Risk factors for white spot lesions associated with orthodontic brackets

Objective: Caries development around orthodontic brackets, specifically white spot lesions (WSL), is an ongoing problem in orthodontic treatment. Other than oral hygiene, it is uncertain as to why they develop. The purpose of this study was to evaluate the prevalence of, and assess factors related to WSL around orthodontic brackets in adolescent subjects from the Iowa Fluoride Study (IFS).

Methods: Data were collected from exam data and digital intra-oral photographs of 85 IFS children ages 12-14 undergoing orthodontic treatment or who had recently been debanded. The presence and total number of WSL on facial surfaces of teeth were recorded using three photographs from each subject. Orthodontically treated subjects with and without associated WSL were compared using t-test statistics, Fisher's Exact Test, and Logistic Regression. Independent variables included previous caries experience, plaque, salivary mutans streptococci levels, demographics, and longitudinal beverage intakes.

Results: Of the 85 subjects, 46 had WSL, and 39 did not. Subjects in the WSL group were significantly more likely to have had other decayed or filled surfaces (p=0.041), drank less fruit juice (p=0.023) and had higher mean plaque scores (p=0.075) than those with no orthodontically related WSL. Preliminary analysis for S. mutans levels showed no difference between groups. Logistic Regression found that having lower fruit juice consumption (p=0.037) and a history of caries experience (p=0.037) were associated with one or more WSL associated with orthodontic treatment.

Conclusions: Previous caries experience and lower fruit juice consumption was significantly associated with WSL around orthodontic brackets. Higher plaque scores also contributed. Higher fruit juice consumption may be indicative of healthier, less cariogenic diets among those with no WSL. Further studies with larger sample sizes are warranted to address this problem.

Supported by NIH Grant #R01-DE09551