Caries-preventive and Remineralizing Effect of Fluoride Gel in Orthodontic Patients After 2 Years

Patients with orthodontic appliances exhibit a higher caries risk, but they are often excluded from preventive studies. Thus, the aim of this observational study was to assess the caries-preventive and remineralizing effect of a high-fluoride gel in orthodontic patients. Two hundred twenty-one orthodontic patients (age, 6-19 years; mean, 13.1 ± 2.3; n = 104 with use of a 1.25% fluoride gel weekly at home, 117 participants without) were recruited and followed for 2 years, recording caries (decayed/missing/filled teeth (DMFT)/decayed/missing/filled surface (DMFS), active/inactive lesions), orthodontic treatment, use of fluorides, plaque and gingivitis. Baseline values regarding demographic and clinical parameters were equivalent for the 75 participants using fluoride gel and the 77 individuals of the control group who completed the study. The initial plaque and gingivitis values (approximal plaque index (API), 37% ± 34 and 42% ± 39, resp.; papillary bleeding index (PBI), 19% ± 28 and 22% ± 27, resp.) deteriorated slightly during the 2-year study (API, 54%/56%; PBI, 25%/28%). The increase in carious defects or fillings was minimal in both groups (fluoride, 0.75 DMFT ± 1.2, 1.27 DMFS ± 1.9; control, 0.99 ± 1.3 and 1.62 ± 2.6, resp.) without reaching statistical significance (p = 0.12 for DMFT, 0.44 for DMFS). The main statistically significant effect of the fluoride use was the reversal of active initial lesions diagnosed (fluoride group, -0.96 ± 1.82; control, -0.19 ± 2.0, p = 0.004), while the number of inactive initial lesions increased (2.3 ± 2.1 and 1.7 ± 2.1, resp.; p = 0.02). In conclusion, the weekly application of a fluoride gel in orthodontic patients can reduce their caries activity. Initial caries lesions in orthodontic patients can be inactivated by weekly fluoride gel use at home.