Prevalence of New Carious Lesions among Patients Undergoing Orthodontic Treatment with Fixed Appliances

The development of new carious lesions is a significant clinical problem during orthodontic treatment. The aim of this study was to evaluate the prevalence of carious lesions, commonly presented as white spots (WSLs) on banded molars among patients undergoing orthodontic treatment with fixed appliances. In addition, the relation between prevalence and treatment duration was evaluated. Another aim was to investigate the relation between severities of detected WSLs and treatment durations. A study group of randomly selected 100 patients undergoing orthodontic treatment with fixed orthodontic appliances were examined for the presence of white spot lesions on banded molars. The examination was performed after removal of cemented bands. Direct visual examination was the detection method used. The study group patients were divided into three groups according to treatment duration. The detected white spot lesions were given four scores according to severity; zero, one, two and three. A control group of 100 patients who were referred for orthodontic treatment, but no treatment had started yet, were also examined for the presence of white spot lesions on molars to be banded. The results show that the overall prevalence of white spot lesions in the test group patients was 87%, while it was 18% in control group. Studying the relation between prevalence of WSLs and treatment duration show that prevalence was 74% for the first group with treatment durations less than one year, 85% for second group with treatment durations between one and two years, and 100% for the third group with treatment durations more than two years. A scoring system which consisted of 4 scores (from 0-3) was designed for the study according to white spot lesions depth. Score 0 was given when no WSL was detected, score 1 for detected WSLs with no hard tissue disintegration, score 2 for lesions with disintegration of enamel surface, and score 3 for lesions extending into Dentin. In the first group of the study group patients, 47% of the detected lesions had score of 1, 47% had score of 2 and 6% had score 3. In the second group: 63% of lesions had score of 1, 37% of the lesions had score of 2. In the third group 48% had score of one, 52% had score of two. Despite preventive measures improvements, development of white spot lesions is still a side effect that can’t be ignored and should always be kept in mind by orthodontist before, during and after initiating orthodontic treatment with fixed appliances. Prevalence of WSLs on banded molars increased significantly among patients undergoing orthodontic treatment with fixed orthodontic appliances compared to control group. Prevalence of WSLs was highest when treatment duration increased for more than two years. No relation was found between severity or depth of WSLs and treatment duration.