PREVALENCE OF WHITE SPOT LESIONS IN ORTHODONTIC PATIENTS

Dr .Hareem Bukhari,Dr Taha,Dr Muhammed Uzair,Dr Syed Nihal,Dr Asim

Department of orthodontic
Hamdard University Dental Hospital

Introduction Results
The White Spot Lesion has been defined as “subsurface enamel porosity from Sparemen Correlation between plaque index & WSL score is 0.151 with p-value
carious demineralization” that present itself as “a milky white opacity when 0.127. P-value is > than α so denoting no association between plaque index & WSL
located on smooth surfaces”The ICDAS II has scoring system consist of 0 - 6. The Spare man correlation between calculus index Correlation between calculus index
most common negative side effect of orthodontic treatment with fixed 7 WSL score is 0.291 with p-value of 0.002 . P-value is < α so denoting significant
appliances is the development of incipient carious lesions around brackets and association between these two variables. Stat Chi-square test of independence is
bands as it limit natural self-cleaning mechanism, such as movement of the oral used to find out association between WSL scores & plaque index
musculature and saliva because of plaque adhering surfaces of brackets, bands, Comparing plaque index & WSL score Pearson Chi-square p value 0.147 P-value >
wires, and other attachments. 3 WSLs can become noticeable around the fixed α.(0.05) so we accept Ho & conclude that plaque index & WSL score are
appliances within 1 month of placement, although the formation of regular independent of each other On comparing calculus score & WSL score .Pearson chi-
caries usually takes at least 6 months commonly seen on the buccal surfaces of square p value + 0.001 hence, P value < α so we reject Ho & conclude that calculus
the teeth, around the brackets, especially in the gingival area. Estimates of the score & WSL score are dependent to each other revealing association between
prevalence of WSL arising during fixed orthodontic treatment ranges from 2% to them.
96%.Chapman et al. (2010) showed results, with 36% of patients having visible
WSLs, which increased to 46% in the 12-month treatment group. Gorelick et al.
(1982) reported a prevalence of approximately 50% for WSLs. Boersma et al.
(2005) reported that 97% of patients had one or more lesions at the end of
orthodontic treatment.We found no significant difference in the number of
patients between girls and boys 5The orthodontic population is known to have
more WSL than non-orthodontic patients.8The orthodontic literature has quoted
a variable incidence of WSL, reportedly affecting from 50% to 97% of patients
treated with fixed appliances.

objective
1. To find out the prevalence of white spot lesion in orthodontic patients
2. To find out correlation between plaque index and white spot lesion
3. To find out relationship between calculus index and white spot lesion

Materials and method

Study design: This study was a cross-sectional prospective clinical study
Sample selection: The study involved patients who reported for orthodontic
therapy in Hamdard university dental hospital Karachi in the city Karachi, WSL score Correlations

Pakistan.100 patients were selected for the study.

gender WSL score
gender Pearson Correlation
1 .067
Frequency Percent Valid Percent Cumulative Percent
Valid no change Sig. (2-tailed) .498
62 58.5 58.5 58.5

The WSL scoring criteria in accordance to the ICDAS-II system for Coronal: opacity visible after air dry
9 8.5 8.5 67.0
WSL score
N

Pearson Correlation
106

.067
106

Smooth Surface Caries are graded from 0to6. ICDAS II Assessment criteria 0-2
opacity visible on wet sufrace
35 33.0 33.0 100.0
Sig. (2-tailed) .498
Total
106 100.0 100.0 N 106 106

were considered in our study as we dealt with non-cavitated lesions on enamel

surface. (0 - No change in enamel translucency after prolonged air drying (>5 s)1
- Opacity or discoloration hardly visible on a wet surface, but distinctly visible
after air drying. 2 - Opacity or discoloration distinctly visible without air
drying).The plaque score is identified by visual and clinical examination of
specified index teeth .
Before examination of each patient informed consent was taken for
examination of plaque score and WSL index according to parameter.
Inclusion and exclusion criteria
The inclusion criteria of the subjects included for the Control group were:
Subjects between the age groups of 12-25 years.
Subjects with mild to moderate crowding
DMF score of less than 1
Both male & female patients are included
Patients undergoing non-surgical orthodontic treatment
Patients undergoing orthodontic treatment from 1-6 months
Only upper lower anterior teeth are included in study
The exclusion criteria for the selection of samples were:
Patients with a DMFS index of more than 1 during the start of treatment.
Patients undergoing orthodontic treatment for more than 8-12 months.
Patients with mixed dentition.
Patients on long term medication for systemic illness.
Subjects with fixed functional appliances, extensive use of appliance
attachments other than the base arch-wire (for e.g., coil springs, arch wire
sleeves, multi-loop arch wires, etc.)
Patients undergoing surgical orthodontic treatment
Discussion
The present survey indicates that white spot lesions remain a significant problem
during orthodontic management. Overall prevalence of WSLs among the study
participants was 33%. The prevalence of WSLs among orthodontic patients ranged
from 0 to 97% as shown by many studies. But recent investigations had shown the
incidence of WSLs among orthodontic populations as 73-95%, which is much
higher than the present data. The results were non- significant in relation to
gender while considering the prevalence of WSLs and these findings weresimilar
to the results of Sagarika et al . Fixed orthodontic appliances serve as plaque
retention sites, and, In case of poor oral hygiene, plaque accumulates
and along with this acidogenic bacteria cause marked demineralization of enamel.
The incidence of WSLs was increasing with the duration of treatment in the
present data and similar correlation was seen in Lucchese et al study in 2012.
In our study calculus index is significantly related to occurrence of white spot lesion
that was not studied before. The present data also revealed that oral hygiene
status had a strong and significant correlation with the prevalence of white spot
lesions. It is well known that poor oral hygiene was an important risk factor in the
formation of WSLs. Juliena et al found WSLs in only 17% of patients with good oral
hygiene index, compared to 24% with fair and 38% with poor oral hygiene status.
Conclusion
The study showed that 39.7% of patients developed white spot lesions during
orthodontic procedure.
Furthermore, WSLs, showed a significant correlation with oral hygiene
status. So, patients undergoing orthodontic treatment should receive proper oral
hygiene treatment to stop the progress of demineralization.