White Spot Lesions After Orthodontic Treatment

This article examines the prevalence and distribution of white spots after orthodontic treatment and reviews their management in the postorthodontic phase. Demineralized white spot lesions occur disturbingly frequently after orthodontic treatment, with some reports of high numbers of teeth affected, and approximately a third of orthodontic patients have at least one white lesion. Some teeth are more prone to demineralization, typically the maxillary lateral incisors and mandibular canine teeth. The distogingival area of the labial enamel surface is the most commonly affected. In the first few weeks after removal of appliances there is typically an exponential reduction of white spot lesion size by remineralization, and about half of the original lesion has remineralized after 6 months with no specific treatment. Various treatments have been proposed to assist remineralization. Fluoride must not be used in high concentration, as it arrests the remineralization as well as the demineralization and can lead to unsightly staining. Low concentrations of fluoride may assist remineralization, but this cannot be demonstrated in a prospective randomized study. Casein calcium phosphate materials and salivary stimulation by chewing gum may be effective in assisting remineralization, but as yet there are no clinical studies to demonstrate benefit over natural remineralization. For severe cases, acid microabrasion is recommended.