title: Factors Affecting the Formation, Severity and Location of White Spot Lesions during Orthodontic Treatment with Fixed Appliances.
abstract: OBJECTIVE
  The purpose of the present study was to investigate factors affecting the formation, severity and location of white spot lesions in patients completing fixed appliance therapy.
  
  
  METHODS
  A total of 45 patients (19 males and 26 females, mean age 15.81 years, standard deviation 2.89 years) attending consecutively Aberdeen Dental Hospital (ADH) between January and June 2013 to have their fixed appliances removed were given a questionnaire to elicit information regarding their dental care and diet. They were then examined clinically as well as their pre-treatment photographs to record treatment data and white spot lesion (WSL) location and severity using a modified version of Universal Visual Scale for Smooth Surfaces (UniViSS Smooth). Absolute risk (AR) and risk ratios (RR) were also calculated.
  
  
  RESULTS
  The incidence of at least one WSL observed in patients was 42%, with males displaying a higher incidence than females. The highest incidence of WSLs was recorded on the maxillary canines and lateral incisors, and on the maxillary and mandibular premolars and first molars. The gingival areas of the maxillary and mandibular teeth were the most affected surfaces. Significant (P < 0.05) relationships were found between the presence of WSLs and the following factors: poor oral hygiene (OH), males, increased treatment length, lack of use of fluoride supplements, use of carbonated soft drinks and/or fruit juices and the use of sugary foods. Poor OH posed the highest risk of developing WSL (RR = 8.55).
  
  
  CONCLUSIONS
  42% of patients have developed white spot lesions during fixed appliance therapy. Various contributing risk factors were identified with the greatest risk posed by a poor oral hygiene.
authors.affiliation: Department of Orthodontics, University of Aberdeen, Aberdeen United Kingdom.
authors.forename: Khaled
authors.initials: K
authors.lastname: Khalaf
keywords: dental white spot; fluoride; orthodontic brackets; orthodontic wires; risk factors; teeth.