Methods used for prevention of white spot lesion development during orthodontic treatment with fixed appliances

Objectives: The aim of this study was to survey methods that Dutch orthodontists use to prevent development or progression of enamel decalcifications during orthodontic treatment. Materials and methods: A pre-tested questionnaire was sent by post to all orthodontists in the Netherlands with a private practice (n = 189). Results: The response rate was 81%. At the start of orthodontic treatment a basic practice protocol for prevention of enamel demineralization was used by 93% of the orthodontists. This included oral hygiene instructions (92%) and the advice for additional use of a fluoride mouth rinse (64%). Other preventive measures were rarely prescribed. About 85% of those who prescribed a fluoride mouth rinse advised to rinse once a day, directly after evening tooth brushing. Conclusions: The results suggest that the commonly used practice of fluoride mouth rinsing directly after evening tooth brushing by orthodontic patients during fixed appliance treatment ignores actual evidence of preventive advices. This study recommends mouth rinsing at another moment than after evening tooth brushing, thus increasing the frequency of fluoride intakes, which might enhance the effectiveness in preventing WSL development or progression during orthodontic treatment.