A Review on Prevention and Treatment of Post-Orthodontic White Spot Lesions – Evidence-Based Methods and Emerging Technologies

Fredrik Bergstrand1, Svante Twetman2, 3, *
1 Private Practice, Stockholm, Sweden
2 Department of Odontology, Section for Cariology, Endodontics and Pediatric Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
3 Maxillofacial Unit, Halland Hospital, Halmstad, Sweden

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Creative Commons License
© Bergstrand and Twetman; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Odontology Faculty of Health Sciences, University of Copenhagen, Nørre Allé 20 DK-2200 Copenhagen N, Denmark; Tel: 004535326810; Fax: 004535326505; E-mail:



The aim of this paper was to update the evidence for primary and secondary prevention (treatment) of white spot lesions (WSL) adjacent to fixed orthodontic appliances.

Material and methods:

A search for relevant human clinical trials published in English between 2004 and March 2011 retrieved 25 publications that fulfilled the inclusion criteria. The papers were assessed for prevented fraction and/or absolute risk reduction when possible.

Results and conclusions:

The findings consolidated the use of topical fluorides in addition to fluoride toothpaste as the best evidence-based way to avoid WSL. The mean prevented fraction based on 6 trials was 42.5% with a range from -4% to 73%. The recent papers provided the strongest support for regular professional applications of fluoride varnish around the bracket base during the course of orthodontic treatment. For the treatment of post-orthodontic WSL, home-care applications of a remineralizing cream, based on casein phosphopeptide-stabilized amorphous calcium phosphate, as adjunct to fluoride toothpaste could be beneficial but the findings were equivocal. For emerging technologies such as sugar alcohols and probiotics, still only studies with surrogate endpoints are available. Thus, further well-designed studies with standardized regimes and endpoints are needed before guidelines on the non-fluoride technologies can be recommended.

Keywords: Decalcification, fixed appliances, fluoride, orthodontics.