Fluorides for the prevention of white spots on teeth during fixed brace treatment

Benson PE, Parkin N, Millett DT, Dyer F, Vine S, Shah A

Published Online:

October 8, 2008

There is some evidence that a daily fluoride mouthrinse or a fluoride-containing cement will reduce tooth decay if used during treatment with fixed braces.
Tooth decay, in the form of unsightly white spots, can occur on teeth being straightened with fixed braces if they are not cleaned properly. The review found that a daily sodium fluoride mouthrinse reduces the depth of decay that develops on a tooth during treatment with fixed braces. Also, one fluoride-containing cement reduced the number of white spots and the amount of tooth material lost to decay. More high quality research is needed to be sure which is the best way to get the fluoride to the tooth surface in patients during treatment with braces and whether there are any adverse effects. Based on current best practice in other areas of dentistry for which there is evidence, we recommend that patients with fixed braces rinse daily with a 0.05% sodium fluoride mouthrinse.

Abstract (click to read)

Background:

White spots can appear on teeth during fixed brace treatment because of early decay around the brace attachments. Fluoride is effective at reducing decay in susceptible individuals and is routinely prescribed in various different forms to patients during orthodontic treatment.

Objectives:

To evaluate the effectiveness of fluoride in preventing white spots during orthodontic treatment and to compare the different modes of delivery of fluoride.

Search strategy:

We searched the Cochrane Oral Health Group's Trials Register (January 2004); CENTRAL (The Cochrane Library 2002, Issue 3); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to July 2003). Authors of trials were contacted for further data.

Selection criteria:

Trials were selected if they met the following criteria: a randomised or quasi-randomised clinical trial, involving the use of a fluoride-containing product compared with no use or use of a non-fluoride control and enamel demineralisation was assessed during or after orthodontic treatment.

Data collection and analysis:

Six reviewers independently, in duplicate, extracted data. The primary outcome was the difference in the presence or absence of white spots between experimental and control patients for parallel design studies, and between experimental and control quadrants, for split-mouth design studies. Potential sources of heterogeneity were examined. Sensitivity analyses were undertaken for the items assessed for quality and publication bias.

Main results:

The primary outcome of the review was the presence or absence of white spots by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Other outcomes such as differences in size and severity of white spots, any patient based outcomes, such as perception of white spots could not be included because there were insufficient data.

Fifteen trials, with 723 participants, provided data for this review. None of the studies fulfilled all of the methodological quality assessment criteria.

There is some evidence that a daily sodium fluoride mouthrinse reduces the severity of enamel decay surrounding a fixed brace (weighted mean difference for lesion depth -70.0; 95% CI -118.2 to -21.8) and that use of a glass ionomer cement for bracket bonding reduces the prevalence (Peto OR 0.35; 95% CI 0.15 to 0.84) and severity of white spots (weighted mean difference for mineral loss -645 vol%.μm; 95% CI -915 to -375) compared with composite resins.

Authors' conclusions:

There is some evidence that the use of topical fluoride or fluoride-containing bonding materials during orthodontic treatment reduces the occurrence and severity of white spot lesions, however there is little evidence as to which method or combination of methods to deliver the fluoride is the most effective. Based on current best practice in other areas of dentistry, for which there is evidence, we recommend that patients with fixed braces rinse daily with a 0.05% sodium fluoride mouthrinse. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient.

This record should be cited as:

Benson PE, Parkin N, Millett DT, Dyer F, Vine S, Shah A. Fluorides for the prevention of white spots on teeth during fixed brace treatment. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003809. DOI: 10.1002/14651858.CD003809.pub2

Assessed as up to date:

May 21, 2004

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Craniofacial anomalies > Orthodontic treatment

Dentistry & oral health > Dental caries > Prevention

Demographic:

Children

Cochrane group topics: