How to… prevent white-spot lesions in ortho patients

White-spot lesions (WSLs) are a common complication of orthodontic treatment whenever patients cannot effectively clean around their orthodontic appliances, resulting in an increase in plaque around their fixed brackets.

As the pH level in the mouth drops, carious decalcification occurs, and Hamdan et al determined that ‘the first clinical evidence of this demineralisation is seen as a WSL’.[1]

According to Fundamentals of Operative Dentistry: A Contemporary Approach, WSLs can be described as subsurface enamel porosites resulting from carious demineralisation that appear as a milky white opacity on smooth surfaces.[2]

Proffit et al found that WSLs remain the most common complication of fixed orthodontic appliance therapy.[3]

A 2011 study reported that as many as 72.9% of patients developed at least one WSL during orthodontic treatment, of which 2.3% were cavitated.[4]

WSLs are notoriously difficult to treat, and very often become permanent regardless of the treatment approach. Clearly prevention is preferable to attempts to cure, and patients must be encouraged to commit to higher levels of oral hygiene during orthodontic treatment by being supplied with the tools to make this possible.

There are many devices currently available to assist orthodontic patients with their daily oral hygiene regime, including “V” shaped toothbrushes for cleaning around braces and single tuft toothbrushes for patients prepared to spend time on their oral hygiene. Products such as interdental brushes and dental floss are able to clean otherwise inaccessible spaces, although string floss may be less effective than was once thought. [5]

In recent years, Water Flossers have rapidly grown in popularity because of their ease of use and efficacy. A recent study has shown that using a Waterpik Water Flosser (with an orthodontic tip) alongside brushing is three times more effective at plaque removal than brushing and flossing and up to five times more effective than brushing alone.[6]

However, there are a wide range of Water Flossers available, with varying levels of performance, and clinicians should be aware when making recommendations to patients that most studies are specific to a particular appliance and results do not apply across the sector.

When used within a comprehensive oral hygiene regime, a high quality Water Flosser can reduce gingivitis[7], bleeding[8], probing pocket depth[9], host inflammatory mediators[10] and calculus[11]. The Waterpik® Water Flosser, for example, is proven to remove up to 99.9% of plaque biofilm from treated areas after only a 3-second treatment.[12],

To prevent the development of WSLs coordination between the orthodontist and the GDP is required to give patients the necessary training and motivation to achieve a high standard of oral hygiene. [13]

Undoubtedly, Water Flossers have a key role to play in maintaining orthodontic patients’ long term oral health, and choosing a tested, proven and quality product is vital to achieve the best results.

For more information on Waterpik Water Flossers contact your wholesaler or visit www.waterpik.co.uk. Waterpik products are widely available in Boots stores and selected Lloyds Pharmacies.

[1] Hamdam AM et al (2012) Preventing and treating white-spot lesions associated with orthodontic treatment: A survey of general dentists and orthodontists. J Am Dent Assoc. Jul; 143(7):777-83.

[2] Summitt JB, Robbins JW, Hilton TJ, Scwartz RS, eds (2006) Fundamentals of Operative Dentistry: A Contemporary Approach. 3rd ed. Chicago. Quintessence. 2-4.

 [3] Proffit WR, White RP, Sarver DM (2003). Contemporary Treatment of Dentofacial Deformity. St Louis. Mosby. 681.

 [4] Richter AE, Arruda AO, Peters MC, Sohn W (2011) Incidence of caries lesions among patients treated with comprehensive orthodontics. Am J Orthod Dentofavial Orthop. 139(5):657-664.

 [5] Berchier et al (2008) The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hygiene. 6(4):265-279.

 [6] Sharma NC, et al (2008) Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. J Ortho Dentofacial Orthop 133(4):565-571.

 [7] Barnes, CM, Russell CM, Reinhardt RA et al (2005) Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis and supragingival plaque. J Clin Dent. 16(3): 71 -77.

 [8] Barnes, CM, Russell CM, Reinhardt RA et al (2005) Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis and supragingival plaque. J Clin Dent. 16(3): 71 -77.

 [9] Jolkovsky DL et al (1990) Clinical and microbiological effects of subgingival and gingival marginal irrigation with chlorhexidine gluconate. J Periodontol. 61: 663-669.

 [10] Cutler CW, Stanford TW, Abraham C, Cederberg RA, Boardman TJ, Ross C. Clinical benefits of oral irrigation are related to reduction of pro-inflammatory cytokine levels and plaque (2000) J Clin Periodontol. 27: 134-143.

 [11] Lobene RR (1969) The effect of a pulsed water pressure cleansing device on oral health. J Periodontol. 40(11): 667-670.

 [12] Gorur A, Lyle, DM, Schaudinn C, Costerton JW (2009) Biofilm removal with a dental water jet. Compend Contin Ed Dent. 30(Special Iss 1):1–6.

 [13] Hamdam AM, et al (2012) Preventing and treating white-spot lesions associated with orthodontic treatment: A survey of general dentists and orthodontists. J Am Dent Assoc. 143(7): 777-83.

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