White spot lesions usually develop around orthodontic brackets and bands due to poor oral hygiene. These lesions are preventable by educating and motivating the patient to practice good oral hygiene, oral prophylaxis and advising fluoride containing products during fixed orthodontic therapy. Amflor toothpaste and mouthwash is used to prevent white spots and cavities during fixed orthodontic .

1. 19STUDENT DIGEST | MUMBAI | JULY 2018
Introduction
White spot lesions (WSLs), around fixed orthodontic
appliances is a major challenge during and after fixed
orthodontic treatment. They usually develop around
orthodontic brackets and bands due to poor oral hygiene. The
irregular surface of brackets, bands and wires limit the natural
self cleansing mechanism and make tooth cleaning difficult.
This encourages plaque accumulation and demineralization
which leads to white spot lesions and cavity.
White spot lesions are areas of demineralized enamel.
Clinically, WSLs might develop on the fourth week after
initiating treatment in the presence of poor oral hygiene
and are found in 30%‒to 70% patients receiving orthodontic
treatment. These lesions are managed by educating and
motivating the patient to practice good oral hygiene and
advising fluoride containing products during fixed orthodontic
therapy.
Preventive Strategies
Oral Hygiene: The most important prophylactic measure
to prevent WSLs in orthodontic patient is implementing
a good oral hygiene regimen. Mechanical plaque control
by proper tooth brushing, use of orthodontic toothbrush,
disclosing solution and floss can help patients in attaining
good oral hygiene. Besides oral hygiene at home, professional
prophylaxis reduces the bacterial load, enhance the efficacy
of brushing and facilitate cleaning by the patient.
Fluoride: For many years, fluoride has been considered the
most effective remineralizing agent to prevent white spot
lesions during fixed orthodontic treatment. Fluoride can be
administered to the teeth in various ways, including topical
fluoridated toothpaste, mouth rinse, gel, varnish, adhesives
like fluoride-releasing cements, elastomeric chains and
restorative treatment for established white spot lesions.
Fluoride varnish is applied two to four times per year to
provide an additional caries prevention benefit. They release
fluoride over a long period and protect enamel in the absence
of patient compliance.
Dr. Kamala D. N.
Group Pharmaceuticals Limited
Bangalore, Karnataka
Preventive Strategies of
White Spot Lesions
Amine fluoride: Amine fluoride is an organic fluoride. It has
a unique molecular structure and surface active property. The
hydrophilic part of amine fluoride is aligned towards the tooth
surface and hydrophobic part towards the oral cavity. Hence,
the fluoride ions accumulate close to the tooth surface and
readilyavailableforremineralization.Thecalciumfluoridelayer
formed on the tooth surface is stabilized by the hydrophobic
part that prevents it from being washed out rapidly by
saliva. Thus it helps in high uptake, retention, deposition of
fluoride on enamel and offers long term protection against
caries. Surface active property of Amine fluoride helps faster
distribution of fluoride in the oral cavity.
Amine fluoride promotes remineralization by forming
fluorapatite, inhibits demineralization and helps to prevent
WSLs in fixed orthodontic therapy. Research studies found
that Amine fluoride has greater anti–cariogenic property
and significantly increased micro hardness of enamel and
reduced the white spot lesions better than sodium fluoride,
sodium monofluorophosphate and stannous fluoride.
Conclusion: White spot lesion is a common complication
during orthodontic treatment. These lesions are preventable
by educating and motivating the patient to practice good oral
hygiene, oral prophylaxis and advising fluoride containing
products during fixed orthodontic therapy.
Research