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The prevalence of demineralization, or enamel caries which is the first clinically recognizable stage of caries, has been reported to be as high as 73% during fixed appliance treatment. It is recognized that wearing an orthodontic appliance increases the caries risk of the individual. The orthodontist can effectively reduce demineralization by applying fluoride varnish at each visit. Selecting patients on their oral hygiene clearly is one factor which can prevent patients suffering from demineralization. Excellent home care with optimal use of fluoride will also help prevent the condition. There is little evidence that fluoride-releasing materials used for bonding orthodontic appliances offer protection from demineralization. The first of these two papers describes the aetiology, prevalence and prevention of demineralization associated with orthodontic care. The second paper will describe the treatments available to manage caries focusing on demineralization post orthodontic treatment.
CPD/Clinical Relevance: Demineralization is the most common complication of orthodontic care. The clinician should understand how to prevent this.
Article
Orthodontic care involves the practitioner in an assessment of a number of risks and benefits. It would be inappropriate to continue treatment when unexpected complications, poor patient compliance or behaviour leads to detrimental effects for the patient as a result of orthodontic treatment.1 One of the most commonly recognized complications of orthodontic care is demineralization due to poor oral hygiene. Demineralization is enamel caries and is the first clinically recognizable stage of caries. Although such lesions can develop irrespective of orthodontic treatment, it has been shown to be a recognized complication of orthodontic treatment.2
Introducing fixed or removable orthodontic appliances to the oral environment alters the ecology of the mouth by adding another variable to the system. Figure 1 shows a proposed hypothesis suggested by Chang et al of the influences orthodontic appliances may have on the process of enamel demineralization.3
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