Post-Orthodontic WSL Management — ORE Part 1 MCQ

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ModerateDental Public Health & EpidemiologyPost-Orthodontic WSL ManagementORE Part 1

A 13-year-old patient attends immediately after removal of fixed orthodontic appliances. Multiple non-cavitated white spot lesions are present on the labial surfaces of the maxillary anterior teeth at previous bracket sites. What is the most appropriate initial management?

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Correct answer: A — Institute intensive fluoride-based remineralisation with oral-hygiene and dietary advice

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

A is correct. These are non-cavitated post-orthodontic enamel demineralisation lesions, so initial care should be non-invasive: reinforce plaque control and dietary advice and use an intensive topical-fluoride remineralisation programme, with fluoride varnish where indicated. Systematic-review evidence supports fluoridated toothpaste and fluoride varnish for early treatment of orthodontically associated WSLs. Veneers and extraction are wholly disproportionate for intact teeth. Microabrasion removes enamel and is not first-line immediately after debonding; it may be considered only for selected persistent superficial aesthetic defects after lesion control and remineralisation. Observation alone is inadequate because regression is variable and does not address the continuing caries risk.

Reference: Höchli D, Hersberger-Zurfluh M, Papageorgiou SN, Eliades T. Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis. European Journal of Orthodontics. 2017. https://pubmed.ncbi.nlm.nih.gov/30007454/