Incidence and Prevention of White Spot Lesions Associated with Fixed Orthodontic Appliances: A Literature Review

REVIEW
Gazmend Jusufi

 

For citation: Jusufi G. Incidence and Prevention of White Spot Lesions Associated with Fixed Orthodontic Appliances: A Literature Review. International Journal of Biomedicine. 2026;16(3):327-332. doi:10.21103/Article16(3)_RA5

Originally published September 5, 2026

Abstract: 

Background: White spot lesions (WSLs) are a common adverse effect of fixed orthodontic treatment, resulting from enamel demineralization associated with plaque accumulation around orthodontic appliances. Their prevention remains a clinical challenge in orthodontic practice. The present review aimed to evaluate the available evidence regarding the effectiveness of preventive strategies for reducing the risk of white spot lesion development in patients undergoing fixed orthodontic treatment.

Materials and Methods: A literature search was performed in Medline/PubMed and the Cochrane Library for English-language clinical studies published up to 2010. Controlled in vivo human studies reporting the incidence and/or prevalence of WSLs in patients undergoing fixed orthodontic treatment were included. Studies with a minimum treatment duration of 12 months were considered. Data regarding incidence, prevalence, risk factors, and preventive measures were extracted and analyzed descriptively.

Results: Ten studies involving 1,241 patients were included. The overall incidence of WSLs was 45.8%, while the prevalence was 68.4%. Reported risk factors included poor oral hygiene, younger age at treatment initiation, male sex, and longer treatment duration. Protective factors included adequate salivary flow and the use of fluoride-based preventive measures, which were associated with reduced lesion development.

Conclusion: WSLs are a frequent complication of fixed orthodontic treatment. Their development is multifactorial, with identifiable patient- and treatment-related risk factors. Preventive strategies, particularly fluoride-based interventions and improved oral hygiene measures, should be integrated into routine orthodontic care to reduce the risk of enamel demineralization.

Keywords: 
white spot lesions • orthodontic treatment • enamel demineralization • caries • fluoride • fixed appliances
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Received June 24, 2026.
Accepted August 6, 2026.
© 2026 The Author(s). International Journal of Biomedicine is published by IMRDC. This is an open access article under the CC BY-NC-ND 4.0 license.