.2016.05.006",
journal = "Seminars in Orthodontics",
issn = "1073-8746",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Demineralized white spot lesions

T2 - Seminars in Orthodontics

AU - Miller,Matthew J.

AU - Bernstein,Shira

AU - Colaiacovo,Stephanie L.

AU - Nicolay,Olivier

AU - Cisneros,George J.

PY - 2016

Y1 - 2016

N2 - White spot lesions (WSLs) are an all too common negative outcome of orthodontic treatment: a disheartening truth in an esthetically driven profession. WSLs are areas of enamel demineralization 100-150-μm deep, with an intact porous surface layer, which can progress until a complete inward collapse of the surface occurs. Their un-esthetic opaque appearance is potentially reversible, but irreversible once cavitated. Clinically detectable WSLs can occur as early as 1 month after fixed appliance placement. It is estimated that 50% of patients develop WSLs in at least one tooth by the end of orthodontic treatment. Although orthodontists have recognized this issue, the problem still persists. An immediate application of fluoride to a white spot lesion will cause a rapid surface remineralization, leaving deeper layers demineralized, so prevention of lesion progression is necessary for an ideal esthetic outcome. Aside from excellent oral hygiene, fluoride varnish, MI Paste, and smooth surface sealants are currently the primary methods of WSL prevention. There is an existing body of research related to the use of topical fluoride and calcium-phosphate pastes to prevent demineralization during orthodontic treatment, including at-home topical treatments. However, the self-reported compliance rate is approximately 50%. Professional fluoride varnish is thought to have the advantages of reducing demineralization without being technique sensitive. Other methods of WSL prevention are available, such as placement of sealants on facial surfaces of teeth, but preliminary research has shown conflicting results on their effectiveness. Regression of WSLs after treatment is attributed to gradual surface abrasion of tooth structure. Research has shown no improvement in WSLs when comparing non-invasive treatment methods such as MI Paste to routine oral hygiene practice. Success has been shown in treating arrested WSLs with a resin infiltration technique, but this is most useful on a small scale.

AB - White spot lesions (WSLs) are an all too common negative outcome of orthodontic treatment: a disheartening truth in an esthetically driven profession. WSLs are areas of enamel demineralization 100-150-μm deep, with an intact porous surface layer, which can progress until a complete inward collapse of the surface occurs. Their un-esthetic opaque appearance is potentially reversible, but irreversible once cavitated. Clinically detectable WSLs can occur as early as 1 month after fixed appliance placement. It is estimated that 50% of patients develop WSLs in at least one tooth by the end of orthodontic treatment. Although orthodontists have recognized this issue, the problem still persists. An immediate application of fluoride to a white spot lesion will cause a rapid surface remineralization, leaving deeper layers demineralized, so prevention of lesion progression is necessary for an ideal esthetic outcome. Aside from excellent oral hygiene, fluoride varnish, MI Paste, and smooth surface sealants are currently the primary methods of WSL prevention. There is an existing body of research related to the use of topical fluoride and calcium-phosphate pastes to prevent demineralization during orthodontic treatment, including at-home topical treatments. However, the self-reported compliance rate is approximately 50%. Professional fluoride varnish is thought to have the advantages of reducing demineralization without being technique sensitive. Other methods of WSL prevention are available, such as placement of sealants on facial surfaces of teeth, but preliminary research has shown conflicting results on their effectiveness. Regression of WSLs after treatment is attributed to gradual surface abrasion of tooth structure. Research has shown no improvement in WSLs when comparing non-invasive treatment methods such as MI Paste to routine oral hygiene practice. Success has been shown in treating arrested WSLs with a resin infiltration technique, but this is most useful on a small scale.

UR - http://www.scopus.com/inward/record.url?scp=84977557505&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84977557505&partnerID=8YFLogxK

U2 - 10.1053/j.sodo.2016.05.006

DO - 10.1053/j.sodo.2016.05.006

M3 - Article

JO - Seminars in Orthodontics

JF - Seminars in Orthodontics

SN - 1073-8746

ER -