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White spot lesions (WSL) are a commonly reported risk of fixed appliance orthodontic treatment. This article reviews the incidence, aetiology and effectiveness of prevention and management of WSLs with a relevant case report. An adolescent male had fixed-appliance treatment and developed WSLs, despite prevention advice and careful monitoring, the WSLs progressed and ultimately led to the need for early removal of his orthodontic appliances. Removal of appliances prevented further damage and allowed partial resolution of the WSLs.
CPD/Clinical Relevance: Careful monitoring of a patient's dental health during orthodontic treatment is essential; however, if oral health deteriorates, and demineralization occurs, rapid decisive action is necessary to limit irreversible damage.
Article
Decalcification, or demineralization, is the first clinically recognizable stage of enamel caries. The co-existence of plaque bacteria (mutans streptococci and lactobacilli), substrate, susceptible tooth surface and time are necessary for decalcification.1 Its incidence among patients undergoing fixed-appliance treatment varies greatly with sociodemographic areas and individual risk factors, but a commonly accepted incidence is that WSLs occur in up to half of orthodontic patients.2 The labio-gingival aspect of the maxillary lateral incisors has the highest incidence followed by mandibular buccal segment teeth, and the lowest is in the maxillary posterior region.3 These sites are most likely to be affected due to reduced salivary flow to these regions.4 They may also have an number of attachments which, along with the length of orthodontic treatment, are risk factors.5,6 WSLs are commonly graded via the index of Gorelick et al (Figure 1).1
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