White Spot Lesions During Orthodontic Treatment: Mechanisms and Fluoride Preventive Aspects

Decalcifications in the form of white spot lesions appear frequently in orthodontic patients as small lines along the bracket periphery and in a few patients as large decalcifications with or without cavitations. Improper oral hygiene around the appliance induces a low resting pH plaque that may reduce the cariostatic properties of fluoride therapy. Optimal oral hygiene and daily use of a fluoride toothpaste and mouth rinse are essential and have a synergistic effect. Recent advances in fluoride research have shown that fluoride agents like stannous fluoride and titanium fluoride deposit reservoirs on the tooth surface that may resist even low pH and severe caries challenges.