Document Type : Original Article

Authors

1 Dental Students’ Research Center, School of Dentistry, Isfahan University of Medical Sciences

2 Private Practice, Isfahan, Iran

Abstract

INTRODUCTION: White spot lesions (WSLs) are common adverse effect of orthodontic treatment,
which can be prevented and treated by orthodontists. This study was conducted to assess Iranian
orthodontists’ practice regarding the prevention and treatment of WSLs in their patients.
METHODS: In this cross‑sectional study, 109 Iranian orthodontists were selected from the Iranian
Association of Orthodontists’ directory by cluster sampling. For data collection, a questionnaire was
designed and its validity and reliability was confirmed (Cronbach’s α =0.85). The questionnaire
included eight general questions and eight questions about practice with regard to the prevention
and treatment of WSL. Data were analyzed by descriptive tests, ANOVA test, and t‑test in SPSS 20
software. P < 0.05 was considered statistically significant.
RESULTS: The mean score of orthodontists’ practice was 7.62 (range: 0–8), and 94.4% of the
participants were rated as good, while 3.7% and 1.9% were rated as moderate and weak, respectively.
Women’s score was significantly higher than that of men (P = 0.001). With increasing participants’
age, their practice has been improved (P = 0.001), but there was no significant relation between years
of experience and their practice (P = 0.230). Nearly 94.4% of the orthodontists prescribed fluoride
products. Toothpastes and fluoride mouth rinses were the most common prescribed products (34%).
CONCLUSIONS: With regard to Iranian orthodontists’ practice, it was fortunate to note that majority
of the respondents were taking care of their patients with regarding to the prevention and treatment
of WSLs. For enhancing their competencies, it is recommended to plan educational courses which
are useful for promoting their knowledge and practice about new products and procedures used for
the prevention and treatment of WSLs.

Keywords

1. Gwinnett AJ, Ceen RF. Plaque distribution on bonded brackets:
A scanning microscope study. Am J Orthod 1979;75:667‑77.
2. Chatterjee R, Kleinberg I. Effect of orthodontic band placement
on the chemical composition of human incisor tooth plaque. Arch
Oral Biol 1979;24:97‑100.
3. Scheie AA, Arneberg P, Krogstad O. Effect of orthodontic
treatment on prevalence of Streptococcus mutans in plaque and
saliva. Eur J Oral Sci 1984;92:211‑7.
4. Proffit WR, White RP, Sarver DM. Contemporary Treatment of
Dentofacial Deformity. St. Louis, MO: Mosby; 2003.
5. Ogaard B, Rølla G, Arends J. Orthodontic appliances and enamel
demineralization. Part 1. Lesion development. Am J Orthod
Dentofacial Orthop 1988;94:68‑73.
6. Robbins JW, Hilton TJ, Schwartz RS. Fundamentals of operative
dentistry: A contemporary approach. Summitt JB, editor.
Quintessence Pub.; 2006.
7. Hamdan AM, Maxfield BJ, Tüfekçi E, Shroff B, Lindauer SJ.
Preventing and treating white‑spot lesions associated with
orthodontic treatment: A survey of general dentists and
orthodontists. J Am Dent Assoc 2012;143:777‑83.
8. Øgaard B. Prevalence of white spot lesions in 19‑year‑olds:
A study on untreated and orthodontically treated persons 5 years
after treatment. Am J Orthod Dentofacial Orthop 1989;96:423‑7.
9. Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white spot
formation after bonding and banding. Am J Orthod 1982;81:93‑8.10. Richter AE, Arruda AO, Peters MC, Sohn W. Incidence of caries
lesions among patients treated with comprehensive orthodontics.
Am J Orthod Dentofacial Orthop 2011;139:657‑64.
11. Bishara SE, Ostby AW. White spot lesions: Formation, prevention,
and treatment. In Seminars in Orthodontics. Vol. 14. US.Elsevier:
WB Saunders; 2008. p. 174-82.
12. Øgaard B. White spot lesions during orthodontic treatment:
mechanisms and fluoride preventive aspects. In: Seminars in
orthodontics. Vol. 14. U.S.A.: WB Saunders; 2008. p. 183-93.
13. O’Reilly MM, Featherstone JD. Demineralization and
remineralization around orthodontic appliances: An in vivo
study. Am J Orthod Dentofacial Orthop 1987;92:33‑40.
14. Geiger AM, Gorelick L, Gwinnett AJ, Benson BJ. Reducing white
spot lesions in orthodontic populations with fluoride rinsing. Am
J Orthod Dentofacial Orthop 1992;101:403‑7.
15. Todd MA, Staley RN, Kanellis MJ, Donly KJ, Wefel JS. Effect of
a fluoride varnish on demineralization adjacent to orthodontic
brackets. Am J Orthod Dentofacial Orthop 1999;116:159‑67.
16. Farhadian N, Miresmaeili A, Eslami B, Mehrabi S. Effect of fluoride
varnish on enamel demineralization around brackets: An in‑vivo
study. Am J Orthod Dentofacial Orthop 2008;133 4 Suppl: S95‑8.
17. Hallgren A, Oliveby A, Twetman S. Fluoride concentration in
plaque adjacent to orthodontic appliances retained with glass
ionomer cement. Caries Res 1993;27:51‑4.
18. Benson PE, Parkin N, Millett DT, Dyer F, Vine S, Shah A. Fluorides
for the prevention of white spots on teeth during fixed brace
treatment. London: The Cochrane Library; 2004.
19. Stecksén‑Blicks C, Renfors G, Oscarson ND, Bergstrand F,
Twetman S. Caries‑preventive effectiveness of a fluoride
varnish: A randomized controlled trial in adolescents with fixed
orthodontic appliances. Caries Res 2007;41:455‑9.
20. Bergstrand F, Twetman S. Evidence for the efficacy of various
methods of treating white‑spot lesions after debonding of fixed
orthodontic appliances. J Clin Orthod 2003;37:19‑21.
21. Reynolds EC. Calcium phosphate‑based remineralization systems:
Scientific evidence? Aust Dent J 2008;53:268‑73.
22. ReynoldsEC, Cai F, Cochrane NJ, ShenP, WalkerGD, MorganMV,
et al. Fluoride and casein phosphopeptide‑amorphous calcium
phosphate. J Dent Res 2008;87:344‑8.
23. Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of
white spot lesions during orthodontic treatment with fixed
appliances. Angle Orthod 2011;81:206‑10.
24. Ostberg AL, Halling A, Lindblad U. Gender differences in
knowledge, attitude, behavior and perceived oral health among
adolescents. Acta Odontol Scand 1999;57:231‑6.
25. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational
interviewing: A systematic review and meta‑analysis. Br J Gen
Pract 2005;55:305‑12.
26. Ogaard B, Rølla G, Arends J, ten Cate JM. Orthodontic
appliances and enamel demineralization. Part 2. Prevention
and treatment of lesions. Am J Orthod Dentofacial Orthop
1988;94:123‑8.
27. Ogaard B. Effects of fluoride on caries development and
progression in vivo. J Dent Res 1990;69:813‑9.
28. Benson PE, Shah AA, Millett DT, Dyer F, Parkin N, Vine RS.
Fluorides, orthodontics and demineralization: A systematic
review. J Orthod 2005;32:102‑14.
29. Bergstrand F, Twetman S. A review on prevention and treatment
of post‑orthodontic white spot lesions – Evidence‑based methods
and emerging technologies. Open Dent J 2011;5:158‑62.
30. Charalambous C, Maniadakis N, Polyzos N, Fragoulakis V,
Theodorou M. The efficiency of the public dental services (PDS)
in Cyprus and selected determinants. BMC Health Serv Res
2013;13:420