Prevalence of white spot lesions (WSL) at debonding, subject level · Healthy adolescents and adults undergoing orthodontic treatment with fixed multi-bracket appliances
Fluoride varnish applied regularly during fixed orthodontic treatment may reduce the prevalence of white spot lesions at debonding (pooled RR 0.64, 95% CI 0.42 to 0.98), but the certainty of evidence is very low.
1 finding from 1 review
Severity of white spot lesions (surface area and depth) · Orthodontic patients undergoing comprehensive treatment (late mixed or permanent dentition, no active caries)
White spot lesion severity was assessed narratively in a small number of studies and not meta-analyzed; evidence is limited (ungraded).
1 finding from 1 review
Gingival index (GI) · Orthodontic patients (any age) undergoing orthodontic treatment (mostly fixed appliances)
Chlorhexidine mouthwash may reduce the Gingival Index versus blank control in the short term (WMD -0.54, 95% CI -0.96 to -0.13), but with very high heterogeneity the evidence is very uncertain (very low certainty).
1 finding from 1 review
Gingival inflammation-related index · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
Herbal mouthwash reduced gingival inflammation-related indices versus placebo, but certainty is very low.
1 finding from 1 review
Gingival index (GI) · Orthodontic patients (any age) undergoing orthodontic treatment (mostly fixed appliances)
Herbal mouthwash probably reduces the Gingival Index versus blank control in the short term (WMD -0.20, 95% CI -0.32 to -0.09; moderate certainty).
1 finding from 1 review
Plaque index (PI) / oral hygiene · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
Chlorhexidine mouthwash reduced Plaque Index versus placebo, but certainty is very low.
1 finding from 1 review
Salivary caries-associated bacteria (S. mutans and Lactobacilli, subjects with >10^5 CFU/mL) · Orthodontic patients undergoing comprehensive treatment (late mixed or permanent dentition, no active caries)
Both included studies reported higher salivary caries-associated bacteria (S. mutans and Lactobacilli) with fixed appliances than clear aligners; not meta-analyzed (ungraded).
1 finding from 1 review
White spot lesion clinical score (mean values), subject level · Healthy adolescents and adults undergoing orthodontic treatment with fixed multi-bracket appliances
In a pooled analysis of two placebo-controlled trials, fluoride varnish also reduced white spot lesion clinical scores (pooled SMD -0.44, 95% CI -0.64 to -0.24); this secondary outcome was not separately GRADE-rated.
1 finding from 1 review
Cariogenic bacteria (Mutans streptococci) · Orthodontic patients (any age) undergoing orthodontic treatment (mostly fixed appliances)
Probiotic mouthwash has inconsistent effects on Mutans streptococci colony counts versus blank control; the evidence is very uncertain (very low certainty).
1 finding from 1 review
Gingival index (GI) · Orthodontic patients (any age) undergoing orthodontic treatment (mostly fixed appliances)
Chlorhexidine mouthwash probably reduces the Gingival Index versus placebo in the short term (WMD -0.45, 95% CI -0.70 to -0.20; low certainty).
1 finding from 1 review
Poor oral health-related quality of life (OHRQoL) · Adolescents (10-19 years)
Malocclusions probably have a negative effect on OHRQoL in adolescents, after adjustment for confounders (moderate certainty).
1 finding from 1 review
Impaired OHRQoL, qualitative synthesis: relative effect not estimable across the 13 studies (13,864 participants); moderate quality of evidence (GRADE).
13 studies · 13864 participants
Moderate
Plaque · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
Herbal mouthwash reduced several plaque-related indices, but certainty is very low.
1 finding from 1 review
Total bacteria (colony count) · Orthodontic patients (any age) undergoing orthodontic treatment (mostly fixed appliances)
Chlorhexidine mouthwash may reduce total bacteria colony counts versus blank control in the short term, but the evidence is very uncertain (very low certainty).
1 finding from 1 review
Gingival inflammation-related index · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
Herbal mouthwash reduced some gingival inflammation-related indices, but certainty is very low.
1 finding from 1 review
Cariogenic bacteria (Mutans streptococci) · People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
Herbal mouthwash showed mixed effects on Mutans streptococci, with very low-certainty evidence.
1 finding from 1 review
Lightness change · Patients with post-orthodontic white spot lesions and permanent dentition
Knosel (2019) reported a statistically significant lightness-change effect.
3 findings from 1 review
Cohen's d 0.71 [0.32, 1.09]
1 study
GRADE not reported
Cohen's d -1.76 [-2.22, -1.30]
1 study
GRADE not reported
Cohen's d 0.40 [0.11, 0.65]
1 study
GRADE not reported
Color change · Patients with post-orthodontic white spot lesions and permanent dentition
Eckstein (2015) reported a statistically significant color-change effect.
4 findings from 1 review
Cohen's d 0.40 [0.11, 0.65]
1 study
GRADE not reported
Cohen's d 0.82 [0.43, 1.20]
1 study
GRADE not reported
Cohen's d 6.80 [5.70, 7.82]
1 study
GRADE not reported
Show 1 more finding
Lightness/brightness change of white spot lesion (luminosity L*, T0 to T1) · Patients with post-orthodontic white spot lesions and permanent dentition
ICON resin infiltration showed no statistically significant change in lightness/brightness of post-orthodontic white spot lesions at 6 months (pooled Cohen's d/SMD -0.001, 95% CI -0.23 to 0.23; 3 studies, 330 teeth; I2=97%); not GRADE-rated.
1 finding from 1 review
Color change of white spot lesion (color difference, T0 to T1) · Patients with post-orthodontic white spot lesions and permanent dentition
ICON resin infiltration significantly improved the color of post-orthodontic white spot lesions at 6 months (pooled Cohen's d/SMD 1.36, 95% CI 1.14 to 1.59; 4 studies, 458 teeth), although heterogeneity was very high (I2=98%) with a heavy outlier (Kannan); not GRADE-rated.
1 finding from 1 review
Initiation of white spot lesions (WSL), visual-tactile assessment · Patients of any age (11-40 years) receiving comprehensive/fixed orthodontic treatment with fixed appliances
For a glass-ionomer-based bonding agent (single study), fluoride release significantly reduced WSL initiation (RR 0.64); subgroup not separately GRADE-rated.
1 finding from 1 review