Incidence of white spot formation after bonding and banding

White spots or areas of decalcification are carious lesions of varying extent. The incidence and severity of white spots after a full term of orthodontic treatment were studied among patients in the separate private practices of two of the authors. To establish a base line of comparison, the presence of white spots in a random sample of untreated persons was observed. The incidence of white spots among patients treated by a multibonded technique was recorded at the time of debonding. In addition, white spots were sought in the before- and after-treatment Kodachrome slides of persons whose maxillary incisors had been handed. It was found that individual teeth, banded or bonded, exhibited significantly more white spot formation than was found in the control group. For the teeth studied, there was no difference in white spot formation in those that were banded or bonded. The labiogingival area of the maxillary lateral incisors had the highest incidence of white spots. When studied by segments, the highest incidence occurred among the maxillary incisors; the lowest was in the maxillary posterior segment. No white spots were found on the lingual surfaces of mandibular canines and incisors after prolonged use of a canine-to-canine bonded retainer. These findings suggest a relationship between resistance to white spot formation and the rate of salivary flow. Despite the lack of any preventive fluoride program among the study groups, 50% of the patients demonstrated resistance to white spot formation. The obvious degree of iatrogenic damage during orthodontic treatment suggests the need for preventive programs using fluoride. Further clinical research is needed.