Preventive effect of varnish fluoride and fluoride mouthwash on enamel demineralization in patients undergoing fixed orthodontic treatment: A systematic review

Background and aim: Orthodontically induced white spot lesions(WSLs) and enamel demineralization are the most common adverse effects of comprehensive fixed applience treatment. The aim of current study was to systematically review the randomized clinical trial(RCT) articles assessing preventive effect of varnish fluoride and fluoride mouthwash on enamel demineralization in patients undergoing fixed orthodontic traetment. Materials and methods: The electronic search was performed in Medline via PubMed and Cochrane library in November 2020. The search was restricted to the English Language. No restriction was set on publication date. RCT articles assessing the preventive effect of fluoride varnish and mouthwash on WSLs or enamel demineralization by clinical or radiographic methods in ten or more patients were included. Result: A total of six articles and a total of 728 participants were included. In 5 articles of them, the patients in test groups were using fluoride mouthwash daily or they were received varnish fluoride multiple times (4-20 times) during their treatment, and those in control groups were received placebo or no treatment; four of them indicated the test groups significantly had lesser new WSLs compared with the placebo groups and the other one article indicated the test groups significantly had lesser demineralization. One of the included articles used varnish once at the beginning of treatment, and there was no significant difference in the amount of enamel demineralization between test and placebo groups. No adverse effects were reported by articles. Conclusion: Based on existing RCT articles, applying multiple varnish fluoride or daily fluoride mouthwash seems to be effective for preventing enamel demineralization, but single use of them has no effect. However, further research is needed.