M Beerens

106 CHAPTER 6 Monitoring WSL over time Orthodontic treatment with fixed appliances is a risk factor for developing WSL (Øgaard et al. , 1988). Key to prevention and management of WSL is finding a monitoring method for WSL formation and severity. Lesion assessment is defined as the method of determining whether or not caries is present and to characterise or monitor a lesion, once it has been detected (Gomez, 2015). The conventional method for caries assessment is visual inspection. The International Caries Detection and Assessment System (ICDAS) is the current standard in visual inspection (Ismail et al ., 2007). The technique discriminates various stages of disease on an ordinal scale, from the first visual change in the enamel to frank caries lesions involving the pulp. The ICDAS scoring system was shown to be an accurate and reproducible method to detect early lesions and also to detect changes during longitudinal follow-up (Ferreira Zandona et al ., 2010). However, clinical lesions monitoring by ICDAS scoring on smooth surfaces did not prove to be an accurate method (Guedes et al ., 2014). In the past years, quantitative (objective) methods for detecting andmonitoring caries lesions that assess caries severity on a continuous scale have been introduced (ten Bosch and Angmar-Mansson, 2000). Quantitative light induced fluorescence (QLF) is such a potential tool for the detection of early caries lesions and for monitoring preventive interventions (Gomez, 2015). This method was used for the monitoring of WSL in this thesis. However, QLF is not yet available in clinical practices as most orthodontists have a photo camera for documenting treatment outcomes on clinical oral photographs. The use of clinical oral photographs to monitor WSL in time was studied in this thesis. The findings show that visual comparison of photographs taken in time provides discriminatory power to reveal changes in WSL. The use of ICDAS assessment on these clinical oral photographs did not have sufficient discriminatory power. Monitoring WSL by comparing time series of clinical oral photographs side-by side is useful for clinical decision making in the management of WSL. An internationally accepted assessment method for monitoring WSL over time should be agreed upon. Preventive measures during orthodontic treatment To prevent development of WSL, orthodontists should judge each patient’s caries risk before and during treatment, given that maintaining adequate oral