Treatment of orthodontic white spot lesions with a remineralizing dentifrice applied by toothbrushing or mouth trays

This pilot study investigated the effect of a remineralizing fluoride denti frice (Enamelon(R)) on newly formed incipient carious lesions using two met hods of application. Teenage orthodontic patients with obvious white spot l esions on their teeth were selected to begin treatment within 30 days after debanding. At baseline, the surface enamel of the test teeth was cleaned b y air etching with 50 mu m alumina at 150 psi. Lesion size (mm(2)) was meas ured using a calibrated periodontal probe and surface appearance was quanti fied as shiny (0), dull (1), or chalky (2). Twice daily for 3 months, one g roup with a total of 27 lesions brushed with the remineralizing dentifrice, while a second group with 41 total lesions brushed and used a mouth tray t o apply the paste directly to the lesions for 5 min. In order to promote tr eatment compliance, test group assignment was based on subject and parental preference. After 1, 2, and 3 months, lesion size was reduced by 5% (ns), 10% (p < 0.05) and 22% (p < 0.01), respectively, for the brushing group, an d 16% (p < 0.05), 37% (p < 0.01) and 30% (p < 0.01) for the combined brushi ng and tray group, respectively. The dull appearance of the lesions treated by brushing improved slightly over 3 months. However, the lesions receivin g combined brushing and tray applications became significantly (p < 0.01) l ess dull by 28%, 44% and 61% after 1, 2, and 3 months, respectively, indica ting the formation of a shiny, intact surface layer. In conclusion, brushin g with a remineralizing dentifrice significantly reduced the size of new or thodontic white spots within 2 months, while brushing combined with topical tray applications reduced lesion size within 1 month with concomitant form ation of a shiny enamel surface layer. Thus, the combined brushing and mout h tray treatment significantly accelerated the remineralization process.