title: Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial.
abstract: BACKGROUND
  One of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs.
  
  
  METHODS
  Forty-five subjects in the age range of 16-25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinically and by DIAGNOdent immediately after debonding and subsequently after 1, 3, and 6 months of their use.
  
  
  RESULTS
  Twice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations (P = 0.078). Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs (P < 0.01). Twice daily use of CPP-ACP plus crème along with fluoride toothpaste had significant effect on remineralization of WSLs at the end of 6 months of observation (P < 0.05). Between the group comparison showed that the mean visual and DIAGNOdent scores at various time intervals of observations were decreased more when fluoride varnish and CPP-ACP crème were used in addition to daily use of fluoride toothpaste, but the differences were not statistically significant (P > 0.05).
  
  
  CONCLUSIONS
  The use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs.
authors.affiliation: Unit of Orthodontics, Oral Health Sciences Centre Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
authors.forename: Sombir
authors.initials: S
authors.lastname: Singh
authors.affiliation: Unit of Orthodontics, Oral Health Sciences Centre Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
authors.forename: Satinder Pal
authors.initials: SP
authors.lastname: Singh
authors.affiliation: Unit of Pedodontics and Preventive Dentistry, Oral Health Sciences Centre Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
authors.forename: Ashima
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Unit of Orthodontics, Oral Health Sciences Centre Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Utreja
authors.affiliation: Department of Dental Surgery, All India Institute of Medical Sciences Sijua, Dumduma, Bhubaneswar, Odisha, India. drashokkjena@gmail.com.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Jena
mesh_terms: D000293:Adolescent; D000328:Adult; D002327:Cariostatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002364:Caseins / Q000008:administration & dosage / Q000627:therapeutic use*; D003731:Dental Caries / Q000188:drug therapy* / Q000209:etiology; D004338:Drug Combinations; D005260:Female; D005459:Fluorides / Q000008:administration & dosage / Q000627:therapeutic use; D005460:Fluorides, Topical / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008422:Materials Testing; D009067:Mouthwashes / Q000008:administration & dosage / Q000627:therapeutic use; D010710:Phosphates / Q000008:administration & dosage / Q000627:therapeutic use; D011897:Random Allocation; D014087:Tooth Movement Techniques / Q000009:adverse effects*; D014089:Tooth Remineralization; D014100:Toothpastes / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D002327:Cariostatic Agents; D002364:Caseins; D004338:Drug Combinations; D005460:Fluorides, Topical; D009067:Mouthwashes; D010710:Phosphates; D014100:Toothpastes; C447032:casein phosphopeptide-amorphous calcium phosphate nanocomplex; C012980:fluorophosphate; D005459:Fluorides
keywords: CPP-ACP crème; Fluoride toothpaste; Fluoride varnish; Orthodontics; White spot lesion