Switch to Dark theme

References

Meeran NA. Iatrogenic possibilities of orthodontic treatment and modalities of prevention. J Orthod Sci. 2013; 2:73-86 https://doi.org/10.4103/2278-0203.119678
Summitt JB, Robbins JW, Schwartz RS. Fundamentals of Operative Dentistry: A Contemporary Approach, 3rd edn. Hanover Park, IL: Quintessence Publishing; 2006
Chapman JA, Roberts WE, Eckert GJ Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2010; 138:188-189
Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011; 81:206-210
Julien KC, Buschang PH, Campbell PM. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod. 2013; 83:641-647 https://doi.org/10.2319/071712-584.1
Mizrahi E. Enamel demineralization following orthodontic treatment. Am J Orthod Dentofacial Orthop. 1982; 82:62-67
Bevinagidad S, Setty S, Patil A, Thakur S. Estimation and correlation of salivary calcium, phosphorous, alkaline phosphatase, pH, white spot lesions, and oral hygiene status among orthodontic patients. J Indian Soc Periodontol. 2020; 24:117-121 https://doi.org/10.4103/jisp.jisp_440_19
Maxfield BJ, Hamdan AM, Tüfekçi E Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists. Am J Orthod Dentofacial Orthop. 2012; 141:766-773 https://doi.org/10.1016/j.ajodo.2011.10.030
Al-Omari I, Al-Bitar Z, Hamdan AM. Do various degrees of tooth decalcification affect orthodontists. general dentists' and laypersons' ratings of smile esthetics?. Angle Orthod. 2020; 90:405-410 https://doi.org/10.2319/080619/515.1
Bishara SE, Ostby AW. White spot lesions: formation, prevention, and treatment. Semin Orthod. 2008; 14:174-182 https://doi.org/10.1053/j.sodo.2008.03.002
Ren Y, Jongsma MA, Mei L Orthodontic treatment with fixed appliances and biofilm formation-a potential public health threat?. Clin Oral Investig. 2014; 18:1711-1718 https://doi.org/10.1007/s00784-014-1240-3
Sonesson M, Bergstrand F, Gizani S, Twetman S. Management of post-orthodontic white spot lesions: an updated systematic review. Eur J Orthod. 2017; 39:116-121
Pereira Paula AB, Fernandes AR, Coelho AS Therapies for white spot lesions: a systematic review. J Evid Based Dent Pract. 2016; 17:23-38 https://doi.org/10.1016/j.jebdp.2016.10.003
Höchli D, Hersberger-Zurfluh M, Papageorgiou S, Eliades T. Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis. Eur J Orthod. 2017; 39:122-133
Bakdach W, Hadad R. Effectiveness of different adjunctive interventions in the management of orthodontically induced white spot lesions: A systematic review of systematic reviews and meta-analyses. Dent Med Probl. 2020; 57:305-325 https://doi.org/10.17219/dmp/118330
Chatterjee R, Kleinberg I. Effect of orthodontic band placement on the chemical composition of human incisor plaque. Arch Oral Biol. 1979; 24:97-100
Lundstrom F, Krasse B. Streptococcus mutans and lactobacilli frequency in orthodontic patients: the effect of chlorhexidine treatments. Eur J Orthod. 1987; 9:109-116
Øgaard B, Rølla G, Arends J. Orthodontic appliances and enamel demineralization: Part 1. Lesion development. Am J Orthod Dentofacial Orthop. 1988; 94:68-73
Øgaard B, Rølla G, Arends J, ten Cate JM. Orthodontic appliances and enamel demineralization: Part 2. Prevention and treatment of lesions. Am J Orthod Dentofacial Orthop. 1988; 94:123-128
van der Veen MH, Mattousch T, Boersma JG. Longitudinal development of caries lesions after orthodontic treatment evaluated by quantitative light-induced fluorescence. Am J Orthod Dentofacial Orthop. 2007; 131:223-228 https://doi.org/10.1016/j.ajodo.2005.07.017
Øgaard B. White spot lesions during orthodontic treatment: mechanisms and fluoride preventive aspects. Semin Orthod. 2008; 14:183-193
Torlakovic L, Olsen I, Petzold C Clinical color intensity of white spot lesions might be a better predictor of enamel demineralization depth than traditional clinical grading. Am J Orthod Dentofacial Orthop. 2012; 142:191-198 https://doi.org/10.1016/j.ajodo.2012.03.025
Denis M, Atlan A, Vennat E White defects on enamel: Diagnosis and anatomopathology: Two essential factors for proper treatment (part 1). Int Orthod. 2013; 11:139-165 https://doi.org/10.1016/j.ortho.2013.02.014
Gugnani N, Pandit IK, Srivastava N International Caries Detection and Assessment System (ICDAS): a new concept. Int J Clin Pediatr Dent. 2011; 4:93-100
Russell AL. The differential diagnosis of fluoride and nonfluoride enamel opacities. J Public Health Dent. 1961; 21:143-146
Lopatiene K, Borisovaite M, Lapenaite E. Prevention and treatment of white spot lesions during and after treatment with fixed orthodontic appliances: a systematic literature review. J Oral Maxillofac Res. 2016; 7 https://doi.org/10.5037/jomr.2016.7201
van der Kaaij NCW, Faaij MJ, ten Cate JM, van der Veen MH. The reproducibility of assessment of white spot lesions adjacent to orthodontic brackets, with a quantitative light induced fluorescence digital camera at different rotations of teeth: an in vitro study. BMC Oral Health. 2018; 18 https://doi.org/10.1186/s12903-018-0667-3
Kim S, Katchooi M, Bayiri B Predicting improvement of postorthodontic white spot lesions. Am J Orthod Dentofacial Orthop. 2016; 149:625-633 https://doi.org/10.1016/j.ajodo.2015.10.025
Khoroushi M, Kachuie M. Prevention and treatment of white spot lesions in orthodontic patients. Contemp Clin Dent. 2017; 8:11-19
Benson PE, Shah AA, Millett DT Fluorides, orthodontics and demineralization: a systematic review. J Orthod. 2005; 32:102-114 https://doi.org/10.1179/146531205225021033
Zabokova-Bilbilova E, Popovska L, Kapusevska B, Stefanovska E. White spot lesions: prevention and management during the orthodontic treatment. Prilozi. 2014; 35:161-168 https://doi.org/10.2478/prilozi-2014-002
Abu Horana OG, Al-Khateeb SN. Comparison of three orthodontic bonding systems in white spot lesion development: a randomized clinical trial. Angle Orthod. 2023; 93:531-537
Sengun A, Sari Z, Ramoglu SI Evaluation of the dental plaque pH recovery effect of a xylitol lozenge on patients with fixed orthodontic appliances. Angle Orthod. 2004; 74:240-244
Pithon MM, Dos Santos MJ, Andrade CSS Effectiveness of varnish with CPP-ACP in prevention of caries lesions around orthodontic brackets: an OCT evaluation. Eur J Orthod. 2015; 37:177-182 https://doi.org/10.1093/ejo/cju031
Ulkur F, Sungurtekin Ekçi E In vitro effects of two topical varnish materials and Er:YAG laser irradiation on enamel demineralization around orthodontic brackets. Sci World J. 2014; 2014 https://doi.org/10.1155/2014/490503
Seino PY, Freitas PM, Marques MM Influence of CO2 (10.6 μm) and Nd:YAG laser irradiation on the prevention of enamel caries around orthodontic brackets. Lasers Med Sci. 2015; 30:611-616
Du M, Cheng N, Tai B Randomised controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. Clin Oral Investig. 2012; 16:463-468 https://doi.org/10.1007/s00784-011-0520-4
Agarwal A, Pandey H, Pandey L, Choudhary G. Effect of fluoridated toothpaste on white spot lesions in postorthodontic patients. Int J Clin Pediatr Dent. 2013; 6:85-88 https://doi.org/10.5005/jp-journals-10005-1195
Huang GJ, Roloff-Chiang B, Mills BE Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomised controlled trial. Am J Orthod Dentofacial Orthop. 2013; 143:31-41 https://doi.org/10.1016/j.ajodo.2012.09.007
Güçlü ZA, Alaçam A, Coleman NJ. A 12-week assessment of the treatment of white spot lesions with CPP-ACP paste and/or fluoride varnish. Biomed Res Int. 2016; 2016:8357621-9 https://doi.org/10.1155/2016/8357621
Beerens MW, van der Veen MH, van Beek H, ten Cate JM. Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up. Eur J Oral Sci. 2010; 118:610-617 https://doi.org/10.1111/j.1600-0722.2010.00780.x
Bröchner A, Christensen C, Kristensen B Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin Oral Investig. 2011; 15:369-373 https://doi.org/10.1007/s00784-010-0401-2
Singh S, Singh S, Goyal A Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial. Prog Orthod. 2016; 17:1-8 https://doi.org/10.1186/s40510-016-0138-9
Karabekiroğlu S, Ünlü N, Küçükyilmaz E Treatment of post-orthodontic white spot lesions with CPP-ACP paste: a three year follow up study. Dent Mater J. 2017; 36:791-797 https://doi.org/10.4012/dmj.2016-228
Beerens MW, ten Cate JM, Buijs MJ, van der Veen MH. Long-term remineralizing effect of MI Paste Plus on regression of early caries after orthodontic fixed appliance treatment: a 12-month follow-up randomised controlled trial. Eur J Orthod. 2018; 40:457-464 https://doi.org/10.1093/ejo/cjx085
Jumanca D, Atena G, Podariu A Infiltration therapy: an alternative to fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. Rev Chim. 2012; 63:783-786
Bailey DL, Adams GG, Tsao CE Regression of post-orthodontic lesions by a remineralizing cream. J Dent Res. 2009; 88:1148-1153 https://doi.org/10.1177/0022034509347168
Yassaei S, Motallaei MN. The Effect of the Er:YAG Laser and MI Paste Plus on the treatment of white spot lesions. J Lasers Med Sci. 2020; 11:50-55 https://doi.org/10.15171/jlms.2020.09
Kwon SR, Ko SH, Greenwall LH. Tooth Whitening in Esthetic Dentistry: Principles and Techniques.London: Quintessence; 2008
Knösel M, Attin R, Becker K, Attin T. External bleaching effect on the color and luminosity of inactive white-spot lesions after fixed orthodontic appliances. Angle Orthod. 2007; 77:646-652 https://doi.org/10.2319/060106-224
Choi Y, Lee D, Kim Y. Colorimetric evaluation of white spot lesions following external bleaching with fluoridation: an in-vitro study. Korean J Orthod. 2018; 48:377-383 https://doi.org/10.4041/kjod.2018.48.6.377
Gizani S, Kloukos D, Papadimitriou A Is bleaching effective in managing post-orthodontic white-spot lesions? A systematic review. Oral Health Prev Dent. 2020; 18:1-10 https://doi.org/10.3290/j.ohpd.a44113
Paris S, Meyer-Lueckel H. Masking of labial enamel white spot lesions by resin infiltration: a clinical report. Quintessence Int. 2009; 40:713-718
Peters MC. Strategies for non-invasive demineralized tissue repair. Dent Clin North Am. 2010; 54:507-525
Bahadır HS, Karadağ G, Bayraktar Y. Minimally invasive approach for improving anterior dental aesthetics: case report with 1-year follow-up. Case Rep Dent. 2018; 2018:4601795-5 https://doi.org/10.1155/2018/4601795
Neuhaus K, Graf M, Lussi A, Katsaros C. Late infiltration of post-orthodontic white spot lesions. J Orofac Orthop. 2010; 71:442-447 https://doi.org/10.1007/s00056-010-1038-0
Kim S, Kim E, Jeong T, Kim J. The evaluation of resin infiltration for masking labial enamel white spot lesions. Int J Paediatr Dent. 2011; 21:241-248 https://doi.org/10.1111/j.1365-263X.2011.01126.x
Hammad SM, El Banna M, El Zayat I, Mohsen MA. Effect of resin infiltration on white spot lesions after debonding orthodontic brackets. Am J Dent. 2012; 25:3-8
Knösel M, Eckstein A, Helms H. Durability of esthetic improvement following Icon resin infiltration of multibracket-induced white spot lesions compared with no therapy over 6 months: a single-center, split-mouth, randomised clinical trial. Am J Orthod Dentofacial Orthop. 2013; 144:86-96 https://doi.org/10.1016/j.ajodo.2013.02.029
Senestraro SV, Crowe JJ, Wang M Minimally invasive resin infiltration of arrested white-spot lesions. J Am Dent Assoc. 2013; 144:997-1005 https://doi.org/10.14219/jada.archive.2013.0225
Eckstein A, Helms H, Knösel M. Camouflage effects following resin infiltration of postorthodontic white-spot lesions in vivo: one-year follow-up. Angle Orthod. 2015; 85:374-380 https://doi.org/10.2319/050914-334.1
Kannan A, Padmanabhan S. Comparative evaluation of Icon resin infiltration and Clinpro XT varnish on colour and fluorescence changes of white spot lesions: a randomised controlled trial. Prog Orthod. 2019; 20:1-8 https://doi.org/10.1186/s40510-019-0276-y
Kobbe C, Fritz U, Wierichs RJ, Meyer-Lueckel H. Evaluation of the value of re-wetting prior to resin infiltration of post-orthodontic caries lesions. J Dent. 2019; 91 https://doi.org/10.1016/j.jdent.2019.103243
Lo Giudice R, Lipari F, Puleio F Spectrophotometric evaluation of enamel color variation using infiltration resin treatment of white spot lesions at one year follow-up. Dent J. 2020; 8 https://doi.org/10.3390/dj8020035
Rohym SM, Harhash AY, Riad MF. One year clinical evaluation of white spot lesions with newly introduced resin modified glassionomer in comparison to resin infiltration in anterior teeth: a split mouth randomised controlled clinical trial from Egypt. Braz Dent Sci. 2021; 24:1-13
Abbas B, Marzouk E, Zaher A. Treatment of various degrees of white spot lesions using resin infiltration: in vitro study. Prog Orthod. 2018; 19:1-10 https://doi.org/10.1186/s40510-018-0223-3
Ardu S, Castioni NV, Benbachir N, Krejci I. Minimally invasive treatment of white spot enamel lesions. Quintessence Int. 2007; 38:633-636
Murphy TC, Willmot DR, Rodd HD. Management of postorthodontic demineralized white lesions with microabrasion: a quantitative assessment. Am J Orthod Dentofacial Orthop. 2007; 131:27-33 https://doi.org/10.1016/j.ajodo.2005.04.041
Jahanbin A, Ameri H, Shahabi M, Ghazi A. Management of post-orthodontic white spot lesions and subsequent enamel discoloration with two microabrasion techniques. J Dent. 2015; 16:56-60
Welbury RR, Carter NE. The hydrochloric acid-pumice microabrasion technique in the treatment of post-orthodontic decalcification. Br J Orthod. 1993; 20:181-185 https://doi.org/10.1179/bjo.20.3.181
Pliska BT, Warner GA, Tantbirojn D, Larson BE. Treatment of white spot lesions with ACP paste and microabrasion. Angle Orthod. 2012; 82:765-769 https://doi.org/10.2319/111611-710.1
Safitri MS, Anggani HS, Purwanegara MK, Sumardi S. Enamel surface quality improvement in white spot lesions after orthodontic treatment using a microabrasion technique with fluoride or calcium phosphopeptide-amorphous calcium phosphate application. Int J Appl Pharm. 2017; 9:114-116
Yetkiner E, Wegehaupt F, Wiegand A Colour improvement and stability of white spot lesions following infiltration, microabrasion, or fluoride treatments in vitro. Eur J Orthod. 2014; 36:595-602 https://doi.org/10.1093/ejo/cjt095
Angriawan IP, Anggani HS, Ismah N. Color changes of post-debonding white spot lesion after microabrasion technique with fluoride and casein phosphopeptide-amorphous calcium phosphate application. Asian J Pharm Clin Res. 2018; 11 https://doi.org/10.22159/ajpcr.2018.v11s1.26605
Fernández-Ferrer L, Vicente-Ruíz M, García-Sanz V Enamel remineralization therapies for treating postorthodontic white-spot lesions. J Am Dent Assoc. 2018; 149:778-786.e2 https://doi.org/10.1016/j.adaj.2018.05.010

Clinical management of post-orthodontic white-spot lesions: an evidence-based approach

From Volume 2, Issue 2, June 2025 | Pages 80-88

Authors

Stefania Stamatiadi

DDS, MSc Aesth Dent (King's College London), PGCert Impl (CAOFDI), Assoc FCGDent (UK), Associate Dentist, Edinburgh Dental Studio, Edinburgh

Articles by Stefania Stamatiadi

Email Stefania Stamatiadi

Manjuthan Ponnampalam

BDSc (Melb), MSc (Lond), MFGDP (RCS Eng), Module Lead MSc in Aesthetic Dentistry, Unit of Distance Learning, King's College London Faculty of Dentistry, Oral and Craniofacial Sciences, London; Private Practice, Camberwell, Victoria, Australia

Articles by Manjuthan Ponnampalam

Shamir B Mehta

BDS, BSc, MClin Dent (Prosth), Dip FFGDP (UK), PhD, FCGDent, FDSRCPS (Glas), FDSRCS (Eng), FDTFEd (RCSEd), FHEA

BDS, BSc, MClin Dent (Prosth), Dip FFGDP (UK), PhD, FCGDent, FDSRCPS (Glas), FDSRCS (Eng), FDTFEd (RCSEd), FHEA, Programme Director MSc in Aesthetic Dentistry, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London; Visiting Professor, Department of Dentistry, Radboud University Medical Centre, Nijmegen, Netherlands

Articles by Shamir B Mehta

Email Shamir B Mehta

Subir Banerji

BDS, MClinDent(Prostho), PhD

BDS, MClinDent (Prostho), PhD, FDS RCPS (Glasg), FCGDent (UK), FDTFEd (RCS Ed), Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London; Professor, School of Dental Health and Care Professions, University of Portsmouth; Associate Professor, Department of Prosthodontics, Melbourne Dental School, University of Melbourne; Private Practice, Ealing, London

Articles by Subir Banerji

Email Subir Banerji

Abstract

White spot lesions (WSLs) are a frequent and unwelcome aesthetic complication following fixed orthodontic therapy. Their management has evolved with the introduction of minimally invasive, conservative, and cosmetically driven techniques. This article outlines the contemporary evidence-based approaches for general dental practitioners to manage WSLs effectively in clinical practice.

CPD/Clinical Relevance: Aesthetic management of post-orthodontic white spot lesions can significantly enhance patient satisfaction and dental appearance when managed with suitable, evidence-informed techniques.

Article

White spot lesions (WSLs) are a common complication of orthodontic treatment.1 They are defined as a ‘subsurface enamel porosity from carious demineralization,’ and appear clinically as ‘a milky white opacity… when located on smooth surfaces’.2 Although they can be present on teeth naturally, they can also appear following orthodontic treatment. Orthodontic treatment with fixed appliances is highly popular, but it is associated with a high prevalence of local enamel demineralization without cavity formation (Figure 1). These lesions become apparent after the removal of brackets and pose an aesthetic problem.3,4

The prevalence of WSLs varies among studies. Tufekci et al4 reported a prevalence of 38% and 46% at 6 and 12 months of orthodontic treatment, respectively, while Julien et al5 documented a prevalence of 23.4% during orthodontic treatment. Existing enamel decalcification prior to orthodontic treatment also tends to deteriorate when patients receive therapy with fixed orthodontic appliances.6 Maxillary canines and lateral incisors are more frequently affected by white spots compared to other teeth.5,7 Various factors contribute to the development of these lesions during orthodontic treatment, with the patient's oral hygiene being most relevant.1

Register now to continue reading

Thank you for visiting Aesthetic Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Up to 2 free article per month
  • New content available

Already have an account? Sign in here