Prevention and treatment of demineralisation during fixed appliance therapy: a review of current methods and future applications

Br Dent J. 2013 Nov;215(10):505-11. doi: 10.1038/sj.bdj.2013.1094.


Orthodontic treatment, like all aspects of dentistry, exposes the clinician to the risk of malpractice and litigation. Demineralisation of tooth enamel is still one of the main complications of orthodontic treatment and it is essential patients are made aware of this risk during the consent process. There are a variety of fluoride delivery systems (mouthrinse, varnish, bonding system, and elastics), which can be used to prevent white spot lesion (WSL) formation. Glass-ionomer bonding cements (GIC) have also been shown to reduce WSL formation and have the benefit of not relying on patient compliance. However, these materials have not found widespread acceptance, possibly due to handling characteristics. A number of new technologies, principally fillers and coatings, have recently become available with potential antimicrobial and antibiofilm properties. Coatings can be applied to brackets and wires, which prevent bacterial adhesion. However, the longevity of these coatings is questionable. There are a number of methods available aimed at reducing the incidence of WSL, but they all have limitations. Capitalising on technological advances will enable the production of tailor made orthodontic brackets and adhesive systems, which provide long-term protection against WSL without relying on patient compliance.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / chemistry
  • Cariostatic Agents / administration & dosage
  • Cariostatic Agents / therapeutic use
  • Coated Materials, Biocompatible / chemistry
  • Dental Caries / prevention & control
  • Dental Caries / therapy
  • Fluorides / administration & dosage
  • Fluorides / therapeutic use
  • Glass Ionomer Cements / chemistry
  • Humans
  • Orthodontic Brackets* / adverse effects
  • Tooth Demineralization / prevention & control*
  • Tooth Demineralization / therapy
  • Tooth Remineralization / methods


  • Anti-Bacterial Agents
  • Cariostatic Agents
  • Coated Materials, Biocompatible
  • Glass Ionomer Cements
  • Fluorides