Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: A systematic review and meta-analysis

Objectives: To systematically review the effectiveness of professionally applied topical fluorides in the prevention and reversal of Enamel White Spot Lesions (EWSLs) occurring during multi-bracketed fixed orthodontic treatment. Data: Randomized/quasi-randomized controlled clinical trials. Sources: Four electronic databases and grey literature (up to February, 2018). Study selection: Two reviewers independently selected studies, extracted data and assessed risk of bias using the Cochrane Risk of bias tool 2.0. Only 11 studies fulfilled the inclusion criteria, seven assessing reversal and four assessing prevention of EWSLs. Six of the eleven studies were included for quantitative synthesis, three assessing prevention and three assessing reversal of EWSLs. Conclusions: Using the Mantel-Haenszel fixed-effect method, the risk ratio was found to be 0.39 (95% C.I.: 0.26-0.59) in studies evaluating the prevention of EWSLs. On employing an inverse-variance fixed-effect method for mean DIAGNOdent scores, the standardized mean difference was found to be 0.57 less in the professional topical fluoride group than the control group (95% C.I.: 0.23 to -0.91) in studies evaluating reversal of EWSLs. Professional topical fluoride application brought 25-30% reduction in the incidence of EWSLs after debonding; however, the effect of professional topical fluoride application in a reversal of EWSLs was unclear due to the concerns in interpreting DIAGNOdent values to estimate EWSLs. Clinical significance: Due to a limited number of clinical trials, further research is warranted to identify the type of professional fluoride agent, the concentration of fluoride and the frequency of applications in prevention or reversal of EWSLs in patients undergoing multi-bracketed fixed orthodontic treatment.