White Spot Lesions Prevalence and Severity During Early Orthodontic Treatment: a Multicenter Study

Objectives: To assess the prevalence and severity of white spot lesions following phase I (early) fixed orthodontic treatment.
Methods: This retrospective study assessed the presence of white spot lesions (WSL) on maxillary incisors in 200 randomly selected patients who underwent early orthodontic treatment. Pre- and post-treatment images were analyzed using ImageJ software (Version 1.53t, National Institutes of Health, Bethesda, MD). Data on gender, age, oral hygiene, fluorosis, emergency visits, and treatment duration were extracted from electronic health records (EHR). The mean WSL area (%) for each incisor was calculated and compared between pre- and post-treatment. The study also evaluated the impact of age, oral hygiene, gender, and treatment duration on WSL development.
Results: A total of 61 patients met the inclusion criteria, with a mean age of 9.5 years (SD = 1.7). The sample included 38 (62.3%) females and 23 (37.7%) males. A statistically significant increase in the mean percent WSL surface area was observed across all maxillary incisors between pre- and post-treatment (P < 0.05). The upper left lateral incisor (UL2) exhibited the largest increase in WSL area (10.4%, P < 0.05) compared to other incisors. Oral hygiene (P = 0.05) and age (P = 0.04) significantly influenced the presence of WSL on the UL2. However, treatment duration and gender had no significant effect on WSL development (P > 0.05). The Pearson correlation coefficient indicated a weak positive correlation between age and the development of WSL on both the UR1 and UL1.
Conclusions: The prevalence of white spot lesions is significantly associated with early fixed orthodontic treatment in the mixed dentition stage. All maxillary incisors were affected, with a notable increase in the surface area of spot lesions. Emphasis should be placed on maintaining oral hygiene and closely monitoring patients for white spot lesions during phase one treatment.