Commentary by Howard E. Strassler, DMD

Regression of post-orthodontic lesions by a remineralizing cream.

Bailey DL, Adams GG, Tsao CE, et al. J Dent Res. 2009;12:1148-1153

Abstract
Orthodontic patients have an increased risk of white-spot lesion formation. A clinical trial was conducted to test whether, in a post-orthodontic population using fluoride toothpastes and receiving supervised fluoride mouthrinses, more lesions would regress in participants using a remineralizing cream containing casein phosphopeptide-amorphous calcium phosphate compared with a placebo. Forty-five participants (aged 12-18 yrs) with 408 white-spot lesions were recruited, with 23 participants randomized to the remineralizing cream and 22 to the placebo. Product was applied twice daily after fluoride toothpaste use for 12 weeks. Clinical assessments were performed according to ICDAS II criteria. Transitions between examinations were coded as progressing, regressing, or stable. Ninety-two percent of lesions were assessed as code 2 or 3. For these lesions, 31% more had regressed with the remineralizing cream than with the placebo (OR = 2.3, P = 0.04) at 12 weeks. Significantly more post-orthodontic white-spot lesions regressed with the remineralizing cream compared with a placebo over 12 weeks.

Commentary

Significant progress has been made in the prevention of dental caries in children and adolescents over the past 30 years. As the dentition matures and malocclusion becomes evident, parents take their children for an evaluation for orthodontic treatment. Many of these patients, before the initiation of orthodontic therapy, can be classified as low caries risk.

Unfortunately, however, conventional orthodontic treatment creates an oral environment that changes a child’s caries risk from low to high because of the presence of bonded brackets, orthodontic bands, ligatures, and wires. The presence of all of this orthodontic hardware makes it difficult for the child to remove plaque, in turn increasing his or her caries risk.

This well-designed research study provides additional information and guidance in the management of white-spot lesions resulting from access issues for oral hygiene with the presence of fixed orthodontic hardware. Typically, the presence of white-spot lesions is most noticeable after debonding of the brackets.

For this study, the subjects were already using fluoride toothpastes and mouthrinses. This study investigated the addition of a remineralizing cream containing casein phosphopeptide-amorphous calcium phosphate (MI Paste, GC America) to the regimen compared to a placebo. After 12 weeks, it was found that significantly more of the white-spot lesions regressed using the remineralizing cream when compared to the placebo.

As clinicians we need to provide orthodontic patients with mechanical brushes, fluoride toothpastes, and mouthrinses to avoid white-spot lesion formation during treatment and posttreatment. Now we should consider the addition of remineralizing cream containing casein phosphopeptide-amorphous calcium phosphate to our clinical recommendations.