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Antimicrobial varnish and fluoride are not more effective than fluoride varnish alone in reducing white spot lesions on the labial surfaces of teeth during orthodontic therapy
A RT I C L E A N A LY S I S & E VA LUAT I O N : T H E R A PY Antimicrobial varnish and fluoride are not more effective than fluoride varnish alone in reducing white spot lesions on the labial surfaces of teeth during orthodontic therapy Original Article:
Øgaard B, Larsson E, Henriksson T, Birkhed D, Bishara SE. Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients. Am J Orthod Dentofacial Orthop 2001;120:2835.
• Level of Evidence: • Purpose:
1b
• Source of Funding: • Type of Study/Design:
To determine whether antimicrobial varnish in combination with fluoride varnish is more effective in reducing white spot formation than fluoride varnish alone Partially supported by Skaraborgsinstitutet and Vivadent AG Randomized controlled trial
SUMMARY SUBJECTS Before orthodontic therapy, 220 subjects were randomized into 2 experimental groups: group 1, antimicrobial and fluoride varnish (n = 110); group 2, fluoride varnish only (n = 110). EXPOSURE The primary exposure in the study was the use of antimicrobial varnish. Although all subjects in this randomized study received fluoride varnish, a
control group (n = 100) received neither an antimicrobial nor a fluoride varnish.
MAIN OUTCOME MEASURE The primary outcome was the formation of white spot lesions, which was measured by using the index of Gorelick et al. 1 Records were available for the experimental groups before and after orthodontic therapy. For the control group, records were available only after orthodontic therapy.
MAIN RESULTS Approximately 58% of the subjects in group 1 (antimicrobial and fluoride) developed white spot lesions during treatment, whereas 61% in group 2 (fluoride only) developed lesions. This difference was not statistically significant. In the control group (no antimicrobial or fluoride), 88% of the subjects developed white spot lesions. This was significantly higher than the percentages in groups 1 and 2.
J Evid Base Dent Pract 2002;2:115-16 © 2002 Mosby, Inc. All rights reserved. doi:10.1067/med.2002.125675
115
COMMENT ARY CONCLUSIONS
REFERENCES
The authors did not find a significant reduction in white spot lesions when an antimicrobial varnish was used in addition to a fluoride varnish during orthodontic treatment.
ANALYSIS The purpose of this study was to determine the effectiveness of using an antimicrobial varnish in addition to a fluoride varnish to reduce white spot lesions. The study was well designed to answer this question. However, a question that was not answered was whether using a varnish is better than using none at all. Currently, the literature is mixed with regard to the efficacy of fluoride and antimicrobial products in reducing white spot lesions and caries.2-7 The authors reported that the nonrandomized control group of orthodontic patients exhibited a significantly higher prevalence of white spot lesions than the 2 experimental groups at the end of treatment. However, they also pointed out that the control group did not undergo the experimental protocol, thereby precluding meaningful comparison. Future researchers should consider incorporating an untreated control group into the randomization scheme. • Content Reviewer:
116 Øgaard et al
1. Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white spot formation after bonding and banding. Am J Orthod 1982;81:93-8. 2. Bratthall D, Serinirach R, Rapisuwon S, Kuratana M, Luangjarmekorn V, Luksila K, et al. A study into the prevention of fissure caries using an antimicrobial varnish. Int Dent J 1995;45:245-54. 3. Gaworski M, Weinstein M, Borislow AJ, Braitman LE. Decalcification and bond failure: a comparison of a glass ionomer and a composite resin bonding system in vivo. Am J Orthod Dentofacial Orthop 1999;116:518-21. 4. Petersson LG, Magnusson K, Andersson H, Deierborg G, Twetman S. Effect of semi-annual applications of a chlorhexidine/fluoride varnish mixture on approximal caries incidence in schoolchildren. A three-year radiographic study. Eur J Oral Sci 1998;106(2 Pt 1):623-7. 5. Petersson LG, Magnusson K, Andersson H, Almquist B, Twetman S. Effect of quarterly treatments with a chlorhexidine and a fluoride varnish on approximal caries in cariessusceptible teenagers: a 3-year clinical study. Caries Res 2000;34:140-3. 6. Twetman S, Petersson LG. Interdental caries incidence and progression in relation to mutans streptococci suppression after chlorhexidine-thymol varnish treatments in schoolchildren. Acta Odontol Scand 1999;57:144-8. 7. Wenderoth CJ, Weinstein M, Borislow AJ. Effectiveness of a fluoride-releasing sealant in reducing decalcification during orthodontic treatment. Am J Orthod Dentofacial Orthop 1999;116:629-34.
Greg J. Huang, DMD, MSD, MPH, University of Washington, Seattle
Journal of Evidence-Based Dental Practice June 2002
Øgaard B, Larsson E, Henriksson T, Birkhed D, Bishara SE. Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients. Am J Orthod Dentofacial Orthop 2001;120:2835.
• Level of Evidence: • Purpose:
1b
• Source of Funding: • Type of Study/Design:
To determine whether antimicrobial varnish in combination with fluoride varnish is more effective in reducing white spot formation than fluoride varnish alone Partially supported by Skaraborgsinstitutet and Vivadent AG Randomized controlled trial
SUMMARY SUBJECTS Before orthodontic therapy, 220 subjects were randomized into 2 experimental groups: group 1, antimicrobial and fluoride varnish (n = 110); group 2, fluoride varnish only (n = 110). EXPOSURE The primary exposure in the study was the use of antimicrobial varnish. Although all subjects in this randomized study received fluoride varnish, a
control group (n = 100) received neither an antimicrobial nor a fluoride varnish.
MAIN OUTCOME MEASURE The primary outcome was the formation of white spot lesions, which was measured by using the index of Gorelick et al. 1 Records were available for the experimental groups before and after orthodontic therapy. For the control group, records were available only after orthodontic therapy.
MAIN RESULTS Approximately 58% of the subjects in group 1 (antimicrobial and fluoride) developed white spot lesions during treatment, whereas 61% in group 2 (fluoride only) developed lesions. This difference was not statistically significant. In the control group (no antimicrobial or fluoride), 88% of the subjects developed white spot lesions. This was significantly higher than the percentages in groups 1 and 2.
J Evid Base Dent Pract 2002;2:115-16 © 2002 Mosby, Inc. All rights reserved. doi:10.1067/med.2002.125675
115
COMMENT ARY CONCLUSIONS
REFERENCES
The authors did not find a significant reduction in white spot lesions when an antimicrobial varnish was used in addition to a fluoride varnish during orthodontic treatment.
ANALYSIS The purpose of this study was to determine the effectiveness of using an antimicrobial varnish in addition to a fluoride varnish to reduce white spot lesions. The study was well designed to answer this question. However, a question that was not answered was whether using a varnish is better than using none at all. Currently, the literature is mixed with regard to the efficacy of fluoride and antimicrobial products in reducing white spot lesions and caries.2-7 The authors reported that the nonrandomized control group of orthodontic patients exhibited a significantly higher prevalence of white spot lesions than the 2 experimental groups at the end of treatment. However, they also pointed out that the control group did not undergo the experimental protocol, thereby precluding meaningful comparison. Future researchers should consider incorporating an untreated control group into the randomization scheme. • Content Reviewer:
116 Øgaard et al
1. Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white spot formation after bonding and banding. Am J Orthod 1982;81:93-8. 2. Bratthall D, Serinirach R, Rapisuwon S, Kuratana M, Luangjarmekorn V, Luksila K, et al. A study into the prevention of fissure caries using an antimicrobial varnish. Int Dent J 1995;45:245-54. 3. Gaworski M, Weinstein M, Borislow AJ, Braitman LE. Decalcification and bond failure: a comparison of a glass ionomer and a composite resin bonding system in vivo. Am J Orthod Dentofacial Orthop 1999;116:518-21. 4. Petersson LG, Magnusson K, Andersson H, Deierborg G, Twetman S. Effect of semi-annual applications of a chlorhexidine/fluoride varnish mixture on approximal caries incidence in schoolchildren. A three-year radiographic study. Eur J Oral Sci 1998;106(2 Pt 1):623-7. 5. Petersson LG, Magnusson K, Andersson H, Almquist B, Twetman S. Effect of quarterly treatments with a chlorhexidine and a fluoride varnish on approximal caries in cariessusceptible teenagers: a 3-year clinical study. Caries Res 2000;34:140-3. 6. Twetman S, Petersson LG. Interdental caries incidence and progression in relation to mutans streptococci suppression after chlorhexidine-thymol varnish treatments in schoolchildren. Acta Odontol Scand 1999;57:144-8. 7. Wenderoth CJ, Weinstein M, Borislow AJ. Effectiveness of a fluoride-releasing sealant in reducing decalcification during orthodontic treatment. Am J Orthod Dentofacial Orthop 1999;116:629-34.
Greg J. Huang, DMD, MSD, MPH, University of Washington, Seattle
Journal of Evidence-Based Dental Practice June 2002