How to manage white spot lesions in fixed orthodontic appliances?
This summary is based on the article published in the Journal of Esthetic and Restorative Dentistry: A contemporary review of white spot lesions in orthodontics (April 2013)
Context
White spot lesions (WSL) associated with fixed orthodontic appliances are a common adverse effect of orthodontic treatment and represent a significant challenge to achieving esthetic excellence.
Purpose
The purpose of this article is to review the current evidence regarding diagnosis, risk assessment, prevention, intratreatment management, and post-orthodontic treatment of WSL and to provide clinical recommendations useful for both the orthodontist and the general dentist.
Key Messages
- White spot lesions associated with orthodontic treatment are a common problem that can be minimized with appropriate prevention, management, and treatment approaches.
- The risk-assessment methods and recommendations for prevention and intratreatment management of WSL may help to minimize this common problem in your patients; however, no matter how hard we strive, it is unlikely that we can completely eliminate this problem.
- It is imperative for both orthodontists and general practitioners to have consistent protocols for caries risk assessment, prevention, intratreatment management, and treatment of WSL.
- Clinicians should take care to include discussion of WSL risk as part of any orthodontic informed consent process, and thorough documentation of preventive measures, as well as assessment of compliance with oral hygiene is essential.
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The title was “How to manage WSL” was not really answered but only recognized the problem….I have tried re-mineralization with MI paste used as an ointment at bed time for 10-14 days and have had varying degrees of success. I believe some of the newer brands of toothpaste such as Colgate Relief, Crest Pro…could also be used. The other avenue is to whiten the teeth, which tones down the WSL. It would be interesting to see if a chlorohexidine varnish around the fixed appliance would be effective? I try this less intrusive therapies first before doing resin restorations, depending on depth and location of the WSL….just a few thoughts.
For your information and consideration.
Warmest regards,
Dr. Gary S. Ford
I have had great success with developmental and post-orthodontic WSL treatment by gentle discing and polishing of those smooth surface lesions, being careful not to create abnormal enamel contours. Instead of micro-abrasion, use of fine cutting or polishing burs to remove as much as micro-abrasion (less than 0.3 mm) has been very successful in most cases. In severe cases the WSL reduction is significant, often requiring no more treatment. This technique is inexpensive and readily understandable by patients and leaves plenty of enamel to protect the dentin and maintain aesthetic colour and shape.
I have had moderate to excellent success using a product called ICON (by DMG America) to mask white spot lesions following orthodontic treatment, even years later. In cases where the WSL was not completely masked with ICON, additional whitening has been chosen by patients, with good results, or if I suspect that the lesion will be difficult to mask, some pre-polishing to remove very minimal decalcified structure before proceeding seems to help. With MI paste alone I have had limited success, but in combination with some of the above techniques, results have improved.
The best treatment options and treatment ratoionale for early demineralization that I have seen comes from Dr. Hien Ngo. He advocates etching the enamel prior to applying MI paste so that it gets to subsurface depths….makes sense to me. I have also etched, then applied Fuji Triage (use the pink stuff…kids hate it and try to brush it off….so it helps with OH) for a few months.
Just to note, if you click on the link to the full article, it does go into detail about treatment and prevention.
The article mentions micro-abrasion as a treatment option… I was wondering if someone could explain their clinical protocol for doing this as the article didn’t explain very well