November 2012 Professional Oral Care Newsletter

Trick or treating followed by the holiday season means sugar-laden treats abound. While it can be challenging for patients (and ourselves) to resist some of these sweet treats, the season presents an opportunity to talk about the relationship between sugar and the caries process with our patients.  Helping patients recognize white spot lesions as the initial stage in the caries process is important.  Orthodontic patients can be especially vulnerable.  Learn more about what you can do to help your patients prevent them!


Carol A. Jahn, RDH, MS, Editor

Senior Professional Relations Manager
Water Pik, Inc
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Preventing White Spot Lesions in Orthodontic Patients

White spot lesions (WSLs) are areas of decalcification that appear opaque or chalky white and represent the early stages of the caries process. The white appearance is due to increased demineralization coupled with a lower rate of remineralization generally resulting from a low pH level. With treatment, WSLs can be arrested and in some cases reversed.

Orthodontic treatment increases the risk of WSL. A recent study found that the incidence of developing at least one WSL during orthodontic treatment was 72%.1 Poor oral hygiene both before and during orthodontic treatment has been shown to increase the risk of WSLs.2 Not surprisingly, gingivitis has also been shown to be positively associated with WSLs.3

Preventing and treating WSLs involves improving oral hygiene and targeted fluoride application.4 Fluoride varnish applied every 3 months during 12 months of orthodontic therapy resulted in 44.3% less demineralization.5 Having good oral hygiene can be challenging and time consuming with orthodontic appliances. Helping patients find the tools they like and use can make a big difference in getting them to adhere to a regular routine and a happier orthodontic outcome.

  1. Richter AE et al. Incidence of caries lesions among patients treated with comprehensive orthodontics. Am J Orthod Dentofacial Orthop 2011; 139:657-64.
  2. Chapman JA et al. Risk factors and incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2010; 138:188-94
  3. Tanner AC et al. White spot lesions and gingivitis microbiotas in orthodontic patients. J Dent Res 2012, 91:853-8.
  4. Hamdan AM et al. Preventing and treating white spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists. J Am Dent Assoc 2012; 143:777-83.
  5. Vivaldi-Rodrigues G et al. The effectiveness of a fluoride varnish in preventing the development of white spot lesions. World J Orthod 2006; 7:138-44.

Self-Care Products to Helping Patients Prevent WSL

The goal of self-care for orthodontic patients is to find a simplified and effective routine that helps them achieve optimal oral health and prevent WSLs.

The Waterpik® Water Flosser has been recommended for orthodontic patients for decades. While it is clearly one of the best ways to remove food debris around bands, brackets and other appliances, today we know it does much more than just remove food. Studies show it reduces gingivitis and bleeding, removes plaque, and cleans areas that are not accessible by other devices; interproximally and subgingivally.1-4 have The Water Flosser is more effective than other regimens, including floss, at removing plaque, reducing acidogenic bacteria such as lactobacillus, and improving oral health whether used with a manual toothbrush or power toothbrush.5-7 One study found that adolescents who used the orthodontic tip removed 3x as much plaque as brushing and flossing with a floss threader and 5x as much as brushing alone.6

A recent Delta Dental survey of children's oral health habits found that only a little more than half (56%) brush for the requested two minutes.8 Incorporating a power toothbrush with a two-minute timer and quadrant sensor can help patients increase brushing time. The Waterpik® Sensonic® Professional Plus Toothbrush has been shown to remove significantly more effective than a manual toothbrush in removing plaque and reducing bleeding and gingivitis. When the Sensonic® was used with the Water Flosser, it was 159% better at reducing bleeding, 135% better for gingivitis, and 134% at plaque removal.2

  1. Barnes CM, Russell CM, Reinhardt RA, Payne JB, Lyle DM. Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent. 2005; 16(3):71-77.
  2. Goyal CR, Lyle DM, Qaqish JG, Schuller R. The addition of a water flosser to power tooth brushing: effect on bleeding, gingivitis, and plaque. J Clin Dent 2012; 23(2):57-63.
  3. Gorur A, Lyle, DM, Schaudinn C, Costerton JW. Compend Contin Ed Dent. 2009;30(Special Iss 1):1 - 6.
  4. Cobb CM, Rodgers RL, Killoy WJ. Ultrastructural examination of human periodontal pockets following the use of an oral irrigation device in vivo. J Periodontol. 1988;59(3):155-163.
  5. Hurst JE, Madonia JV. The effect of an oral irrigating device on the oral hygiene of orthodontic patients. J Am Dent Assoc 1970; 81(9):678-683.
  6. Sharma NC, Lyle DM, Qaqish JG, Galustians J, Schuller R (2008) Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. American Journal of Orthodontics and Dentofacial Orthopedics 133:565-571.
  7. Burch JG, Lanese R, Ngan P. A two-month study of the effects of oral irrigation and automatic toothbrush use in an adult orthodontic population with fixed appliances. Am J Orthod Dentofacial Orthop 1994; 106(2):121-12
  8. Morpace Inc conducted the 2011 Delta Dental Children's Oral Health Survey.  

Fluoride Helps Prevent WSL

There is no doubt that fluoride is the best defense against dental caries. Regardless of mechanical regimens, fluoride should be recommended to patients at high risk for WSLs. Fluoride use can be in the form of a toothpaste, mouth rinse, or professional application like varnish or foam.Varnish applications every 3 months have been shown to reduce the risk of WSLs.

To learn more about Waterpik® UltraThin varnish click here