White Spot Lesions: A Serious but Often Ignored Complication of Orthodontic Treatment

Anand Marya1, 2, *, Adith Venugopal3, Mohmed Isaqali Karobari4, Dinesh Rokaya5
1 Department of Orthodontics, Faculty of Dentistry, University of Puthisastra, 12211 Phnom Penh, Cambodia
2 Center for Transdisciplinary Research, Saveetha Dental College , Saveetha Institute of Medical and Technical Science , Saveetha University, Chennai 600077, India
3 Department of Orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
4 Conservative Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
5 Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok 10400, Thailand

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 81
Abstract HTML Views: 21
PDF Downloads: 11
ePub Downloads: 6
Total Views/Downloads: 119
Unique Statistics:

Full-Text HTML Views: 59
Abstract HTML Views: 17
PDF Downloads: 11
ePub Downloads: 6
Total Views/Downloads: 93

Creative Commons License
© 2022 Marya et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address of Correspondence to this author at Department of Orthodontics, University of Puthisastra, Phnom Penh, Cambodia;



The objective of this narrative review is to present an overview of the prevalence, clinical manifestation, diagnosis, and latest advances on white spot lesions.


White spot lesions have been defined as the earliest stage of demineralization on enamel surfaces that are easily discernible to the human eye.


Relevant articles on white spot lesions were searched and reviewed from March 1975 till May 2021 in Pubmed, Scopus, Google Scholar, and ScienceDirect and were included in this review.


Even though the orthodontic field has seen several advances over the last few years, this is one complication that persists. White spot lesions are very commonly seen after completion of fixed orthodontic therapy when brackets are debonded. Previously conducted research has shown that there is a high prevalence rate of white spot lesions, which ranges from 50 to 90%. On intra-oral examination, a white spot can be seen as a matte-textured, opaque white lesion. Since the demineralization process takes place below the enamel surface, the outer layer only demonstrates pores that affect the natural light refractory properties of a tooth. This is what leads to the characteristic appearance of these lesions. One of the goals of modern dentistry is to treat non-cavitated lesions by promoting remineralization without the involvement of any invasive procedures.


Fixed orthodontic therapy is usually a lengthy process and requires active cooperation between the orthodontist and the patient. However, it is the responsibility of the treating orthodontist to examine the tooth surfaces at each appointment to diagnose a developing white spot lesion as early as possible. With recent advances in diagnostic techniques, it has become much easier to identify these initial lesions and prevent their progression to cavitated lesions.

Keywords: White spot lesions, Orthodontic, Demineralization, Complication, Esthetic, Decay.