{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:29:10Z","timestamp":1786422550114,"version":"build-2736575974"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Paediatr Dent"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>White spot lesions (WSLs) are a common and aesthetically concerning side-effect of orthodontic treatment with fixed appliances. Despite their high prevalence, the impact of adolescent awareness on caries preventive behaviour remains poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study investigated associations between WSL awareness, perceived annoyance with WSLs, adherence to caries-related clinical practice guidelines (CPGs), and patient characteristics amongst adolescents receiving orthodontic fixed appliance treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study included 393 orthodontic patients aged 12\u201317\u00a0years from ten orthodontic practices. Participants completed an electronic survey assessing WSL awareness, participant characteristics, perceived annoyance (score range: 3\u201315), and adherence to six CPG behaviours (participants brushed 2 times\/day (1), for 2\u00a0min (2), using fluoride toothpaste (3), cleaning interdentally (4), yearly dental visits (5), their food and drink intake\u2009\u2264\u20097 times\/day (6); score range: 1\u20136).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 329 valid responses, 38% reported prior awareness of WSLs. These participants had significantly higher annoyance scores compared to those without awareness (median 13) compared to those not aware of WSLs (median 12,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). However, awareness was not associated with treatment duration or level of CPG adherence. Annoyance was associated with CPG adherence (Spearman\u2019s\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.149,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). No significant associations were found between annoyance and participant characteristics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although prior WSL awareness was associated with greater perceived annoyance, it was not associated with better adherence to caries preventive measures. These findings suggest that whilst adolescents may recognise the aesthetic impact of WSLs, current educational approaches are insufficient to translate concern into patient actions. Additional efforts are needed to promote sustained adherence during orthodontic treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40368-026-01179-x","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T12:13:24Z","timestamp":1770639204000},"page":"1113-1122","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Awareness and perception of white spot lesions amongst adolescents undergoing orthodontic treatment with fixed appliances: a cross-sectional study of caries preventive adherence"],"prefix":"10.1007","volume":"27","author":[{"given":"S. P.","family":"van Doornik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Lietmeijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. J.","family":"Manton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. U.","family":"Dijkstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. M.","family":"Kuijpers-Jagtman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"issue":"8","key":"1179_CR1","doi-asserted-by":"publisher","first-page":"2019","DOI":"10.1007\/s11136-018-1830-7","volume":"27","author":"LG Abreu","year":"2018","unstructured":"Abreu LG, Dos Santos TR, Melgaco CA, Abreu MHN, Lages EMB, Paiva SM. Impact of orthodontic treatment on adolescents\u2019 quality of life: a longitudinal evaluation of treated and untreated individuals. Qual Life Res. 2018;27(8):2019\u201326. https:\/\/doi.org\/10.1007\/s11136-018-1830-7.","journal-title":"Qual Life Res"},{"issue":"1","key":"1179_CR2","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1111\/cdoe.12131","volume":"43","author":"K Asimakopoulou","year":"2015","unstructured":"Asimakopoulou K, Newton JT. The contributions of behaviour change science towards dental public health practice: a new paradigm. Community Dent Oral Epidemiol. 2015;43(1):2\u20138. https:\/\/doi.org\/10.1111\/cdoe.12131.","journal-title":"Community Dent Oral Epidemiol"},{"key":"1179_CR3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003809.pub4","author":"PE Benson","year":"2019","unstructured":"Benson PE, Parkin N, Dyer F, Millett DT, Germain P. Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment. Cochrane Database Syst Rev. 2019. https:\/\/doi.org\/10.1002\/14651858.CD003809.pub4.","journal-title":"Cochrane Database Syst Rev"},{"issue":"8","key":"1179_CR4","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.68178","volume":"16","author":"R Bilici Gecer","year":"2024","unstructured":"Bilici Gecer R, Dursun D. Patients\u2019 perspectives and attitudes about the relationship between fixed orthodontic treatment and oral hygiene. Cureus. 2024;16(8):e68178. https:\/\/doi.org\/10.7759\/cureus.68178.","journal-title":"Cureus"},{"issue":"8","key":"1179_CR5","doi-asserted-by":"publisher","first-page":"4711","DOI":"10.1007\/s00784-021-03931-7","volume":"25","author":"S Bourouni","year":"2021","unstructured":"Bourouni S, Dritsas K, Kloukos D, Wierichs RJ. Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a systematic review and meta-analysis. Clin Oral Investig. 2021;25(8):4711\u20139. https:\/\/doi.org\/10.1007\/s00784-021-03931-7.","journal-title":"Clin Oral Investig"},{"issue":"1","key":"1179_CR6","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/idh.12304","volume":"16","author":"M Ghaffari","year":"2018","unstructured":"Ghaffari M, Rakhshanderou S, Ramezankhani A, Noroozi M, Armoon B. Oral health education and promotion programmes: meta-analysis of 17-year intervention. Int J Dent Hyg. 2018;16(1):59\u201367. https:\/\/doi.org\/10.1111\/idh.12304.","journal-title":"Int J Dent Hyg"},{"issue":"5","key":"1179_CR7","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1093\/ejo\/cjr068","volume":"34","author":"S Hadler-Olsen","year":"2012","unstructured":"Hadler-Olsen S, Sandvik K, El-Agroudi MA, Ogaard B. The incidence of caries and white spot lesions in orthodontically treated adolescents with a comprehensive caries prophylactic regimen--a prospective study. Eur J Orthod. 2012;34(5):633\u20139. https:\/\/doi.org\/10.1093\/ejo\/cjr068.","journal-title":"Eur J Orthod"},{"issue":"2","key":"1179_CR8","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"PA Harris","year":"2009","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377\u201381. https:\/\/doi.org\/10.1016\/j.jbi.2008.08.010.","journal-title":"J Biomed Inform"},{"key":"1179_CR9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208","volume":"95","author":"PA Harris","year":"2019","unstructured":"Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O\u2019Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. https:\/\/doi.org\/10.1016\/j.jbi.2019.103208.","journal-title":"J Biomed Inform"},{"issue":"47","key":"1179_CR10","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000013182","volume":"97","author":"J Huang","year":"2018","unstructured":"Huang J, Yao Y, Jiang J, Li C. Effects of motivational methods on oral hygiene of orthodontic patients: a systematic review and meta-analysis. Medicine (Baltimore). 2018;97(47):e13182. https:\/\/doi.org\/10.1097\/MD.0000000000013182.","journal-title":"Medicine (Baltimore)"},{"issue":"4","key":"1179_CR11","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1111\/ocr.12776","volume":"27","author":"X Huang","year":"2024","unstructured":"Huang X, Qin D, Ngan P, Cao L, Hua F, He H. White spot lesion-related perception of aesthetics and treatment satisfaction among orthodontic patients, orthodontists and other dental specialists. Orthod Craniofac Res. 2024;27(4):626\u201334. https:\/\/doi.org\/10.1111\/ocr.12776.","journal-title":"Orthod Craniofac Res"},{"issue":"2","key":"1179_CR12","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1111\/ocr.12888","volume":"28","author":"U Hussain","year":"2025","unstructured":"Hussain U, Wahab A, Kamran MA, Alnazeh AA, Almoammar S, Alshahrani SSM, et al. Prevalence, incidence and risk factors of white spot lesions associated with orthodontic treatment - a systematic review and meta-analysis. Orthod Craniofac Res. 2025;28(2):379\u201399. https:\/\/doi.org\/10.1111\/ocr.12888.","journal-title":"Orthod Craniofac Res"},{"key":"1179_CR13","unstructured":"IvorenKruis. Advies Cari\u00ebspreventie.[Advice on Caries Prevention] Nieuwegein; 2011. Available: https:\/\/ivorenkruis.org\/adviezen\/advies-cariespreventie-2011\/ [Accessed 25 august 2025]"},{"issue":"6","key":"1179_CR14","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-024-05695-2","volume":"28","author":"Y Kashash","year":"2024","unstructured":"Kashash Y, Hein S, Gostemeyer G, Aslanalp P, Weyland MI, Bartzela T. Resin infiltration versus fluoride varnish for visual improvement of white spot lesions during multibracket treatment. A randomized-controlled clinical trial. Clin Oral Investig. 2024;28(6):308. https:\/\/doi.org\/10.1007\/s00784-024-05695-2.","journal-title":"Clin Oral Investig"},{"issue":"1","key":"1179_CR15","doi-asserted-by":"publisher","first-page":"11","DOI":"10.4103\/ccd.ccd_216_17","volume":"8","author":"M Khoroushi","year":"2017","unstructured":"Khoroushi M, Kachuie M. Prevention and treatment of white spot lesions in orthodontic patients. Contemp Clin Dent. 2017;8(1):11\u20139. https:\/\/doi.org\/10.4103\/ccd.ccd_216_17.","journal-title":"Contemp Clin Dent"},{"issue":"5","key":"1179_CR16","doi-asserted-by":"publisher","DOI":"10.3390\/gels11050371","volume":"11","author":"M Lamorgese","year":"2025","unstructured":"Lamorgese M, Veiga N, Correia MJ, Gomes ATPC, Lopes S, Lopes-Rocha L, et al. White spot lesion treatment options: a systematic review of different techniques for masking these lesions. Gels. 2025;11(5):371.","journal-title":"Gels"},{"key":"1179_CR17","doi-asserted-by":"publisher","DOI":"10.3390\/dj13030103","author":"FS Ludovichetti","year":"2025","unstructured":"Ludovichetti FS, Stellini E, Zuccon A, Lucchi P, Dessupoiu N, Mazzoleni S, et al. Prevention of white spot lesions induced by fixed orthodontic therapy: a literature review. Dent J. 2025. https:\/\/doi.org\/10.3390\/dj13030103.","journal-title":"Dent J"},{"issue":"3","key":"1179_CR18","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.ajodo.2011.08.024","volume":"141","author":"BJ Maxfield","year":"2012","unstructured":"Maxfield BJ, Hamdan AM, Tufekci E, Shroff B, Best AM, Lindauer SJ. Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists. Am J Orthod Dentofacial Orthop. 2012;141(3):337\u201344. https:\/\/doi.org\/10.1016\/j.ajodo.2011.08.024.","journal-title":"Am J Orthod Dentofacial Orthop"},{"issue":"5","key":"1179_CR19","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1007\/s10459-010-9222-y","volume":"15","author":"G Norman","year":"2010","unstructured":"Norman G. Likert scales, levels of measurement and the \u201claws\u201d of statistics. Adv Health Sci Educ Theory Pract. 2010;15(5):625\u201332. https:\/\/doi.org\/10.1007\/s10459-010-9222-y.","journal-title":"Adv Health Sci Educ Theory Pract"},{"key":"1179_CR20","unstructured":"NVvO. Klinische praktijkrichtlijn White spot laesies.[Clinical Practice Guideline for White Spot Lesions] Harderwijk; 2022. Available: https:\/\/www.orthodontist.nl\/files\/richtlijn-white-spot-laesies.pdf [Accessed 25 augustus 2025]"},{"issue":"1","key":"1179_CR21","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/0889-5406(88)90453-2","volume":"94","author":"B Ogaard","year":"1988","unstructured":"Ogaard B, Rolla G, Arends J. Orthodontic appliances and enamel demineralization. Part 1. Lesion development. Am J Orthod Dentofacial Orthop. 1988;94(1):68\u201373. https:\/\/doi.org\/10.1016\/0889-5406(88)90453-2.","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"1179_CR22","doi-asserted-by":"publisher","DOI":"10.3390\/dj12120375","author":"AM Prada","year":"2024","unstructured":"Prada AM, Potra Cicalau GI, Ciavoi G. A review of white spot lesions: development and treatment with resin infiltration. Dent J (Basel). 2024. https:\/\/doi.org\/10.3390\/dj12120375.","journal-title":"Dent J (Basel)"},{"issue":"4","key":"1179_CR23","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1111\/cdoe.12224","volume":"44","author":"JF Scheerman","year":"2016","unstructured":"Scheerman JF, van Loveren C, van Meijel B, Dusseldorp E, Wartewig E, Verrips GH, et al. Psychosocial correlates of oral hygiene behaviour in people aged 9 to 19 - a systematic review with meta-analysis. Commun Dent Oral Epidemiol. 2016;44(4):331\u201341. https:\/\/doi.org\/10.1111\/cdoe.12224.","journal-title":"Commun Dent Oral Epidemiol"},{"issue":"8","key":"1179_CR24","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.9626","volume":"6","author":"JFM Scheerman","year":"2018","unstructured":"Scheerman JFM, van Empelen P, van Loveren C, van Meijel B. A mobile app (WhiteTeeth) to promote good oral health behavior among Dutch adolescents with fixed orthodontic appliances: intervention mapping approach. JMIR Mhealth Uhealth. 2018;6(8):e163. https:\/\/doi.org\/10.2196\/mhealth.9626.","journal-title":"JMIR Mhealth Uhealth"},{"issue":"2","key":"1179_CR25","doi-asserted-by":"publisher","first-page":"136 e131","DOI":"10.1016\/j.ajodo.2009.05.020","volume":"138","author":"D Shungin","year":"2010","unstructured":"Shungin D, Olsson AI, Persson M. Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment. Am J Orthod Dentofacial Orthop. 2010;138(2):136 e131-138. https:\/\/doi.org\/10.1016\/j.ajodo.2009.05.020.","journal-title":"Am J Orthod Dentofacial Orthop"},{"issue":"4","key":"1179_CR26","doi-asserted-by":"publisher","first-page":"594","DOI":"10.2319\/060213-417.1","volume":"84","author":"AS Silvola","year":"2014","unstructured":"Silvola AS, Varimo M, Tolvanen M, Rusanen J, Lahti S, Pirttiniemi P. Dental esthetics and quality of life in adults with severe malocclusion before and after treatment. Angle Orthod. 2014;84(4):594\u20139. https:\/\/doi.org\/10.2319\/060213-417.1.","journal-title":"Angle Orthod"},{"issue":"4","key":"1179_CR27","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1111\/ocr.12322","volume":"22","author":"T Tasios","year":"2019","unstructured":"Tasios T, Papageorgiou SN, Papadopoulos MA, Tsapas A, Haidich AB. Prevention of orthodontic enamel demineralization: a systematic review with meta-analyses. Orthod Craniofac Res. 2019;22(4):225\u201335. https:\/\/doi.org\/10.1111\/ocr.12322.","journal-title":"Orthod Craniofac Res"},{"key":"1179_CR28","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjaf041","author":"SP van Doornik","year":"2025","unstructured":"van Doornik SP, Lietmeijer S, Ren Y, Manton DJ, Dijkstra PU, Kuijpers-Jagtman AM. Adherence to clinical practice guidelines amongst adolescents with buccal fixed orthodontic appliances in northeast Netherlands: a cross-sectional study. Eur J Orthod. 2025. https:\/\/doi.org\/10.1093\/ejo\/cjaf041.","journal-title":"Eur J Orthod"},{"key":"1179_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.chbr.2022.100206","volume":"7","author":"M-J Wu","year":"2022","unstructured":"Wu M-J, Zhao K, Fils-Aime F. Response rates of online surveys in published research: a meta-analysis. Comput Human Behav Rep. 2022;7:100206.","journal-title":"Comput Human Behav Rep"},{"issue":"2","key":"1179_CR30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jebdp.2025.102089","volume":"25","author":"J Yu","year":"2025","unstructured":"Yu J, Qin D, Guo F, Zhao T, He H, Hua F. The effects of preventive interventions for orthodontically induced white spot lesions: an umbrella review and evidence mapping. J Evid Based Dent Pract. 2025;25(2):102089. https:\/\/doi.org\/10.1016\/j.jebdp.2025.102089.","journal-title":"J Evid Based Dent Pract"},{"issue":"1","key":"1179_CR31","doi-asserted-by":"publisher","first-page":"101","DOI":"10.2319\/010915-19.1","volume":"86","author":"F Zotti","year":"2016","unstructured":"Zotti F, Dalessandri D, Salgarello S, Piancino M, Bonetti S, Visconti L, et al. Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod. 2016;86(1):101\u20137. https:\/\/doi.org\/10.2319\/010915-19.1.","journal-title":"Angle Orthod"}],"container-title":["European Archives of Paediatric Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40368-026-01179-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40368-026-01179-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40368-026-01179-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:52:38Z","timestamp":1786420358000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40368-026-01179-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":31,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["1179"],"URL":"https:\/\/doi.org\/10.1007\/s40368-026-01179-x","relation":{},"ISSN":["1818-6300","1996-9805"],"issn-type":[{"value":"1818-6300","type":"print"},{"value":"1996-9805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,9]]},"assertion":[{"value":"4 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The Editor-in-chief of the journal, who is a coauthor of this manuscript, had no involvement in the peer review process and had no access to information regarding its reviews. The other authors have no conflicts of interest to declare.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}