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Izvestia Journal of the Union of Scientists - Varna. Medicine and Ecology Series

Assessment of the specific caries risk profile of patients with fixed orthodontic technique

Elena Dimova


Introduction: Orthodontic therapy carries a risk of complications. The literature shows that dental caries is the most common complication found by orthodontists. Fixed appliances can further predispose, initiate or intensify this process, as they limit salivary flow and self-cleaning, and provide places to retain food debris.

Aim: The aim of the present study is to assess the specific carious risk profile of patients with fixed orthodontic techniques.

Materials and Methods: A total of 246 patients: 123—clinical group (patients undergoing orthodontic treatment with a fixed technique) and 123—control group (patients who visited the dental office for another reason), were studied for a period of 2 years. In order to obtain reliable results, the patients included in the study were evenly distributed by sex and age between the two groups.

Results: Male gender was linked to a high caries risk (OR = 2.25 (1.04–4.85); p < 0.05). It was found that there is a significant difference in caries risk according to the duration of treatment with a fixed orthodontic technique (p < 0.001). From the point of view of the follow-up stages, a significant difference was also found in terms of caries risk (p < 0.001). The lack of cooperation of the patient during orthodontic treatment was associated with a high risk of caries. Lack of cooperation increased the risk of caries more than 7 times during orthodontic treatment (OR = 7.56 (3.17–17.97); p < 0.001).

Conclusion: The high caries risk profile of patients with fixed orthodontic technique includes male gender, metal braces, long-term treatment, and lack of cooperation.


fixed orthodontic technique, carious lesions, risk profile

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Alabdullah M, Nabawia A, Ajaj M, Saltaji H et al. Effect of fluoride-releasing resin composite in white spot lesions prevention: a single-centre, split-mouth, randomized controlled trial. Eur J Orthod. 2017;39(6):634-640

Artun J, Brobakken BO. Prevalence of carious white spots after orthodontic treatment with multibonded appliances. Eur J Orthod 1986;8(4):229–34

Benson, P.E.; Parkin, N.; Dyer, F.; Millett, D.T.; Furness, S.; Germain, P. Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment. In Cochrane Systematic Review—Intervention Version Published; John Wiley & Sons, Ltd.: Hoboken, NJ, USA, 2013

Boersma JG, van der Veen MH, Lagerweij MD, et al. Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors. Caries Res 2005;39(1):41–7

Chang, H.S.; Walsh, L.J.; Freer, T.J. Enamel demineralization during orthodontic treatment. Aetiology and prevention. Aust. Dent. 1997, 42, 322–327

Chapman J, Roberts E, Eckert G et al. Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2010; 138: 188–194

Chin, M. Biofilms in Orthodontics. Ph.D. Thesis, Groningen Rijksuniversiteit, Groningen, The Netherlands, 2007

Dalessandri D. Reduction in incidence of white spot lesions with lingual appliances. Am J Orthod Dentofacial Orthop. 2016;149(1):7-8

Ekanayake, L.S.; Sheiham, A. Reducing rates of progression of dental caries in British schoolchildren. A study using bitewing radiographs. Br. Dent. J. 1987, 163, 267–269

Eltayeb M, Ibrahim Y, El Karim I et al. Distribution of white spot lesions among orthodontic patients attending teaching institutes in Khartoum. BMC Oral Health. 2017;17(1):88-92

Enaia M, Bock N, Ruf S. White-spot lesions during multibracket appliance treatment: a challenge for clinical excellence. Am J Orthod Dentofacial Orthop 2011;140(1):e17–24

Fejerskov O, Nyvad B, Kidd E. Clinical and histological manifestations of dental caries. In Fejerskov O, Kidd EAM, editors. Dental Caries. The disease and its clinical management. Copenhagen: Blackwell Munksgaard; 2003. pp. 71-99

Fornell C, Skold-Larsson K, Hallgren A et al. Effect of a hydrophobic tooth coating on gingival health, mutans streptococci and enamel demineralization in adolescents with fixed orthodontic appliances. Acta Odontologica Scandinavica, 2002; 60; 37-41

Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white spot formation after bonding and banding. Am J Orthod 1982;81(2):93–8

Heinig N, Hartmann A. Efficacy of a sealant: study on the efficacy of a sealant (Light Bond) in preventing decalcification during multibracket therapy. Journal of Orofacial Orthopedics, 2008, 69, 154-67

International Caries Detection and Assessment System Coordinating Committee. Available online: (accessed on 1 October 2020)

Julien K, Buschang P, Campbell P. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod. 2013;83: 641–7

Khoroushi M, Kachuie M. Prevention and treatment of white spot lesions in orthodontic patients. Contemp Clin Dent 2017;8: 11-9

Lovrov S, Hertrich K, Hirschfelder U. Enamel demineralization during fixed orthodontic treatment—incidence and correlation to various oral-hygiene parameters. J Orofac Orthop 2007;68(5):353–63

Lucchese A, Gherlone E. Prevalence of white-spot lesions before and during orthodontic treatment with fixed appliances. Eur J Orthod. 2013;35: 664–8

Lucchese A, Gherlone E. Prevalence of white-spot lesions before and during orthodontic treatment with fixed appliances. European journal of orthodontics. 2012 Oct 8;35(5):664-8

Manuelli M, Marcolina M, Nardi N et al. Oral mucosal complications in orthodontic treatment. Minerva Stomatol. 2019;68(2):84-8

Mitchell L. Decalcification during orthodontic treatment with fixed appliances—an overview. Br J Orthod 1992;19(3):199–205

Mizrahi E. Enamel demineralization following orthodontic treatment. Am J Orthod 1982;82(1):62–7

Nyvad, B.; Machiulskiene, V.; Baelum, V. Construct and predictive validity of clinical caries diagnostic criteria assessing lesion activity. J. Dent. Res. 2003, 82, 117–122

Ogaard B, Rolla G, Arends J, ten Cate JM. Orthodontic appliances and enamel demineralization. Part 2. Prevention and treatment of lesions. Am J Orthod Dentofacial Orthop 1988;94(2):123–8

Øgaard B. Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofacial Orthop.1989; 96: 423-7

Øgaard B. White spot lesions during orthodontic treatment: mechanisms and fluoride preventive aspects. Seminars in Orthod 2008; 14(3): 183-93

O'Reilly M, Featherstone J. Demineralization and remineralization around orthodontic appliances: an in vivo study. Am J Orthod Dentofacial Orthop. 1987; 92(1): 33-40

Pitts, N.B. Modern concepts of caries measurement. J. Dent. Res. 2004, 83, 43–47

Richter AE, Arruda AO, Peters MC, Sohn W. Incidence of caries lesions among patients treated with comprehensive orthodontics. Am J Orthod Dentofacial Orthop 2011;139(5):657–64

Russell A. The differential diagnosis of fluoride and nonfluoride enamel opacities. J Public Health Dent 1962; 21:143-146

Sangamesh B, Kallury A. Iatrogenic effects of orthodontic treatment – Review on white spot lesions. Int J Sci Eng Res 2011; 2(1):16-21

Summitt, J.B.; Robbins, J.W.; Schwartz, R.S. Fundamentals of Operative Dentistry: A Contemporary Approach, 3rd ed.; Quintessence Publishing: Hanover Park, IL, USA, 2006; Chapter 1; pp. 2–4

Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod 2011;81(2):206–10

Zachrisson, B.U.; Zachrisson, S. Caries incidence and orthodontic treatment with fixed appliances. Scand. J. Dent. Res. 1971, 79, 183–192



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