Enamel remineralization therapies for treating postorthodontic white-spot lesions: A systematic review

J Am Dent Assoc. 2018 Sep;149(9):778-786.e2. doi: 10.1016/j.adaj.2018.05.010. Epub 2018 Jul 12.


Background: One of the adverse effects of orthodontic treatment is the appearance of white-spot lesions (WSLs) resulting from enamel demineralization. The objective of this systematic review was to investigate the effectiveness of remineralization therapies on WSLs after orthodontic treatment.

Types of studies reviewed: In this systematic review, the authors identified relevant articles listed in 5 databases-PubMed, the Cochrane Library, Scopus, Embase, and Web of Science-by using a combination of search terms referring to orthodontics, demineralization, and treatment. Ten articles on the efficacy of WSL remineralization therapies met the inclusion criteria.

Results: Among the studies of remineralizing therapy, neither fluoride mouthrinses nor phosphopeptide toothpastes with or without fluoride had any positive effect in addition to oral hygiene maintenance with fluoride toothpaste. A 5% sodium fluoride varnish was the only therapy to show a statistically significant improvement compared with results in the control group. The authors found large variations in results among the studies reviewed because of the different methods used.

Conclusions and practical implications: None of the treatments was capable of remineralizing WSLs. A 5% sodium fluoride varnish could improve remineralization of WSLs.

Keywords: White-spot lesion; enamel demineralization; fluoride; remineralization.

Publication types

  • Systematic Review

MeSH terms

  • Cariostatic Agents
  • Dental Caries*
  • Dental Enamel
  • Fluorides
  • Humans
  • Tooth Remineralization*
  • Toothpastes


  • Cariostatic Agents
  • Toothpastes
  • Fluorides