White Spot Lesions and Hygiene in Patients During Orthodontic Treatment

Objectives: To determine the association between Oral Hygiene (OH) and the incidence of White Spot Lesions (WSLs) in patients undergoing orthodontic treatment with fixed appliances.
Methods: This longitudinal study was conducted at the Graduate Orthodontic Clinic of the Autonomous University of Yucatan, Mexico. Approval was obtained from the Institutional Review Board. Eighty-nine 14-25-year-old patients (17.57 ± 3.09 years old) participated in the study. All patients enrolled in the study were interviewed, received a dental examination by a calibrated examiner and had their oral hygiene (OH) evaluated at the start of orthodontic treatment (baseline), at the third, and the sixth month follow up visits after wires and auxiliary attachments were removed. The International Caries Detection and Assessment System (ICDAS) was used to evaluate enamel demineralization (WSLs) and OH was assessed using the Simplified Oral Hygiene Index.
Results: Overall, 37% (n=33) of the patients developed ≥ 1WSL during their course of treatment. Of the subjects who had ≥ 1 WSL, males had a slightly higher incidence than females (51.51% vs 48.49%). The maxillary lateral incisors were the most susceptible to develop WSLs (n=77). At baseline, the most prevalent OH score was “Good” with 64.04% (n=57), which decreased at the sixth month follow up visits to 52.27% (n=46). The difference between the presence of WSLs at the third and the sixth month follow up visits was statistically significant (Wilcoxon signed-rank test, p≤ 0.05). The association between the presence of WSLs and OH was statistically significant (Pearson's χ2, p≤ 0.05).
Conclusions: The majority of the patients in this study developed WSLs over six months of treatment and this was associated with poorer OH scores. Our results support the need for orthodontists to implement caries preventive measures to improve oral hygiene and prevent enamel demineralization.