White Spot Lesions: Whose fault it is?

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Fixedorthodontic treatment has many side-effects associated with it, especially Demineralization with a very poor oral hygiene. Demineralization of enamel occurs because of the subsequent release of acidic byproducts of the bacteria in the plaque which leads to the formation of White Spot Lesions (WSL). Caries is another side effect leading to poor esthetics, patient dissatisfaction and legal complications. For an orthodontic point of view, the formation of these white spot lesions is very discouraging as the main goal of orthodontics is to improve the esthetics in the dento facial region.

Orthodonticattachments make oral hygiene maintenance the most difficult job as the small size of these attachments on teeth like brackets, bands, arch wires, ligatures and other orthodontic devices leads to prolonged plaque accumulation and appearance of WSL. So, before starting orthodontic treatment and initiating other preventive measures, one has to assess the saliva, oral hygiene status and caries rate. Patients should be properly educated about the importance of maintaining good dietary compliance and excellent oral hygiene regime.

Clinically,these white spots can be seen around orthodontic attachments within 4 weeks of starting of treatment and their prevalence can be as high as 96%. The most frequently affected area is the labio-gingival area of the lateral incisors and the maxillary posterior segments are the least affected sites with a tendency to be seen in males than in females. A critical evaluation of oral hygiene is recommended during the initial periods as the number of white spot lesions increases in the beginning and keep on increasing at a slower rate.

White spot lesions are not only the result of demineralization, however, as fluorosis, hypomineralization /hypomaturation and hypoplasia can also cause lesions. Management of white spots includes the methods of prevention, demineralization and methods used for remineralization of lesions that are already formed. Remineralization is the process of restoring minerals in the form of mineral ions in dental enamels. Demineralization is the process of removing minerals, in the form of mineral ions, from dental enamel.