The effectiveness of caries prevention in patients with enamel defects of noncarious origin at the stages of orthodontic treatment

Abstract

BACKGROUND: White spot caries around braces is a common complication of orthodontic treatment. Numerous studies have indicated varying levels of the effectiveness of preventive measures for patients with braces, particularly for patients with noncarious enamel defects.

AIM: This study aimed to determine the effectiveness of the use of preventive agents around braces and in the area of noncarious spots in patients with enamel defects at the stages of orthodontic treatment.

MATERIALS AND METHODS: The study involved 54 patients aged 14–18 years. All patients were divided into three groups. In group 1, patients were treated monthly with the area around the bracket and the spot with Fluorine-Lux for deep fluoridation. In group 2, the enamel around the braces was fluoridated monthly with Fluorine-Lux varnish. Patients used R.O.C.S. toothpaste for home hygiene (ProBrackets&Ortho). In group 3 (control group), patients received professional oral care twice a year according to the standard regimen. Patients used fluoride toothpaste for oral care at home. Treatment lasted no more than 25 months. The initial levels of hygiene, caries intensity, and enamel resistance in all groups were comparable.

RESULTS: After removing the bracket system, the intensity of the caries in group 1 significantly increased slightly to 13.75 ± 1.12 (p > 0.01), and the “K” component increased to 2.91 ± 0.38 (p > 0.01). After removing the orthodontic equipment, the intensity of the carious process in group 2 was 12.23 ± 1.34, with highly significant differences (p < 0.05), the “K” component was 3.42 ± 0.19 (p < 0.05), and the number of teeth with noncarious defects was 4.19 ± 0.06 (p < 0.05). The appearance of new carious spots and cavity defects in teeth with noncarious enamel lesions that require treatment and filling were recorded. In group 3, the intensity of dental caries after the removal of the orthodontic equipment was 18.21 ± 0.16, with highly significant differences (p < 0.05), the “K” component was 6.83 ± 0.11 (p < 0.05), and the number of teeth with noncarious defects was 1.98 ± 0.04 (p < 0.05). The appearance of new carious spots and cavity defects in teeth with noncarious enamel lesions requiring treatment and filling were registered.

CONCLUSIONS: To prevent caries in the form of white spots on the teeth in patients with noncarious lesions during orthodontic treatment, professional oral hygiene monthly with the removal of the arch wire is recommended. The most effective is the combination of home oral hygiene using calcium-containing paste and monthly application of the drug Fluorine-Lux for deep fluoridation around braces and in noncarious areas.

Keywords

caries prevention / suspenders / orthodontic treatment / white enamel spots / enamel defects / deep fluoridation

References

[1] Shungin D, Olsson AI, Persson M. Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment. Am J Orthod Dentofacial Orthop. 2010; 138(2):136.e1–8; discussion 136–137. DOI: 10.1016/j.ajodo.2009.05.020

[2] Shungin D., Olsson A.I., Persson M. Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment // Am J Orthod Dentofacial Orthop. 2010. Vol. 138, No. 2. P. 136.e1–8; discussion 136–137. DOI: 10.1016/j.ajodo.2009.05.020

[3] Krysanova MA, Kuzmina EM, Polma LV. Determination of the prevalence and intensity of dental caries in patients during treatment using fixed orthodontic equipment. Orthodontics. 2015;(3): 43–46.

[4] Крысанова М.А., Кузьмина Э.М., Польма Л.В. Определение распространенности и интенсивности кариеса зубов у пациентов в период лечения с помощью несъемной ортодонтической аппаратуры // Ортодонтия. 2015. № 3. С. 43–46.

[5] Juliena KC, Buschangb PH, Campbellc PM. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod. 2013;83(4):641–643. DOI: 10.2319/071712-584.1

[6] Juliena K.C., Buschangb P.H., Campbellc P.M. Prevalence of white spot lesion formation during orthodontic treatment // Angle Orthod. 2013. Vol. 83, No 4. 641–647. DOI: 10.2319/071712-584.1

[7] Lone EA, Utreja AK, Singh SP, Jena AK. Effect of multibracket orthodontic appliance on frequency and severity of enamel demineralization-a prospective study. J Dent Special. 2015;3(1): 36–39.

[8] Lone E.A., Utreja A.K., Singh S.P., Jena A.K. Effect of multibracket orthodontic appliance on frequency and severity of enamel demineralization — a prospective study // J Dent Special. 2015. Vol. 3, No. 1. P. 36–39.

[9] Salanitri S, SeowWK. Developmental enamel defects in the primary dentition: aetiology and clinical management. Aust Dent J. 2013;58(2):133–140; quiz 266. DOI: 10.1111/adj.12039

[10] Salanitri S., Seow W.K. Developmental enamel defects in the primary dentition: aetiology and clinical management // Aust Dent J. 2013. Vol. 58, No. 2. P. 133–140; quiz 266. DOI: 10.1111/adj.12039

[11] Costa FS, Silveira ER, Pinto GS, et al. Developmental defects of enamel and dental caries in the primary dentition: A systematic review and meta-analysis. J Dent. 2017;60:1–7. DOI: 10.1016/j.jdent.2017.03.006

[12] Costa F.S., Silveira E.R., Pinto G.S., et al. Developmental defects of enamel and dental caries in the primary dentition: A systematic review and meta-analysis // J Dent. 2017. Vol. 60. P. 1–7. DOI: 10.1016/j.jdent.2017.03.006

[13] Patel A, Aghababaie S, Parekh S. Hypomineralisation or hypoplasia? Br Dent J. 2019;227(8):683–686. DOI: 10.1038/s41415-019

[14] Patel A., Aghababaie S., Parekh S. Hypomineralisation or hypoplasia? // Br Dent J. 2019. Vol. 227, No. 8. P. 683–686. DOI: 10.1038/s41415-019

[15] Crombie FA, Manton DJ, Palamara JE, et al. Characterisation of developmentally hypomineralised human enamel. J Dent. 2013;41(7):611–618. DOI: 10.1016/j.jdent.2013.05.002

[16] Crombie FA, Manton DJ, Palamara JE, et al. Characterisation of developmentally hypomineralised human enamel // J Dent. 2013. Vol. 41, No. 7. P. 611–618. DOI: 10.1016/j.jdent.2013.05.002

[17] William V, Messer LB, Burrow MF. Molar incisor hypomineralization: review and recommendations for clinical management. Pediatr Dent. 2006;28(3):224–232.

[18] William V., Messer L.B., Burrow M.F. Molar incisor hypomineralization: review and recommendations for clinical management // Pediatr Dent. 2006. Vol. 28, No. 3. P. 224–232.

[19] Baroni C, Mazzoni A, BreschiL. Molar incisor hypomineralization: supplementary, restorative, orthodontic, and esthetic long-term treatment. Quintessence Int. 2019;50(5):412–417. DOI: 10.3290/j.qi.a42327

[20] Baroni C., Mazzoni A., BreschiL. Molar incisor hypomineralization: supplementary, restorative, orthodontic, and esthetic long-term treatment // Quintessence Int. 2019. Vol. 50, No. 5. P. 412–417. DOI: 10.3290/j.qi.a42327

[21] Ogaard B, Larsson E, Henriksson T, et al. Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients. Am J Orthod Dentofacial Orthop. 2001;120(1):28–35. DOI: 10.1067/mod.2001.114644

[22] Ogaard B., Larsson E., Henriksson T., et al. Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients // Am J Orthod Dentofacial Orthop. 2001. Vol. 120, No. 1. P. 28–35. DOI: 10.1067/mod.2001.114644

[23] Ogaard B, Rølla G, Arends J, ten Cate JM. Orthodontic appliances and enamel demineralization. Part 2. Prevention and treatment of lesions. Am J Orthod Dentofacial Orthop. 1988;94:123–128. DOI: 10.1016/0889-5406(88)90360-5

[24] Ogaard B., Rølla G., Arends J., ten Cate J.M. Orthodontic appliances and enamel demineralization. Part 2. Prevention and treatment of lesions // Am J Orthod Dentofacial Orthop. 1988. Vol. 94. P. 123–128. DOI: 10.1016/0889–5406(88)90360-5

[25] Cochrane NJ, Cai F, Huq NL, et al. New approaches to enhanced remineralization of tooth enamel. J Dent Res. 2010;89:1187–1197. DOI: 10.1177/0022034510376046

[26] Cochrane N.J., Cai F., Huq N.L., et al. New approaches to enhanced remineralization of tooth enamel // J Dent Res. 2010. Vol. 89. P. 1187–1197. DOI: 10.1177/0022034510376046

[27] Huang GJ, Roloff-Chiang B, Mills BE, et al. Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Am J Orthod Dentofacial Orthop. 2013;143(1):31–41. DOI: 10.1016/j.ajodo.2012.09.007

[28] Huang G.J., Roloff-Chiang B., Mills B.E., et al. Effectiveness of MI Paste Plus and Previ Dent fluoride varnish for treatment of white spot lesions: a randomized controlled trial // Am J Orthod Dentofacial Orthop. 2013. Vol. 143, No. 1. P. 31–41. DOI: 10.1016/j.ajodo.2012.09.007

[29] Borzabadi-Farahani A, Borzabadi E, Lynch E. Nanoparticles in orthodontics, a review of antimicrobial and anti-caries applications. Acta Odontol Scand. 2014;72(6):413–417. DOI: 10.3109/00016357.2013.859728

[30] Borzabadi-Farahani A., Borzabadi E., Lynch E. Nanoparticles in orthodontics, a review of antimicrobial and anti-caries applications // Acta Odontol Scand. 2014. Vol. 72, No. 6. P. 413–417. DOI: 10.3109/00016357.2013.859728

[31] Alessandri Bonetti G, Pazzi E, Zanarini M, et al. The effect of zinc-carbonate hydroxyapatite versus fluoride on enamel surfaces after interproximal reduction. Scanning. 2014;36(3):356–361. DOI: 10.1002/sca.21125

[32] Alessandri Bonetti G., Pazzi E., Zanarini M., et al. The effect of zinc-carbonate hydroxyapatite versus fluoride on enamel surfaces after interproximal reduction // Scanning. 2014. Vol. 36, No. 3. P. 356–361. DOI: 10.1002/sca.21125

[33] Alexander SA, Ripa LW. Effects of self-applied topical fluoride preparations in orthodontic patients. Angle Orthod. 2000;70(6):424–430. DOI: 10.1043/0003-3219(2000)070<0424:EOSATF>2.0.CO;2

[34] Alexander S.A., Ripa L.W. Effects of self-applied topical fluoride preparations in orthodontic patients // Angle Orthod. 2000. Vol. 70, No. 6. P. 424–430. DOI: 10.1043/0003-3219(2000)070<0424:EOSATF>2.0.CO;2

[35] Llena C, Leyda AM, Forner L. CPP-ACP and CPP-ACFP versus fluoride varnish in remineralisation of early caries lesions. A prospective study. Eur J Paediatr Dent. 2015;16(3):181–186. DOI: 10.1007/s40368-014-0153-9

[36] Llena C., Leyda A.M., Forner L. CPP-ACP and CPP-ACFP versus fluoride varnish in remineralisation of early caries lesions. A prospective study // Eur J Paediatr Dent. 2015. Vol. 16, No. 3. P. 181–186. DOI: 10.1007/s40368-014-0153-9

[37] Zantner C, Martus P, Kielbassa AM. Clinical monitoring of the effect of fluorides on long-existing white spot lesions. Acta Odontol Scand. 2006;64(2):115–122. DOI: 10.1080/00016350500443297

[38] Zantner C., Martus P., Kielbassa A.M. Clinical monitoring of the effect of fluorides on long-existing white spot lesions // Acta Odontol Scand. 2006. Vol. 64, No. 2. P. 115–122. DOI: 10.1080/00016350500443297

[39] Sonesson M, Twetman S, Bondemark L. Effectiveness of high-fluoride toothpaste on enamel demineralization during orthodontic treatment-a multicenter randomized controlled trial. Eur J Orthod. 2014;36(6):678–682. DOI: 10.1093/ejo/cjt096

[40] Sonesson M., Twetman S., Bondemark L. Effectiveness of high-fluoride toothpaste on enamel demineralization during orthodontic treatment — a multicenter randomized controlled trial // Eur J Orthod. 2014. Vol. 36, No. 6. P. 678–682. DOI: 10.1093/ejo/cjt096

[41] Boyd RL. Comparison of three self-applied topical fluoride preparations for control of decalcification. Angle Orthod. 1993;63(1):25–30. DOI: 10.1043/0003-3219(1993)063<0025:COTSTF>2.0.CO;2

[42] Boyd R.L. Comparison of three self-applied topical fluoride preparations for control of decalcification // Angle Orthod. 1993. Vol. 63, No. 1. P. 25–30. DOI: 10.1043/0003-3219(1993)063<0025:COTSTF>2.0.CO;2

[43] Al-Khateeb S, Forsberg CM, de Josselin de Jong E, Angmar-Månsson B. A longitudinal laser fluorescence study of white spot lesions in orthodontic patients. Am J Orthod Dentofacial Orthop. 1998;113(6):595–602. DOI: 10.1016/S0889-5406(98)70218-5

[44] Al-Khateeb S., Forsberg C.M., de Josselin de Jong E, Angmar-Månsson B. A longitudinal laser fluorescence study of white spot lesions in orthodontic patients // Am J Orthod Dentofacial Orthop. 1998. Vol. 113, No. 6. P. 595–602. DOI: 10.1016/S0889-5406(98)70218-5

[45] Perrini F, Lombardo L, Arreghini A, et al. Caries prevention during orthodontic treatment: In-vivo assessment of high-fluoride varnish to prevent white spot lesions. Am J Orthod Dentofacial Orthop. 2016;149(2):238–243. DOI: 10.1016/j.ajodo.2015.07.039

[46] Perrini F., Lombardo L., Arreghini A., et al. Caries prevention during orthodontic treatment: In-vivo assessment of high-fluoride varnish to prevent white spot lesions // Am J Orthod Dentofacial Orthop. 2016. Vol. 149, No. 2. P. 238–243. DOI: 10.1016/j.ajodo.2015.07.039

[47] Zorina OA, Boriskina OA, Petrukhina NB, et al. Influence of different type of toothbrushes on the incidence of enamel demineralization and gingivitis in the course of orthodontic treatment. Dentistry. 2020;99(2):34–39. DOI: 10.17116/stomat20209902134

[48] Зорина О.А., Борискина О.А., Петрухина Н.Б., и др. Влияние использования зубных щеток различного типа на вероятность развития деминерализации эмали и гингивита в ходе ортодонтического лечения // Стоматология. 2020. Т. 99, № 2. С. 34–39. DOI: 10.17116/stomat20209902134

[49] Krysanova MA, Kuzmina EM, Polma LV. Application of modern prophylactic means during orthodontic treatment with fixed appliances (review). Orthodontics. 2014;(4):12–19. (In Russ.)

[50] Крысанова, М.А., Кузьмина Э.М., Польма Л.В. Применение современных профилактических средств во время ортодонтического лечения с помощью несъемной аппаратуры (обзор) // Ортодонтия. 2014. № 4. С. 12–19.

[51] Arsenina OI, Kabachek MV, Sakharov EB. Application of enamel-sealing liquid for caries prevention in orthodontic treatment. Orthodontics. 2003;(1):8–12.

[52] Арсенина О.И. Кабачек М.В. Сахаров Э.Б. Применение эмаль-герметизирующего ликвида для профилактики кариеса при ортодонтическом лечении // Ортодонтия. 2003. № 1. С. 8–12.

[53] Arsenina OI, Frolova AV, Popova NV. Algorithm of preventive measures in orthodontic treatment with the use of fixed appliances. Orthodontics. 2009;(1(45)):44–45.

[54] Арсенина О.И., Фролова А.В. Попова Н.В. Алгоритм профилактических мероприятий при ортодонтическом лечении с и спользованием несъемной техники // Ортодонтия. 2009. № 1(45). С. 44–45.

[55] Kuzmina EA, Kapytov AA, Efimova AS, Saraikina OS. Some distinctive features of remineralizing complex Fluoro-lux. Science Bulletin. Series: Medicine. Pharmacia. 2014;(18(189)):139–143. (In Russ.)

[56] Кузьмина Е.А., Капытов А.А., Ефимова А.С., Сарайкина О.С. Некоторые отличительные особенности реминерализирующего комплекса Фтор-люкс // Научные ведомости. Серия: Медицина. Фармация. 2014. № 18(189). C. 139–143.

[57] Ammaev MG, Fattal RK, Tairov VV, Melekhov SV. Advanced way of the assessment of efficiency of treatment of initial caries. Kuban Scientific Medical Bulletin. 2013;(6(141)):32–34.

[58] Аммаев М.Г., Фатталь Р.К., Таиров В.В., Мелехов С.В. Усовершенствованный способ оценки эффективности лечения начального кариеса. Кубанский научный медицинский вестник. 2013. № 6(141). C. 32–34.

RIGHTS & PERMISSIONS

Eco-Vector