Effect of fluoridated chewing sticks (Miswaks) on white spot lesions in postorthodontic patients

Am J Orthod Dentofacial Orthop. 2011 Sep;140(3):291-7. doi: 10.1016/j.ajodo.2010.04.034.


Introduction: This article illustrates a new treatment method and evaluates the effect of the frequent use of fluoridated chewing sticks (miswaks) on the remineralization of white spot lesions (WSLs) diagnosed at debonding.

Methods: Thirty-seven orthodontic patients (mean age, 17.2 years), with a minimum of 4 WSLs on the buccal surfaces of the maxillary incisors, canines, premolars, and first molars after orthodontic therapy, were enrolled in a double-blind, randomized, longitudinal trial lasting 6 weeks. The subjects were divided into 2 groups using fluoridated miswaks impregnated in 0.5% sodium fluoride (test group, n = 19) and nonfluoridated miswaks (control group, n = 18). A custom-made mouth tray, covering half of the maxillary dentition, was used while brushing with the miswaks 5 times per day. The WSLs were scored by using a DIAGNOdent pen (KaVo, Biberach, Germany) and with the International Caries Detection and Assessment System (ICDAS II) index, at baseline and 2, 4, and 6 weeks after debonding.

Results: Both the DIAGNOdent readings and the ICDAS II index of the WSLs decreased in the test group on the uncovered side of the dentition but not on the covered side during the 6-week trial (P <0.0001). There was also a slight improvement in the control group (not significant). There was a strong correlation between the DIAGNOdent values and the ICDAS II index when all the data were pooled (P <0.001).

Conclusions: The frequent use of fluoridated miswaks had a remineralizing effect on WSLs. The DIAGNOdent pen might be a useful tool for diagnosing and monitoring changes of WSLs over a relatively short period of time.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cariostatic Agents / administration & dosage*
  • Dental Caries / etiology
  • Dental Caries / therapy*
  • Dental Caries Activity Tests
  • Dental Devices, Home Care*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Orthodontic Appliances / adverse effects
  • Probability
  • Prospective Studies
  • Research Design / statistics & numerical data
  • Saudi Arabia
  • Sodium Fluoride / administration & dosage*
  • Statistics, Nonparametric
  • Tooth Remineralization / methods*
  • Toothbrushing / instrumentation*


  • Cariostatic Agents
  • Sodium Fluoride