Prevention and Management of White Spot Lesions during Fixed Orthodontic Treatment: A Comprehensive Review

The purpose of this review is to examine current literature concerning methods to prevent white spot lesions (WSLs) that arise during fixed orthodontic treatment. These lesions, caused by enamel demineralization, create both functional and cosmetic problems. This paper assesses the efficacy of different preventive strategies designed to minimize the risk of WSL development during orthodontic care. A structured search was carried out using MeSH terms including “white spot,” “fixed orthodontic treatment,” “CPP-ACP,” “topical fluoride,” and “demineralized lesion,” combined with the Boolean operator AND. Databases such as PubMed, EMBASE, Scopus, and OpenGrey were explored for studies published from January 2014 to September 2024. Only studies that evaluated preventive interventions for patients receiving fixed orthodontics were included. Out of 41 initially screened papers, 17 were retained for analysis based on relevance and methodological quality. Multiple preventive options were identified. Topical fluoride, particularly in high-dose varnish form, consistently lowered the prevalence of WSLs, with several studies favoring varnish compared to other delivery systems. Casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) and CPP-ACPF products also showed remineralization potential, especially when paired with fluoride toothpaste. The use of high-fluoride dentifrice and acidulated phosphate fluoride rinses was effective in reducing lesion incidence, highlighting the critical role of patient compliance with daily hygiene. Periodically repeated professional fluoride applications enhanced preventive success. Addressing WSLs is essential to preserve both function and appearance during orthodontic therapy. The combined use of fluoride-based methods with CPP formulations appears particularly advantageous. Nevertheless, patient motivation and adherence to oral hygiene remain key determinants of outcomes. More research is required to evaluate the long-term benefits of these interventions and to explore novel approaches for WSL control.