1) rendering oral hygiene maintanance more difficult and

1)      Pritam
Mohanty et al in 2015 stated that the increased prevalence of enamel
demineralization during orthodontic therapy is to an extent due to the surface
irregularities of fixed appliances, which create areas for plaque retention
rendering oral hygiene maintanance more difficult and hinder self-cleansing
mechanisms. These in turn reduce the plaque pH in the presence of fermentable
carbohydrates, increase the rate of plaque accumulation and maturation, and
encourage colonization of aciduric bacteria such as Streptococcus mutans and

White Spot
Lesions: A Challenge to Orthodonics ( JRAD -2015 )

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Mohanty1* Nivedita Sahoo2 Debapreeti Mohanty


2)      Mizrahi
E in 1989 (39) and Benson P in
2008 (40) stated that clinically
demineralized enamel manifests as a surface opacity. Subsurface
demineralization marks the onset of enamel crystal dissolution leading to
formation of pores between the enamel rods which inturn results in rough
surface, loss of surface shine and alterations in refractive index all of which
result in greater visual enamel opacity, as porous enamel scatters more light
when compared to sound enamel.



3)      Ogaard
B et al (41) conducted a clinical
trial to investigate carious lesion development associated with fixed
orthodontic therapy using microradiography and scanned electron
microscopy.  To promote plaque
accumulation, orthodontic bands were attached to premolars scheduled to be
extracted as part of fixed orthodontic treatment. White spot lesions were observed
within a month in the absence of any fluoride supplementation. It was concluded
that enamel demineralization associated with fixed orthodontic treatment is a
rapid process caused by cariogenic activity in the plaque developed around


4)      Zachrisson
BU et al (42) conducted a
study including 173 individuals
receiving orthodontic   treatment  to assess the relationship between incidence of
caries and oral hygiene during treatment. Assessments of oral hygiene were
performed every month  by using  plaque index and gingival index . Carious
lesions were scored according
to Caries Index (CI) at the time of debonding .The results showed a definite correlation between oral
health and caries incidence. With increasing mean PII and GI scores, there were
concomitant, almost linear increases in mean CI scores. It was concluded that
a strong co-relation exists between oral hygiene and caries incidence in
orthodontic patients as compared to in non-orthodontic individuals.



5)      Ogaard
B (43) studied  the
prevalence of white spot lesions on the buccal surfaces  in 19-year-olds including 51 orthodontic
patients and 47 untreated individuals. On the average, 5.7 years had elapsed
since fixed orthodontic appliances were removed. The results of the study
showed a significant increase in the white spot score and the number of teeth
with white spot lesions in the orthodontic group than in the untreated group.
Hence it was concluded that the orthodontic patients have significantly
more WSL than non- orthodontic patients and these WSL may remain unesthetic even
years after treatment.


Artun J et al (45) conducted a study to assess the
prevalence, localization and distribution of white spots on buccal tooth
surfaces after orthodontic treatment with fixed orthodontic appliances. The
study included 3 groups comprising of 2 test groups (A and B) , each comprising
60 consecutively treated adolescents treated by two different orthodontist ,
and a control group of 60 subjects,  who did
not receive orthodontic treatment. Patients in groups A and B were instructed to
practice regular oral hygiene measures and were given a prescription of sodium
fluoride for daily rinsing. The fluoride programme was monitored more closely
and patients  in group A were encouraged
more frequently than those in group B.The subjects in groups A and B were
examined 1.8 and 1 year after debonding, respectively. White spots were rated
on a scale of 1 to 3 according to opacity and extension on buccal enamel
surface around the  brackets and bonding
material during treatment. The results showed significantly higher scores,
especially in gingival areas for both opacity and extension of the lesions in
group B than in the control group,.No significant differences were noticed
between group A and the control group and between the test groups.

7)      Fournier
et al (44) conducted an
in-vitro study to assess and compare the affinity of Streptococcus mutans to
orthodontic brackets made out of metal, plastic, and ceramic.Twelve saliva-coated
brackets and 12 non-coated brackets of each type were immersed in a S. mutans
solution labeled with 3H thymidine followed by immersion in  distilled water at 20 degrees C for 24, 48,
and 72 hours. The adherence of S. mutans to these samples were measured. During
the first 24 hours, the adherence of S. mutans reduced regardless of  saliva coating but between 24 and 72 hours, there
was no change in the adherence of S. mutans to the saliva-coated brackets and
the adherence to uncoated brackets reduced. Saliva coating caused a reduction
in the affinity of S. mutans for all products. It was found that the initial
affinity of Streptococcus mutans to metal brackets was significantly lower than
that to porcelain and plastic brackets regardless of saliva coating.


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