White spot lesions during fixed orthodontic therapy

Patient Presentation and examination: 

• Personal information and relevant dental history: 10-year-old female, undergoing fixed multibracket appliance therapy
• Intraoral examination: 

• White spot lesions with rough surfaces observed around the bonded brackets on the labial surfaces of maxillary incisors (Figure 1)
• Signs of improper oral hygiene maintenance observed including plaque deposition and gingival inflammation.

Diagnosis: 

• #7, #8, #9, and #10: Initial caries (ICDAS Score 2), secondary to inadequate oral hygiene maintenance 

Treatment: 

• Thorough oral prophylaxis to control and reverse gingiva inflammation
• The lesions were treated with Curodont Repair Fluoride Plus in the same appointment. 
• The patient was counselled on proper brushing technique and oral hygiene maintenance. 

Follow-up: At the 5-month post-treatment follow-up, the following observations were made: (Figure 2)

• Visible reduction in the size and appearance of the white spot lesions, indicative of remineralization 
• Almost complete reduction in the appearance of the lesions on the central incisors.

Take-away: Oral hygiene maintenance is often complicated during fixed orthodontic therapy, making initial caries, seen as white spot lesions, around bonded brackets a common occurrence.* Curodont Repair Fluoride Plus can be used, with improved oral hygiene, to treat these lesions when they’re detected, without de-bonding the brackets. 

*Richter AE et al. Am J Orthod Dentofacial Orthop. 2011;139:657-64.