Excessive-fluoride toothpaste or excessive fluoride mouthrinse to forestall white spot lesions in adolescent orthodontic sufferers – trial

Early empanel demineralised lesions or white spot lesions are antagonistic results of fixed-appliance orthodontic remedy. A Cochrane assessment replace in 2019 (Dental Elf – 27th Nov 2019) recognized 10 research suggesting useful results for top fluoride merchandise on white spot lesions though the proof was of low certainty.

The goal of this research was to match the impact of high-fluoride toothpaste and high- fluoride mouth rinse for stopping white spot lesions (WSL) throughout orthodontic remedy.


Moral approval was obtained however no protocol was registered. Sufferers aged 12- 20 attending a specialist orthodontic clinic for fastened equipment remedy on each arches had been invited to take part. Sufferers had been randomised to one in all three teams, twice every day toothbrushing with 1450ppm fluoride toothpaste (Management), Twice every day toothbrushing with 5000ppm fluoride toothpaste (HFT group) or twice every day 900ppm fluoride rinse (FMR). The pattern dimension was calculated as 76 sufferers per group together with a 15% anticipated attrition fee. The principle end result was incidence of white spot lesions assessed on digital pictures by two examiners not concerned with scientific information assortment. Compliance was assessed at 12 months utilizing a questionnaire.


  • 270 sufferers (175 females, 95 males) had been recruited between 2010 – 2012.
  • There have been 22 dropouts and 15 sufferers excluded for incomplete information leaving 248 for evaluation.
  • The imply period of remedy was 25.9 (± 9.1) months.
  • 236 of the 248 analysed sufferers (95.2%) self-reported compliance at 12 months.
  • The variety of sufferers with WSLs at baseline and enhance is proven within the desk beneath.
  Baseline WSL No of sufferers (%) Sufferers with enhance ≥ 1 WSL Sufferers with enhance ≥ 2 WSL Sufferers with enhance ≥ 3 WSL
Mouth rinse (FMR) 17 (21%) 47 (58.0%) 39 (48.1%) 29 (35.8%)
Excessive fluoride paste (HFT) 22 (25.9%) 51 (60.0%) 44 (51.8%) 34 (40.0%)
Management 15 (18.3%) 64 (78.0%) 48 (58.5%) 37 (45.1%)
  • The variety of sufferers with a rise of ≥1 WSL within the ‘aesthetic zone’, throughout orthodontic remedy, was considerably decrease within the
    • HFT group in comparison with the management, Danger ratio (RR) = 0.77 (95percentCI: 0.62 to 0.95) and
    • The FMR group in comparison with management, RR = 74 (95percentCI: 0.60 to 0.92).
  • No antagonistic results or harms had been reported by the sufferers.


The authors concluded: –

A optimistic impact of excessive fluoride toothpaste and fluoride mouth rinse in stopping WSL on central incisors, lateral incisors, and canines throughout orthodontic remedy. WSL are nonetheless an issue throughout orthodontic remedy. Subsequently, future randomized managed scientific trials are wanted to evaluate evidence-based tips for stopping WSL throughout orthodontic remedy.


The fieldwork for this randomised managed trial was carried out some years in the past. Nevertheless, because the 2019 Cochrane assessment exhibits that is nonetheless an space the place extra proof is required to enhance our understanding for managing WSLs. This trial was not registered however is properly reported following key components of the CONSORT assertion. The randomisation and allocation procedures are described however do current alternatives for enchancment as famous by the authors . Nevertheless, the baseline traits are properly matched, and the end result evaluation was blind to the group allocation. The findings show a useful impact for each the HFT and FMR over the usual fluoride management paste. For enamel within the aesthetic zone (3-3 within the maxillary and mandibular arches) a statistically important discount within the proportion of sufferers with enhance of ≥1 WSL.


Major Paper  

Enerbäck H, Lövgren ML, Strömberg N, Westerlund A. Impact of high-fluoride toothpaste and mouth rinse on the prevention of demineralized lesions throughout orthodontic remedy: a randomized managed trial. Eur J Orthod. 2023 Sep 18;45(5):477-484. doi: 10.1093/ejo/cjad044. PMID: 37524332.

Different references

Enerbäck H, Lingström P, Möller M, Nylén C, Ödman Bresin C, Östman Ros I, Westerlund A. Impact of a mouth rinse and a high-fluoride toothpaste on caries incidence in orthodontic sufferers: A randomized managed trial. Am J Orthod Dentofacial Orthop. 2022 Jul;162(1):6-15.e3. doi: 10.1016/j.ajodo.2022.03.011. Epub 2022 Apr 28. PMID: 35491328.

Dental Elf – 27th Nov 2019

White spot lesions: Topical fluoride for prevention throughout fastened orthodontic remedy

Dental Elf – 7th Jun 2023

White spot lesions – remedy choices

Dental Elf – 1st Could 2023

Fluoride varnish for prevention of white spot lesions throughout orthodontic remedy


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