IT IS A REVIEW STUDY TO SEE WHETHER THERE IS A CONTROL OF WHITE SPOT LESIONS USING FLUORIDE VARNISH IN ORTHODONTIC TREATMENT

1. BY:
HARITHRRA VENKATARAMAN
CRI

2. CONTENT
 Background
 Search method
 Selection criteria
 Study design
 Data collection and analysis
 Materials and methods
 Result
 Discussion
 Conclusion
 Reference

3. BACKGROUND
 Clinically the demineralization sites are detected as porous and
opaque white spot lesions (WSLs) that may compromise the
final result of the treatment.
 Among the available strategies the use of fluoride varnish has
been shown to be highly effective in controlling white spot
lesions.

4. AIM
To control white spot lesions with use of fluoride
varnish in orthodontic treatment.

5. SEARCH METHOD
 PUBMED
 THE SCIENTIFIC WORLD JOURNAL VOLUME 2015
 AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL
ORTHOPEDICS(2011)
 EUROPEAN JOURNAL OF ORTHODONTICS
 COCHRANE LIBRARY 2004(ISSUE 2)

6. SELECTION CRITERIA
Trials were selected if they met the
following criteria:
• A randomised clinical trial, involving the use of
fluoride varnish and enamel demineralisation was
assessed during or after orthodontic treatment.

7. STUDY DESIGN
Number of original articles: 5
 All the five original articles were done with
the same inclusion and exclusion criteria .
All the five original articles were done in a
Randomised control trial.

8. DATA COLLECTION AND
ANALYSIS
 The primary outcome was the presence or absence of white spot
lesions after using fluoride varnish between experimental and
control quadrants .
 Potential source of heterogeneity were examined.

9. INCLUSION CRITERIA
Study on humans.
No restorative or prosthetics done on planned teeth.
Modified WSL Score 1: Slight white spot formation ,thin
rim.
ELIGIBILITY: Age group of 12-25 years with good general
health.

10. EXCLUSION CRITERIA
Professional administration of highly concentrated fluoride
products within 30 days prior to enrolment.
Professional administration or home use of highly
concentrated fluoride products not related to the study.
Alterations of the enamel ,eg : hypoplasia ,fluorosis.
Subjects underwent non- remineralising therapy(bleaching or
restoration)

11. IDENTIFICATION
PUBMED, Cochrane database ,American Journal of orthodontics:
• Search terms: "fluoride” OR “fluoride varnish” OR “orthodontic treatment” OR “fixed appliances” AND
“White Spot Lesions” OR “demineralisation”;
• Study on humans;
• English language;
• Abstract available.
• (n=46)
FILTERED Duplicated and not relevant titles and
abstracts
(n=21)
Titles and abstracts were selected according relevancy after
duplication removal
(n=25)
SCREENING
FILTERED Not enough information
(n=14)
Full text articles assessed for eligibility
(n=11)
FILTERED Records excluded ,not met inclusion
criteria
(n-=6)
ELIGIBILITYINCLUDED
Full text articles included (n=5)
Total number of participants=824

15. WHITE SPOT LESION SCORE

16. ARTICLE :1
CONTROL OF WHITE SPOT LESIONS
ADJACENT TO ORTHODONTIC BRACKET
WITH USE OF FLUORIDE VARNISH OR
CHLORHEXIDINE GEL

17. •MATERIALS
• 40 healthy human premolars ,free of spots ,cracks,
and fractures.
• 35% phosphoric acid
• Light curing unit
• 5% sodium fluoride varnish
• 2%chlorhexidine gel
Restrepo et al,
2015

18. •Quantitative light induced
fluorescence
•Transverse micro radiography
Methods:

20. ARTICLE : 2
COMPARITIVE ASSESSMENT OF FLUORIDE
VARNISH AND FLUORIDE FILM FOR
REMINERLISATION OF POST ORTHODONTIC
WHITE SPOT LESIONS IN ADOLESCENTS AND
ADULTS OVER A 6 MONTH PERIOD-
RANDOMIZED CONTROLLED TRIAL.

21. STUDY DONE BY
• Tao He
• Xue li,2015
MATERIALS
• FLUORIDE
VARNISH
• FLUORIDE FILM
METHOD
• QUANTITATIVE
LIGHT INDUCED
FLUORESCENCE
IMAGES
ELIGIBLITY
CRITERIAS
• AGE GROUP OF
12-25 YEARS.
• GOOD GENERAL
HEALTH.
• ATLEAST ONE
MAXILLARY
ANTERIOR
TEETH WITH
WHITE SPOT
LESION.

22. ARTICLE :3
EFFECT OF FLUORIDE VARNISH ON
ENAMEL DEMINERALIZATION
ADJACENT TO ORTHODONTIC
BRACKETS-INVIVO STUDY

23. ARTICLE : 4
FLUORIDES FOR THE PREVENTION
OF WHITE SPOTS ON TEETH
DURING FIXED BRACE TREATMENT

24. ARTICLE :5
CHANGES IN WHITE SPOT LESIONS
FOLLOWING POST-ORTHODONTIC
WEEKLY APPLICATION OF 1.25
PERCENT FLUORIDE VARNISH
OVER 6 MONTHS

25. RESULTS

30. LIMITATIONS
ARTICLE 1
• Not done
completely in
the humans oral
cavity
ARTICLE 2
• Not all patients
experienced
remineralisation.
ARTICLE 3
• There were few
dropouts.
ARTICLE 4
• Not able to test
the theory that
split mouth
studies are less
likely to produce
a difference
compared with
parallel study.
ARTICLE 5
• Socioeconomic
status was not
assessed.
• It was impossible
to assess
whether the
participants
followed the
instructions on
oral hygiene.

31. CONCLUSION
The articles reviewed in this study, shows control of
white spot lesions in orthodontic patients with the use of
fluoride varnish which further resulted in reduced or no
white spot lesion formation.
FLOURIDE VARNISH ALONG WITH
THE AESTHETICS IS A BOON!!!

32. REFERENCE
1. Manuel Restrepo et al. Control of white spot lesion adjacent to orthodontic bracket with use of
fluoride varnish or chlorhexidine gel. The Scientific world journal 2015;Article Id 218452.
2. He T,et al. Comparative assessment of fluoride varnish and fluoride film for remineralisation of post
orthodontic white spot lesions in adolescents and adults over a 6 month period-randomized
controlled trial. Am J Orthod Dentofacial Orthop.2016 jun;149(6):810-9.
3. Mehta A,et al. Am J Orthod Dentofacial Orthop.2015 Nov;148(5):814-20.
4. Benson PE , et al. Cochrane Database.2004.
5. Bock NC,et al. Eur J Orthod.2017 Apr1;39(2):134-143.
6. Mizrahi E. Enamel demineralization following orthodontic treatment. Am J Orthod 1982;82:62-7.