Caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. A systematic review.
A systematic review was performed of published data on the caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. The purpose was to develop evidence-based recommendations about the most effective means of preventing white spot lesions in orthodontic patients. The 15 studies included were divided into four groups based on comparable preventive measures: fluoride, chlorhexidine, sealants and bonding materials. The caries-inhibiting effect of the preventive measures was expressed by the prevented fraction (PF). The overall PF of the fluoride-releasing bonding materials was 20% (SEM 0.09). This effect was, however, not statistically significant. It was impossible to calculate an overall PF for the other preventive measures, but the tendency of their caries-inhibiting effect has been described. The use of toothpaste and gel with a high fluoride concentration of 1,500-5,000 ppm or of complementary chlorhexidine during orthodontic treatment showed a demineralisation-inhibiting tendency. The use of a polymeric tooth coating on the tooth surface around the brackets showed almost no demineralisation-inhibiting effect. Many publications had to be excluded from this systematic review because of improper research designs. Future clinical trials are needed to give evidence- based advice on the optimal caries-prevention strategy.
Department of Orthodontics and Oral Biology, University Medical Centre, Nijmegen, The Netherlands. A.Derks@dent.umcn.nl
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A
Derks
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Katsaros
J E
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Frencken
M A
MA
van't Hof
A M
AM
Kuijpers-Jagtman
D002327:Cariostatic Agents / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use; D001840:Dental Bonding; D003731:Dental Caries / Q000517:prevention & control*; D005459:Fluorides / Q000627:therapeutic use; D006801:Humans; D016910:Orthodontic Brackets; D010895:Pit and Fissure Sealants / Q000627:therapeutic use
D002327:Cariostatic Agents; D010895:Pit and Fissure Sealants; D005459:Fluorides; D002710:Chlorhexidine