Prediciting White Spot Lesions in an Orthodontic Population

Objective: Increases in plaque retention and Streptococcus mutans levels are associated with orthodontic treatment. Subsequent enamel decalcification on tooth surfaces resulting in white spot lesions (WSLs) occurs in a portion of subjects, and preventive interventions are currently being devised. Numerous studies have shown that antimicrobial agents such as fluoride, thymol and chlorohexidine varnishes reduce WSL formation during orthodontic treatment. However, currently no protocol exists to identify patients who might benefit the most from these preventive measures. The goal of this study was to determine if the same factors that contribute to WSL formation during orthodontic treatment also made a patient more susceptible to WSLs prior to orthodontic bonding.

Methods: Prior to orthodontic bonding, 37 patients were clinically examined at the University's Orthodontic Clinic and scored on Visible Plaque Index (VPI), Gingival Bleeding Index (GBI) and the number of WSLs. Next, S. mutans levels were then determined using the Stripmutans™ (Orion Diagnostica) assay test. The data was analyzed using bivariate correlations (Kendall's tau-b).

Results: There were no statistically significant (p < .05) correlations between Visible Plaque Index, Gingival Bleeding Index, or S. mutans levels and the number of WSLs.

Conclusion: Currently, a risked based protocol based on VPI, GBI, and S. mutans levels does not appear to be diagnostic of a patient's susceptibility to WSLs. However, because of the multifactor nature of enamel decalcification, more research is needed to determine whether other oral hygiene factors may be more predictive. At this time, without a reliable risk based test, preventive measures, such as antimicrobial varnishes, should be recommended for all orthodontic patients.