White spot lesions (enamel decalcification) is an adverse effect of orthodontic treatment and may be present in up to 50% of patients following removal of fixed appliances.   Topical fluorides have been shown to reduce decalcification and the use of fluoridated bonding composites and elastomerics have also been tested.   The aim of this study was to assess the effectiveness of light-cured sealants in prevention of white spot lesions.

This was a practice-based study. Patients with all upper anterior maxillary teeth fully erupted and commencing orthodontic treatment with bonded appliances were included.  An alternating-tooth split-mouth design was used with the 6 maxillary anterior teeth alternately assigned (following the initial random assignment of the left canine) to receive the test sealant or to be bonded with only the primer normally used in the practice.  There were no restrictions on the orthodontic care provided with fluoride-containing adhesives or elastics being allowed if they were applied to all study teeth. Patients were encouraged to brush their teeth on a regular schedule with fluoridated toothpaste. The main outcome was incidence of white spot lesions measured by non-blinded orthodontists using the 4-point Gorelick scale.

• 62 patients completed the study (3 drop outs)
• There was a statistically lower incidence of white spot lesions on treated teeth (13.5%; 95% CI, 8.6-18.4) compared with the control teeth (17.7%; 95% CI, 12.4-23.7).
• The odds ratio that treated teeth would show white spot lesions relative to the control teeth was 0.68 (95% CI, 0.47-0.95)
• No serious adverse effects were reported.

The authors concluded

The sealant did not prevent all white spot lesions for the full duration of treatment. The sealant demonstrated a clinically small but statistically significant ability to prevent white spot lesions.

Comment
The authors have taken an interesting methodological approach to this study which does suggest a small benefit. Larger trials using a more traditional randomised approach are needed to help clarify whether this approach is an effective and cost effective approach for managing this common problem.

 Links

O’Reilly MT, De Jesús Viñas J, Hatch JP. Effectiveness of a sealant compared with no sealant in preventing enamel demineralization in patients with fixed orthodontic appliances: A prospective clinical trial. Am J Orthod Dentofacial Orthop. 2013 Jun;143(6):837-44. doi: 10.1016/j.ajodo.2013.01.021. PubMed PMID: 23726334.

Dental Elf 3rd March  2013 -Lack of reliable evidence for the effectiveness of remineralizing agents for the treatment of post-orthodontic white spot lesions