M Beerens

DISCUSSION 6 107 hygiene during orthodontic treatment is difficult. Additional measures may be needed when self-care needs to be enforced. Efforts to prevent WSL should be taken jointly by orthodontists, dentists, dental hygienists, the patients, and their parents/caretakers. Based on scientific evidence, fluoride has a beneficial effect for the prevention of WSL (Benson et al. , 2013). In case of good compliance (Geiger et al. , 1988), daily home use of fluoride mouth rinses in addition to brushing with fluoride toothpaste can reduce the occurrence and severity of WSL (Benson et al. , 2013). A type of treatment not requiring patients compliance is the application of high concentration fluoride varnishes; this reduces the formation of WSL and decreases WSL depth during orthodontic treatment (Stecksen-Blicks et al. , 2007). The suggested interval of in-office fluoride varnish application varies from every six weeks to twice a year depending on the caries risk of the patient. The agent is advised for moderate to high risk patients. Unfortunately, a clinical guideline based on the available scientific evidence is lacking. Treatment of existing white spot lesions When prevention has failed, and WSL have formed, effort should be made to prevent further caries decay. Removing the fixed appliances results in less stagnation areas for plaque biofilm accumulation and results in better self- cleaning by the oral musculature and saliva. Treatment of white spot lesions can be specified for four phases after bracket removal: 1) Natural remineralisation, 2) Camouflage, 3) Micro abrasion, and finally 4) Restorative treatment. The first phase is called secondary prevention and consists of control and non-invasive care methods to facilitate remineralisation of existing active WSL. During this phase, the first few months after debonding, a natural regression of WSL often occurs. Active WSL have a better prognosis for recovery when hypermineralisation of the outer surface has not occurred yet. Therefore, high doses of fluoride must not be used to prevent hypermineralisation from occurring. Remineralisation products should enhance remineralisation without blocking the surface layer. CPP-ACPF products have been advocated