Efficacy of Fluoride Varnish in Management of Orthodontic White Spots

Objectives: Fixed orthodontic appliances may harbor plaque and perpetuate the formation of early non-cavitated carious lesions. However, not all patients with poor hygiene develop them. It has been established that fluoride varnish can be used to promote enamel remineralization. The study aimed to assess the efficacy of fluoride varnish in remineralizing early non-cavitated lesions among orthodontic patients.
Methods: A randomized control trial was conducted among 25 patients attending the Orthodontic clinic at Temple University. Patients were ages 11-18 and had fixed orthodontic appliances for a minimum of three months. Eleven were randomly assigned to a test group (Enamel Pro® Varnish fluoride varnish application to white spot lesions every two months) and 14 randomly assigned to a control group (reinforcement of oral hygiene instructions). Data collection was completed every two months over a six-month time period. White spot lesion size, loss of fluorescence (ΔF) and the relative volume of a carious lesion (ΔQ) were measured using Quantitative Light-induced Fluorescence (QLF) photography and the International Caries Detection and Assessment System (ICDAS). Oral hygiene was assessed using Plaque Index (PI) and S. mutans levels were measured using Stripmutans plaque/salivary tests (Dentocult®).
Results: Both the control and experimental group had non-significant decreases in non-cavitated carious ICDAS lesion count (p=0.31, p=0.14, respectively). QLF data illustrated a non-significant increase in ΔF and ΔQ for the control and experimental group (p=0.56, p= 0.59 and p=0.72, .p= 0.25, respectively). The control group displayed significant increases in Stripmutans salivary scores (p<0.05). Stripmutans plaque scores decreased in the experimental group and increased for the control group (p>0.05). PI scores decreased in the control group and increased in the experimental group (p>0.05).
Conclusions: A 5% sodium fluoride varnish containing Amorphous Calcium Phosphate (Enamel Pro® Varnish) fluoride varnish application was not efficacious in reducing early non-cavitated carious lesions when compared to reinforcing oral hygiene.