Abstract
Background:
The present study determined white spots with the help of quantitative light-induced fluorescence (QLF) in patients undergoing fixed orthodontics.
Materials and Methods:
Sixty-four patients undergoing fixed orthodontics above 12 years underwent debonding, and the presence of carious lesion was assessed at baseline and after 6 weeks, 6 months, and 2 years. QLF images were taken with intraoral fluorescence camera. QLF images were examined visually for signs of demineralization, and scoring system was used.
Results:
It is found that there was fluorescence loss over a period of time. The median sum of fluorescence loss per patient was 55.6% and 29.2% and 101.4% at quartiles at baseline which changed to 51.2% and 26.5% at the first quartile and 101.4% at the second quartile. At 2 years, it was 43.7% and at the first quartile was 22.1% and at the second quartile was 99.1%. There was significant improvement at T2 (P < 0.05), however, between baseline and F1 and between F1 and F2, there was nonsignificant improvement (P > 0.05). The median value for total lesion area per patient was 3.6 mm2 with quartiles 1.2 mm2 and 8.2 mm2 at baseline, 2.6 mm2 with quartiles 0.7 mm2 and 6.3 mm2 at 6 weeks, 2.3 mm2 with quartiles 0.7 mm2 and 6.3 mm2 at 6 months, and 1.8 mm2 with quartiles 0.5 mm2 and 5.8 mm2 at 2 years which was statistically significant (P < 0.05).
Conclusion:
The authors found that white spots during fixed orthodontic treatment and after debonding is a common phenomenon. Although there was improvement in disappearance of these lesions, complete removal cannot be ensured.
KEYWORDS: Debonding, fluorescence, white spots
INTRODUCTION
Patients undergoing orthodontic treatment face many difficulties. Most common is difficulty in lip movements, speaking, smiling, and appearance of white spots on tooth surfaces.[1] The appearance of these white spots leads to unesthetic appearance. Whether white spots disappear or not after treatment is still a matter of doubts. Some suggest that these lesions persist as permanent white spots while others say these fades over a period of time.[2]
For the better management of white spots, a thorough knowledge as well as the pathogenesis is required. A prevalence rate of 2%–96% of white spots has been reported.[3] The cause of white spots is the presence of dental plaque which accumulates around orthodontic appliances such as brackets, springs, and wire retainers. Removable orthodontic appliances are easy to be cleaned and removed, whereas in case of fixed orthodontics, maintenance of hygiene is difficult. The occurrence of dental caries owing to bacterial plaque and bacterial growth is not uncommon in fixed orthodontics.[4]
Fluorescence radiance in carious tooth decreases.[5] The method of digitalization of carious lesion can be performed with fluorescence. The fluorescence loss in the lesion can be quantified in reference to fluorescence radiance level of sound enamel. van der Veen and de Josselin de Jong[6] suggested that quantitative light-induced fluorescence (QLF) is suitable for in vivo monitoring of mineral changes in incipient enamel lesions. The present study aimed to assess white spots with the help of QLF in patients undergoing fixed orthodontics.
MATERIALS AND METHODS
The present study was conducted at Awadh Dental College and Hospital, Jamshedpur, India.
In this study, we enrolled 64 patients of both genders undergoing fixed orthodontics. Patients above 12 years, healthy without any ailment, and those willing to participate in the study were included, while those not giving consent were excluded. Ethical clearance from the ethical committee was taken, and all enrolled patients' consent was obtained.
Data such as name, age, and gender were recorded. A thorough clinical examination was performed. Debonding was done, and the presence of carious lesion was assessed at baseline and after 6 weeks, 6 months, and 2 years. QLF images were taken with intraoral fluorescence camera using software by a single orthodontist at the same angle every time with the same magnification.
QLF images were examined visually for signs of demineralization, and scoring system was used. Results were clubbed together, and statistics were applied using standardized method to measure the level of significance (P < 0.05).
RESULTS
Table 1 shows the median sum of fluorescence loss (ΔF) per patient and median ΔF per lesion. It is found that there was fluorescence loss over a period of time. The median sum of fluorescence loss per patient was 55.6% and 29.2% and 101.4% at quartiles at baseline which changed to 51.2% and 26.5% at the first quartile and 101.4% at the second quartile. At 2 years, it was 43.7% and at the first quartile was 22.1% and at the second quartile was 99.1%. There was significant improvement at T2 (P < 0.05), however, between baseline and F1 and between F1 and F2, there was nonsignificant improvement (P > 0.05).
Table 1.
Sum of fluorescence loss (ΔF) per patient and median ΔF per lesion
| Baseline (0) (T0) | 6 weeks (T1) | 6 months (T2) | 2 years (T3) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
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| F% | 25% | 75% | F% | 25% | 75% | F% | 25% | 75% | F% | 25% | 75% | |
| 64 patients | 55.6 | 29.2 | 101.4 | 51.2 | 26.5 | 101.4 | 48.2 | 25.7 | 97.2 | 43.7 | 22.1 | 99.1 |
| 382 lesions | 8.4 | 6.4 | 11.8 | 8.2 | 6.2 | 10.6 | 7.4 | 6.1 | 10.7 | 7.2 | 5.4 | 10.4 |
Table 2 shows that the median value for total lesion area per patient was 3.6 mm2 with quartiles 1.2 mm2 and 8.2 mm2 at baseline, 2.6 mm2 with quartiles 0.7 mm2 and 6.3 mm2 at 6 weeks, 2.3 mm2 with quartiles 0.7 mm2 and 6.3 mm2 at 6 months, and 1.8 mm2 with quartiles 0.5 mm2 and 5.8 mm2 at 2 years. A significant difference was observed T0 and T2 and between T0 and T3 (P < 0.05).
Table 2.
Median sum of lesion area (A) per patient and median area per lesion
| Baseline (0) (T0) | 6 weeks (T1) | 6 months (T2) | 2 years (T3) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
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| A (mm2) | 25% | 75% | A (mm2) | 25% | 75% | A (mm2) | 25% | 75% | A (mm2) | 25% | 75% | |
| 64 patients | 3.6 | 1.2 | 8.2 | 2.6 | 0.7 | 6.3 | 2.3 | 0.7 | 6.2 | 1.8 | 0.5 | 5.8 |
| 382 lesions | 0.4 | 0.2 | 1.2 | 0.3 | 0.2 | 0.8 | 0.4 | 0.2 | 0.8 | 0.3 | 0.1 | 0.7 |
Table 3 shows that from ΔF0 → ΔF3, there were 45 worsened, 151 improved, 168 stable, and 18 restored cases.
Table 3.
Assessment of behavior of lesions by fluorescence loss (ΔF) and area (A)
| Lesions | ΔF0 → ΔF3 | ΔF0 → ΔF1 | ΔF2 → ΔF3 | A0 → A3 | A0 → A1 | A2 → A3 |
|---|---|---|---|---|---|---|
| Worsened | 45 | 51 | 40 | 36 | 30 | 24 |
| Improved | 151 | 80 | 86 | 91 | 50 | 58 |
| Stable | 168 | 244 | 237 | 242 | 297 | 298 |
| Restored | 18 | 7 | 19 | 13 | 5 | 2 |
DISCUSSION
Fixed orthodontics favor bacterial growth, and hence, chances of dental caries increase.[7] White spot appearance after fixed orthodontic treatment is the main complaint for which patients seek treatment. One of the causative factors favoring these lesions is lack of maintaining good oral hygiene.[8] Demineralization of the enamel of tooth may be judged based on the area of the tooth surface covered and the degree of mineral loss. Numerous optical methods are available to determine enamel demineralization.[9] There are nonfluorescent and fluorescent methods. The important nonfluorescent methods are optical caries monitor and fluorescent methods.[10] The limitation with fluorescent methods is the usage ultraviolet or laser light which may be health hazardous, especially to the retina of the eye.[11] The present study aimed to assess white spots with the help of QLF in patients undergoing fixed orthodontics.
In this study, we enrolled 64 patients having 382 white spots. Mattousch et al.[12] involved 51 patients above 12 years of age with females 27 and males 24. The dental caries was evaluated with the help of QLF at different intervals. It revealed median ΔF at T0 of 8.5%, and the lesions varied from incipient to advanced with different levels of fluorescence. There was improvement of lesions between T0 and T2 but no further significant improvement at T3. Two-year follow-up showed 35 significantly worse lesions after 2 years. One hundred and seventy-one lesions were found stable, and significant improvement was observed in 145 lesions and only 10 lesions improved to such an extent that they disappeared.
We found that there was fluorescence loss over a period of time. The median sum of fluorescence loss per patient was 55.6% and 29.2% and 101.4% at quartiles at baseline which changed to 51.2% and 26.5% at the first quartile and 101.4% at the second quartile. At 2 years, it was 43.7% and at the first quartile was 22.1% and at the second quartile was 99.1%. There was significant improvement at T2 (P < 0.05), however, between baseline and F1 and between F1 and F2, there was nonsignificant improvement (P > 0.05).
In this study, we advised patients to continue normal oral hygiene instructions such as brushing with fluoridated toothpaste. No extra precautionary measures were suggested. We found that in our study, white spot lesions improved over the period of time. It was observed that the median value was 3.6 mm2 with quartiles 1.2 mm2 and 8.2 mm2 at baseline, 2.6 mm2 with quartiles 0.7 mm2 and 6.3 mm2 at 6 weeks, 2.3 mm2 with quartiles 0.7 mm2 and 6.3 mm2 at 6 months, and 1.8 mm2 with quartiles 0.5 mm2 and 5.8 mm2 at 2 years for total lesion area per patient. A significant difference was observed T0 and T2 and between T0 and T3 (P < 0.05). We found that mineralization changes were more evident in the first 6 months after debonding. We observed that from ΔF0 → ΔF3, there were 45 worsened, 151 improved, 168 stable, and 18 restored cases. Benson et al. provided information that the occurrence of white spot lesions could be minimized using fluorides at the time of fixed orthodontics.
The limitation of the study is small sample size.
CONCLUSION
The authors found that white spots during fixed orthodontic treatment and after debonding is a common phenomenon. Although there was improvement in disappearance of these lesions, complete removal cannot be ensured. Thus, there is a need to use remineralizing agents in order to minimize these lesions.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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