Fluoride varnish, ozone and octenidine reduce the incidence of white spot lesions and caries during orthodontic treatment: randomized controlled trial

White Spot Lesion Treatment Options: A Systematic Review of Different Techniques for Masking These Lesions

White spot lesions (WSLs) are early clinical stages of enamel demineralization, often related to orthodontic treatment or poor oral hygiene. The use of gels such as fluoride for topical application inhibits demineralization and promotes remineralization of dental tissues through various mechanisms. A variety of therapeutic approaches are available; however, recent research indicates that combined treatment strategies may yield superior clinical outcomes compared to monotherapy. The aim of this study was to critically compare the efficacy of combining multiple treatment techniques for WSLs compared to using these techniques alone. A systematic search was conducted in PubMed, Scopus, and Cochrane databases according to PRISMA guidelines. The PICO strategy was used to formulate the research question: Which clinical approaches combined or isolated (C) influence the treatment and prevention effectiveness (O) of white spot lesions (I) in humans (P) in the last ten years (T)? Inclusion criteria focused on clinical studies from the last ten years evaluating the combined use of at least two treatment techniques for WSL, resulting in a total of 8 randomized controlled trials selected from an initial pool of 1185 articles. Our results suggest that combined treatment strategies, including resin infiltration with fluoride varnish and ozone therapy combined with fluoride application, demonstrated enhanced efficacy in lesion masking and remineralization compared to single-treatment approaches. CPP-ACP and hydroxyapatite-based creams improved aesthetics, particularly when used alongside fluoride varnish. Our study concluded that the combination of remineralization agents like fluoride gel, infiltrative resins, and antimicrobial treatments offers superior outcomes on white spot lesion treatment than using these techniques alone. However, long-term clinical studies are needed to standardize treatment protocols and confirm durability.

Expert consensus on the prevention and treatment of enamel demineralization in orthodontic treatment

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.

Fluoride Varnish For The Prevention Of White Spot Lesions During Orthodontic Treatment: A Systematic Review And Meta-Analysis

BACKGROUND AND AIM

White spot lesions are a potential side effect of orthodontic treatment. This occurs frequently, with a prevalence ranging from 50% to 90%. The lesions typically occur on the labial surface of the gingival region of the tooth. Caries prophylaxis requires use of soluble fluoride to prevent demineralisation and stimulate remineralisation of enamel and dentine. The administration of fluoride varnish is a controlled and professional way of delivering high-fluoride concentrations that do not rely on patient compliance. This meta-analysis will assess the effectiveness of fluoride varnish in avoiding white spot lesions in orthodontics.

MATERIALS

A thorough search was conducted on PubMed/Medline, Scopus, and Google Scholar databases using advanced search strategies, appropriate operators, and tags based on the title and abstract. Two reviewers worked independently to extract data and ensure accuracy and consistency.

RESULTS

Eight randomised control trial articles involving 654 individuals were included. The findings revealed that fluoride varnishes significantly reduced white spot lesions on teeth. Patients who were treated with this substance had visibly reduced lesions (weighted mean difference = -0.54, 95% confidence interval = [-1.01 and -0.07], P < 0.001, I2 = 85.9%).

CONCLUSION

Fluoride varnish significantly reduces the incidence of white spot lesions, but high heterogeneity among studies suggests cautious interpretation of the results.

New Insights Regarding the Use of Relevant Synthetic Compounds in Dentistry

Worldwide, synthetic compounds are used for both in-office and at-home dental care. They are a valuable resource for both prophylactic and curative treatments for various dental problems, such as tooth decay, periodontal diseases, and many more. They are typically preferred due to their broad range of actions and ability to produce targeted, rapid, and long-lasting effects. Using a 0.12% chlorhexidine mouthwash is capable of reducing the plaque index from 47.69% to 2.37% and the bleeding index from 32.93% to 6.28% after just 2 weeks. Mouthwash with 0.1% OCT is also highly effective, as it significantly lowered the median plaque index and salivary bacterial counts in 152 patients in 5 days compared to a control group (p < 0.0001), while also reducing the gingival index (p < 0.001). When povidone-iodine was used as an irrigant during the surgical removal of mandibular third molars in 105 patients, it resulted in notably lower pain scores after 2 days compared to a control group (4.57 ± 0.60 vs. 5.71 ± 0.45). Sodium hypochlorite is excellent for root canal disinfection, as irrigating with 1% NaOCl completely eliminated the bacteria from canals in 65% patients. A 0.05% CPC mouthwash proved effective for perioperative patient care, significantly decreasing gingival bleeding (p < 0.001) and suppressing Streptococcus levels even one week post-surgery. Lastly, a 6% H2O2 paint-on varnish and 6% H2O2 tray formulations successfully bleached the teeth of 40 patients, maintaining a noticeably whiter appearance up to the 6-month follow-up, with significant color differences from the baseline (p < 0.005). Synthetic compounds have a large research base, which also provides a greater awareness of their mechanism of action and potential adverse effects. For a better understanding of how they work, several methods and assays are performed. These are protocolary techniques through which a compound's efficacy and toxicity are established.

The Influence of Fluoride Gels on the Physicochemical Properties of Tooth Tissues and Dental Materials-A Systematic Review

The aim of the presented systematic review is to update the state of knowledge and relate the properties and composition of fluoride gels to their potential application. This article aims to explore the effect of fluoride gel application on changes in the properties of dental biomaterials and tooth tissues. The review includes articles assessing studies on the effects of fluoride gel on dental tissues and materials. Employing the PRISMA protocol, a meticulous search was conducted across the PubMed, Scopus, and Web of Science databases, utilizing keywords such as fluoride, gel, and properties. The publications were selected without limitation by the year of publication, and then Cohen's κ test was used to assess the agreement of the respondents. Exclusion criteria included non-English studies, opinion pieces, editorial papers, letters to the editor, review articles and meta-analyses, clinical reports, studies lacking full-text accessibility, and duplicates. The quality of the chosen papers was assessed by two independent reviewers. A total of 2385 were located in databases, of which only 17 met the inclusion criteria. All publications showed increased surface mineralization, and seven studies showed the effect of fluoride gel on the surface of dental tissues. Three articles stated a negative effect of fluoride gels on titanium and stainless steel alloys and glass ionomer fillings. The effects on shear bond strength and plaque deposition require further investigation because the study results are contradictory.

Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review

BACKGROUND

Fluoride varnish (FV) is an established technology for primary and secondary caries prevention.

OBJECTIVE

The aim of this review was to evaluate the preventive effect of FV on development of white spot lesions (WSL) when regularly applied during orthodontic treatment with fixed appliances.

SEARCH METHODS

We searched PubMed, Scopus and Google Scholar up to October 2022 using predetermined keywords.

SELECTION CRITERIA

We included randomized controlled trials of a duration of minimum 12 months and at least quarterly FV applications.

DATA COLLECTION AND ANALYSIS

Based on abstracts, we retrieved full-text papers, extracted key outcome data, and assessed risk of bias. Primary outcome was prevalence of WSLs on subject level after debonding. We conducted a narrative synthesis and pooled comparable outcome data in a random effects model.

RESULTS

We included seven studies covering 666 patients and assessed four publications with low or moderate risk of bias and three with high. The prevalence of WSLs at debonding varied between 12 and 55%. All studies presented results in favour for the FV intervention, one reached statistical significance on subject level. Five studies provided data for a meta-analysis. The pooled risk ratio was 0.64 [95% CI: 0.42, 0.98], indicating a statistically significant preventive effect. Certainty of evidence was graded as very low after reducing for risk of bias, inconsistency and imprecision.

LIMITATIONS

We pooled data on subject level and did not consider lesion severity on tooth level.

CONCLUSIONS AND IMPLICATIONS

Even if the certainty of evidence was very low, it was shown that FV can prevent development of WSL when regularly applied during orthodontic treatment. Larger investigations reporting a core outcome set are required to increase the certainty of evidence.

REGISTRATION

PROSPERO database (CRD42022370062).

Revisiting Oral Antiseptics, Microorganism Targets and Effectiveness

A good oral health status is mostly dependent on good oral hygiene habits, which knowingly impacts systemic health. Although controversial, chemical oral antiseptics can be useful in adjunct use to mechanical dental plaque control techniques in the prevention and management of local and overall health and well-being. This review aims to revisit, gather and update evidence-based clinical indications for the use of the most popular oral antiseptics, considering different types, microorganism targets and effectiveness in order to establish updated clinical recommendations.