[Prevention of white spot lesion formation during treatment with fixed orthodontic appliances]

One of the main disadvantages of orthodontic treatment with fixed appliances is the formation of demineralisations around the brackets. These demineralisations develop because the brackets produce an increased number of plaque retention sites and a change in the oral environment, resulting in a different plaque composition. To prevent the formation of these demineralisations several methods are used during orthodontic treatment. Using additional fluoride is the best solution, for example, rinsing daily with a fluoride mouthwash, applying a fluoride varnish during every scheduled check-up, or using toothpaste with a high concentration of fluoride. The last 2 methods are less effectively incorporated in daily practice in the Netherlands due to financial or time factors. Additional measures, like using fluoride-releasing adhesives, CPP-ACP(F) or a chlorhexidine rinse appear to be less effective in reducing demineralisations. It is also important to provide specific oral hygiene and dietary instructions, based on an individual risk assessment.