Fluorides, orthodontics and demineralization: a systematic review.
OBJECTIVE
To evaluate the effectiveness of fluoride in preventing white spot lesion (WSL) demineralization during orthodontic treatment and compare all modes of fluoride delivery.


METHODS
The search strategy for the review was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for RCTs or CCTs: Cochrane Clinical Trials Register, Cochrane Oral Health Group Specialized Trials Register, MEDLINE and EMBASE. Inclusion and exclusion criteria were applied when considering studies to be included. Authors of trials were contacted for further data.


METHODS
The primary outcome of the review was the presence or absence of WSL by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth.


METHODS
Six reviewers independently, in duplicate, extracted data, including an assessment of the methodological quality of each trial.


RESULTS
Fifteen trials provided data for this review, although none fulfilled all the methodological quality assessment criteria. One study found that a daily NaF mouthrinse reduced the severity of demineralization surrounding an orthodontic appliance (lesion depth difference -70.0 microm; 95% CI -118.2 to -21.8 microm). One study found that use of a glass ionomer cement (GIC) for bracket bonding reduced the prevalence of WSL (Peto OR 0.35; 95% CI 0.15-0.84) compared with a composite resin. None of the studies fulfilled all of the methodological quality assessment criteria.


CONCLUSIONS
There is some evidence that the use of a daily NaF mouthrinse or a GIC for bonding brackets might reduce the occurrence and severity of WSL during orthodontic treatment. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient.
Department of Oral Health and Development, School of Clinical Dentistry, Claremont Crescent, Sheffield S10 2TA, UK. p.benson@sheffield.ac.uk
P E
PE
Benson
A A
AA
Shah
D T
DT
Millett
F
F
Dyer
N
N
Parkin
R S
RS
Vine
D002327:Cariostatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001840:Dental Bonding; D003731:Dental Caries / Q000517:prevention & control; D005459:Fluorides / Q000008:administration & dosage / Q000627:therapeutic use*; D005899:Glass Ionomer Cements / Q000737:chemistry; D006801:Humans; D009067:Mouthwashes / Q000627:therapeutic use; D009967:Orthodontic Appliances; D017001:Tooth Demineralization / Q000517:prevention & control*
D002327:Cariostatic Agents; D005899:Glass Ionomer Cements; D009067:Mouthwashes; D005459:Fluorides