Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review

Abstract

Background: The regular use of fluoride dentifrices is quite practical, widespread and linked to global decline of dental caries. However, the role of self-applied topical fluorides in prevention and reversal of Enamel White Spot Lesions (EWSLs) during multi-bracketed fixed orthodontic treatment is not yet explored.

Objective: To systematically appraise the current literature on the effectiveness of self-applied topical fluorides in the prevention and reversal of EWSLs occurring during multi-bracketed fixed orthodontic treatment.

Search methods: Four electronic databases (Cochrane Library, Embase via Ovid, Medline via Ovid, and Scopus) and gray literature were searched using the broad MeSH terms and keywords.

Selection criteria: Only randomized/quasi-randomized controlled clinical trials evaluating the effectiveness of self-applied fluorides in the prevention of EWSLs during multi-bracketed fixed orthodontic treatment or reversal of post-orthodontic EWSLs were included.

Data collection and analysis: Two reviewers independently screened for studies, extracted data and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Due to substantial variations in the interventions, control groups, and the measurement of outcome among studies, quantitative synthesis could not be performed as planned.

Results: Only three studies could be included in the present review; two of them assessing prevention of EWSLs and one addressing reversal of post-orthodontic EWSLs. One of the studies was judged to be of low risk of overall bias, whereas 2 studies were adjudged to be of high risk of overall bias because of deviations from intended interventions. The certainty of evidence about the role of self-applied fluorides in prevention and reversal of EWSLs was found to be of low quality; hence, our confidence in the effect estimate is limited, and future well-conducted trials might alter the effect estimates.

Limitations: The inclusion of only English literature and inability to perform quantitative synthesis due to a limited number of studies.

Conclusions and implications: Although the review did not confirm the effectiveness of self-applied fluorides in the reversal of EWSLs, it did partially substantiate the positive role of self-applied fluorides in the prevention of EWSLs occurring during multi-bracketed fixed orthodontic treatment. The review recommends the need for well-designed randomized controlled trials evaluating the effectiveness of self-applied fluorides on the prevention and reversal of EWSLs during multi-bracketed fixed orthodontic treatment.

Registration: PROSPERO database (Registration number: CRD42018108590) and is freely available at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108590

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.