Caries associated with orthodontic care part 2: management

As discussed in the first of these papers, one of the most commonly recognized complications of orthodontic care is demineralization due to poor oral hygiene.¹ Studies have shown the incidence of developing white spot lesions during fixed appliance treatment (Figure 1) to be as high as 73%, with 2.3% of patients developing cavities.²Figure 2 shows demineralization associated with poor oral hygiene and sub-optimal fluoride exposure whilst wearing a fixed appliance.

The first of these papers described the aetiology, prevalence and prevention of demineralization associated with orthodontic care. This second paper describes the treatments available to manage caries focusing on demineralization post orthodontic treatment. The following are the more commonly used treatment methods to treat these lesions.

Natural remineralization of white spot lesions can occur as dental mineral is in equilibrium with its environment. A non-orthodontic study by Backer-Dirks found that 37 out of 72 white spot lesions disappeared over a 6-year period.³ For this to occur, however, it is important to note that the caries challenge must either be reduced or eliminated and sufficient mineral must be introduced into the voids present in the white spot lesions, to return the refractive index of the enamel to normal. This can be achieved firstly by the use of fluoridated toothpaste twice daily as recommended.⁴ In addition, as with the prevention of demineralization, the use of high strength fluoride toothpastes and fluoride mouthrinses should be advised.