title: A practice-based evaluation of the prevalence and predisposing etiology of white spot lesions.
abstract: OBJECTIVE
  To use an alumni-centered, practice-based research network to evaluate white spot lesions (WSLs) among treated orthodontic patients.
  
  
  METHODS
  An initial survey was conducted to ascertain whether orthodontic alumni from Texas A&M University Baylor College of Dentistry were willing to participate. Twenty randomly selected alumni participated, providing 158 treated cases. Each alumnus (1) obtained internal review board consent; (2) submitted pre- and posttreatment photographs of 10 consecutively finished cases; (3) completed a treatment survey; and (4) had the patient/parent complete the American Dental Association (ADA) Caries Risk Assessment.
  
  
  RESULTS
  Almost 90% of the alumni surveyed were willing to participate in the practice-based research, primarily because a fellow alumnus asked them to. Approximately 28% of the patients developed WSLs. The average patient developed 2.4 white spots, affecting 12.7% of the teeth examined. WSLs were significantly (P < .001) more (2.3-3.2 times) likely for patients who were identified on the ADA Caries Risk Assessment. The risk of developing WSLs during treatment was also increased for those with fair (2.7 times) or poor (3.5 times) oral hygiene, poor gingival health (2.3 times), and extended treatment times (2.1 times).
  
  
  CONCLUSIONS
  There is a substantial risk of developing WSLs among private practice patients, depending partially on the length of treatment. Patients at greatest risk can be identified prior to treatment based on the ADA Caries Risk Assessment, oral hygiene, and gingival health.
authors.affiliation: a  Highland Village, Tex.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Brown
authors.affiliation: b  Chairman, Associate Professor, Orthodontic Department, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Tex.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Campbell
authors.affiliation: c  Professor, Department of Biomedical Sciences, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Tex.
authors.forename: Emet D
authors.initials: ED
authors.lastname: Schneiderman
authors.affiliation: d  Regents Professor and Director of Orthodontic Research, Orthodontic Department, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Tex.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Buschang
mesh_terms: D003731:Dental Caries / Q000453:epidemiology* / Q000209:etiology*; D005881:Gingiva / Q000473:pathology; D006801:Humans; D009910:Oral Hygiene; D009972:Orthodontics, Interceptive; D015995:Prevalence; D018570:Risk Assessment; D013781:Texas
keywords: PBRN; Risk factors; White spot lesions