UCLA

Orthodontic treatment impedes the oral hygiene of patients, leading to plaque accumulation and the development of white spot lesions (WSL), which are visible areas of demineralized enamel. Our study aims to investigate the efficacy of different commercially available fluoride varnishes to treat these white spot lesions after the completion of orthodontic treatment and evaluate their effect on the oral microbiome. The present pilot study used a split-mouth design, with each of the eight subjects receiving different treatment on the left and right sides of their mouth. Subjects were assigned to one of three groups using stratified permuted block randomization, with each group receiving two of the following three options: placebo varnish (petroleum jelly), 5% sodium fluoride varnish (Acclean, Henry Schein), and a resin-modified glass ionomer light-cured fluoride varnish (Vanish XT Extended Contact Varnish, 3M). There are four total visits for this study: T1 (baseline taken within one month of braces removal), T2 (day 30), T3 (day 90), and T4 (day 180). Several series of photographs were taken at each visit to assess their oral health and the appearance of the WSL. Stimulated saliva was collected, and the severity of the WSL was assessed using laser fluorescence (DIAGNOdent pen, Kavo), after which the varnishes were applied according to their group allocation.

Clinical photographs were assessed by a trained and blinded scorer using the Turesky-modified Quigley Hein Plaque Index (TQHPI) and the International Caries Detection and Assessment System (ICDAS). These index measurements, along with the DIAGNOdent scores, were used to assess the efficacy of the different interventions at remineralizing WSLs. Salivary loads of total bacteria, Candida albicans, and Streptococcus mutans were determined by plating saliva samples on agar plates containing Brain Heart Infusion (BHI), Sabouraud Dextrose (SAB), and Mitis Salivarius-Bacitracin (MSB) respectively.

Although the small sample size of this pilot study made it difficult to achieve statistical significance, several notable trends were identified. Average TQHPI levels stayed relatively stable, with modest decreases seen in the placebo and light-cured fluoride varnish (LCFV) groups. DIAGNOdent scores decreased in all groups, with the 5% varnish group showing a significant decrease from T1-T3 and the LCFV showing the greatest percent change from T1-T4. ICDAS scores increased in the 5% and placebo groups and decreased in the LCFV group. CFUs representing total bacterial load, S. mutans, and C. albicans all decreased by an average of 60.9 – 99.9 percent, showing decreased oral colonization in the 6 months after completion of orthodontic treatment. These preliminary trends need to be verified in future studies that include more subjects to reach statistical significance.