Effect of high-fluoride toothpaste and mouth rinse on the prevention of demineralized lesions during orthodontic treatment: a randomized controlled trial

Eur J Orthod. 2023 Sep 18;45(5):477-484. doi: 10.1093/ejo/cjad044.


Objective: To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment.

Trial design: Three-armed parallel-group randomized controlled trial.

Methods: The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis.

Recruitment: October 2010 to December 2012.

Results: In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of ≥1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P = .01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P < .01.

Conclusions: To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended.

Limitations: The protocol was not registered, and the present study did not use a double-blinded design.

Keywords: demineralization; fixed appliance; fixed brace treatment; fluoride; high-fluoride toothpaste; mouth rinse; multi bracket appliance treatment; orthodontics; white spot lesion.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Cariostatic Agents / therapeutic use
  • Child
  • Dental Caries* / prevention & control
  • Esthetics, Dental
  • Fluorides* / therapeutic use
  • Humans
  • Mouthwashes / therapeutic use
  • Reproducibility of Results
  • Sodium Fluoride / therapeutic use
  • Toothpastes / therapeutic use
  • Young Adult


  • Fluorides
  • Toothpastes
  • Mouthwashes
  • Sodium Fluoride
  • Cariostatic Agents