White lesions after orthodontic treatment: does low fluoride make a difference?
OBJECTIVE
To compare and measure the changes in size of post-orthodontic demineralized white lesion enamel lesions treated with a low fluoride (50 ppm) versus a non-fluoride mouthrinse/toothpaste regime.


METHODS
An experimental double-blind prospective randomized clinical controlled trial.


METHODS
A university dental school orthodontic clinic (Sheffield, UK).


METHODS
Twenty-six patients identified as having post-orthodontic demineralized white lesions on removal of their fixed appliance. METHOD AND INTERVENTIONS: The participants were randomly and blindly assigned to either a low fluoride mouthrinse/toothpaste treatment regime or an inactive control. Computerized image analysis of calibrated photographic images taken under polarized light were used to measure the lesions.


METHODS
Lesion size and proportion (DWL%t) and percentage reduction (ADPR) at debond, and at 12 and 26 weeks later.


RESULTS
Five participants dropped out of the study, 12 had the low fluoride regime and 9 did not. As a percentage of the total labial tooth area (DWL%t) the mean size of the lesions at debond was 8.1% (SD 3.7). After 12 weeks the mean size of lesion had reduced to 4.6% (SD 2.6), which was a significant reduction (p=0.03). After 26 weeks the mean size was 3.5% (SD 2.1), which was a very significant reduction (p<0.003). This confirmed statistically that post-orthodontic demineralized white lesions do reduce in size with time reflecting remineralization or other enamel surface changes. Intervention using a test low fluoride mouthrinse/toothpaste combination at 26 weeks showed an average difference percentage reduction (ADPR) of 54.3% (Upper 95% CI=62.08, Lower 95% CI=46.44%) compared with a non-active control combination, which showed an ADPR of 66.1% (Upper 95% CI=77.74, Lower 95% CI=54.51%). This failed to show any differences or therapeutic affect.


CONCLUSIONS
Post-orthodontic demineralized white lesions reduced in size during the 6 months following treatment by approximately half the original size. There was no clinical advantage in using the low fluoride formulation of mouthrinse/toothpaste in this study.
Department of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield S10 2TA, UK. D.Willmot@Sheffield.ac.uk.
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Willmot
D000293:Adolescent; D000328:Adult; D002327:Cariostatic Agents / Q000008:administration & dosage*; D003731:Dental Caries / Q000473:pathology / Q000517:prevention & control*; D017005:Dental Debonding; D003743:Dental Enamel / Q000187:drug effects / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D005459:Fluorides / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009067:Mouthwashes / Q000008:administration & dosage; D009967:Orthodontic Appliances / Q000009:adverse effects*; D023861:Photography, Dental; D011446:Prospective Studies; D014089:Tooth Remineralization; D014100:Toothpastes / Q000008:administration & dosage; D016896:Treatment Outcome
D002327:Cariostatic Agents; D009067:Mouthwashes; D014100:Toothpastes; D005459:Fluorides