title: Caries preventive measures in orthodontic practice: the development of a clinical practice guideline.
abstract: OBJECTIVE
  White spot lesions (WSLs) are a side effect of orthodontic treatment, causing esthetic problems and a risk of deeper enamel and dentine lesions. Many strategies have been developed for preventing WSLs, but great variability exists in preventive measures between orthodontists. This study developed statements on which a clinical practice guideline (CPG) can be developed in order to help orthodontists select preventive measures based on the best available evidence.
  
  
  METHODS
  A nominal group technique (RAND-e modified Delphi procedure) was used. A multidisciplinary expert panel rated 264 practice- and evidence-based statements related to the management of WSLs. To provide panel members with the same knowledge, a total of six articles obtained from a systematic review of the literature were read by the panel in preparation of three consensus rounds. According to the technique, a threshold of 75% of all ratings within any 3-point section of the 9-point scale regarding a specific statement was accepted as consensus.
  
  
  RESULTS
  After the first and second consensus rounds, consensus was reached on 37.5 and 31.1% of statements, respectively. For the remaining 31.4% of statements, consensus was reached during a 4-h consensus meeting.
  
  
  CONCLUSIONS
  Statements on the management of WSLs derived from a systematic literature review combined with expert opinion were formally integrated toward consensus through a nominal group technique. These statements formed the basis for developing a CPG on the management of WSLs before and during orthodontic treatment.
authors.affiliation: Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: B C M
authors.initials: BC
authors.lastname: Oosterkamp
authors.affiliation: Department of Global Oral Health, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: W J M
authors.initials: WJ
authors.lastname: van der Sanden
authors.affiliation: Department of Preventive and Restorative Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J E F M
authors.initials: JE
authors.lastname: Frencken
authors.affiliation: Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Kuijpers-Jagtman
mesh_terms: D003731:Dental Caries / Q000209:etiology / Q000517:prevention & control*; D006801:Humans
keywords: Delphi; evidence-based practice; orthodontics; preventive measures; tooth demineralization