{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:57:33Z","timestamp":1788303453557,"version":"build-2803163510"},"reference-count":84,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To establish consensus recommendations for clinicians to manage white spot lesions (WSLs) during orthodontic treatment.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n Three task force members reviewed the literature to identify best practices for minimizing WSLs during orthodontic treatment. Each draft statement was read to the task force members by a facilitator, followed by voting, accepting, or editing if necessary. The statements were then sent electronically by an independent third party (Magellan Medical Technology Consultants Inc, Minneapolis, Minn) to a previously formed content validation panel consisting of 20 independent private practitioners and clinical academicians for validation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty-one statements were developed and sent for content validation. While 19 statements achieved a content validation index (CVI) of 0.78, two items did not. These items were edited by the task force members based on qualitative feedback from content validation participants. Each of these revised statements did achieve a CVI of 0.78 on second evaluation from the content validation panelists and therefore were included in this document.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n To reduce the risk of WSLs, it is essential to implement individualized caries management measures based on a comprehensive assessment of the patient\u2019s oral and systemic health. Effective at-home and professional mechanical and chemical plaque control should be implemented for high-risk orthodontic patients. Fluoride to support prevention and materials such as orthodontic sealants should also be used to provide a physical barrier around the brackets in high-risk patients. By following these guidelines, orthodontic professionals can help promote oral health and minimize the need for restorative treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.2319\/062523-440.1","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T06:10:49Z","timestamp":1691388649000},"page":"621-628","source":"Crossref","is-referenced-by-count":27,"title":["White spot lesions in orthodontics: consensus statements for prevention and management"],"prefix":"10.2319","volume":"93","author":[{"given":"Divesh","family":"Sardana","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falk","family":"Schwendicke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"Kosan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eser","family":"T\u00fcfek\u00e7i","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i1945-7103-93-6-621-b01","series-title":"Am J Orthod","first-page":"93","article-title":"Incidence of white spot formation after bonding and banding","volume":"81","author":"Gorelick","year":"1982","unstructured":"Gorelick\n L,\n \n \n Geiger\n AM,\n \n \n Gwinnett\n AJ.\n \n \n Incidence of white spot formation after bonding and banding. Am J Orthod. 1982;\n81:93\u201398."},{"key":"i1945-7103-93-6-621-b02","series-title":"Am J Orthod Dentofacial Orthop","first-page":"423","article-title":"Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment","volume":"96","author":"Ogaard","year":"1989","unstructured":"Ogaard\n B.\n \n \n Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofacial Orthop. 1989;\n96:423\u2013427."},{"key":"i1945-7103-93-6-621-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"188","article-title":"Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances","volume":"138","author":"Chapman","year":"2010","unstructured":"Chapman\n JA,\n \n \n Roberts\n WE,\n \n \n Eckert\n GJ,\n \n \n Kula\n KS,\n \n \n Gonz\u00e1lez-Cabezas\n C.\n \n \n Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2010;\n138:188\u2013194."},{"key":"i1945-7103-93-6-621-b04","series-title":"Angle Orthod","first-page":"206","article-title":"Prevalence of white spot lesions during orthodontic treatment with fixed appliances","volume":"81","author":"Tufekci","year":"2011","unstructured":"Tufekci\n E,\n \n \n Dixon\n JS,\n \n \n Gunsolley\n JC,\n \n \n Lindauer\n SJ.\n \n \n Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011;\n81:206\u2013210."},{"issue":"suppl 1","key":"i1945-7103-93-6-621-b05","series-title":"Oral Health Prev Dent","first-page":"259","article-title":"The caries balance: the basis for caries management by risk assessment","volume":"2","author":"Featherstone","year":"2004","unstructured":"Featherstone\n JD.\n \n \n The caries balance: the basis for caries management by risk assessment. Oral Health Prev Dent. 2004;\n2(suppl 1):259\u2013264."},{"issue":"suppl 1","key":"i1945-7103-93-6-621-b06","series-title":"BMC Oral Health","first-page":"S14","article-title":"Dental plaque as a biofilm and a microbial community\u2014implications for health and disease","volume":"6","author":"Marsh","year":"2006","unstructured":"Marsh\n PD.\n \n \n Dental plaque as a biofilm and a microbial community\u2014implications for health and disease. BMC Oral Health. 2006;\n6(suppl 1):S14."},{"key":"i1945-7103-93-6-621-b07","series-title":"J Dent Res","first-page":"1065","article-title":"The exopolysaccharide matrix: a virulence determinant of cariogenic biofilm","volume":"92","author":"Koo","year":"2013","unstructured":"Koo\n H,\n \n \n Falsetta\n ML,\n \n \n Klein\n MI.\n \n \n The exopolysaccharide matrix: a virulence determinant of cariogenic biofilm. J Dent Res. 2013;\n92:1065\u20131073."},{"key":"i1945-7103-93-6-621-b08","series-title":"Trends Microbiol","first-page":"76","article-title":"Solving the etiology of dental caries","volume":"23","author":"Sim\u00f3n-Soro","year":"2015","unstructured":"Sim\u00f3n-Soro\n A,\n \n \n Mira\n A.\n \n \n Solving the etiology of dental caries. Trends Microbiol. 2015;\n23:76\u201382."},{"key":"i1945-7103-93-6-621-b09","series-title":"Nat Rev Dis Primers","first-page":"17030","article-title":"Dental caries","volume":"3","author":"Pitts","year":"2017","unstructured":"Pitts\n NB,\n \n \n Zero\n DT,\n \n \n Marsh\n PD,\n \n et al.\n \n Dental caries. Nat Rev Dis Primers. 2017;\n3:17030."},{"key":"i1945-7103-93-6-621-b10","series-title":"Am J Orthod Dentofacial Orthop","first-page":"835","article-title":"Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting","volume":"163","author":"Sharab","year":"2023","unstructured":"Sharab\n L,\n \n \n Loss\n C,\n \n \n Jensen\n D,\n \n \n Kluemper\n GT,\n \n \n Alotaibi\n M,\n \n \n Nagaoka\n H.\n \n \n Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting. Am J Orthod Dentofacial Orthop. 2023;\n163:835\u2013842."},{"key":"i1945-7103-93-6-621-b11","series-title":"Angle Orthod","first-page":"641","article-title":"Prevalence of white spot lesion formation during orthodontic treatment","volume":"83","author":"Julien","year":"2013","unstructured":"Julien\n KC,\n \n \n Buschang\n PH,\n \n \n Campbell\n PM.\n \n \n Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod. 2013;\n83:641\u2013647."},{"key":"i1945-7103-93-6-621-b12","series-title":"J Conserv Dent","first-page":"104","article-title":"Prevalence of white spot lesion in a section of Indian population undergoing fixed orthodontic treatment: an in vivo assessment using the visual International Caries Detection and Assessment System II criteria","volume":"15","author":"Sagarika","year":"2012","unstructured":"Sagarika\n N,\n \n \n Suchindran\n S,\n \n \n Loganathan\n S,\n \n \n Gopikrishna\n V.\n \n \n Prevalence of white spot lesion in a section of Indian population undergoing fixed orthodontic treatment: an in vivo assessment using the visual International Caries Detection and Assessment System II criteria. J Conserv Dent. 2012;\n15:104\u2013108."},{"key":"i1945-7103-93-6-621-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"29","article-title":"The effect of a fluoride program on white spot formation during orthodontic treatment","volume":"93","author":"Geiger","year":"1988","unstructured":"Geiger\n AM,\n \n \n Gorelick\n L,\n \n \n Gwinnett\n AJ,\n \n \n Griswold\n PG.\n \n \n The effect of a fluoride program on white spot formation during orthodontic treatment. Am J Orthod Dentofacial Orthop. 1988;\n93:29\u201337."},{"key":"i1945-7103-93-6-621-b14","series-title":"Caries Res","first-page":"41","article-title":"Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors","volume":"39","author":"Boersma","year":"2005","unstructured":"Boersma\n JG,\n \n \n van der Veen\n MH,\n \n \n Lagerweij\n MD,\n \n \n Bokhout\n B,\n \n \n Prahl-Andersen\n B.\n \n \n Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors. Caries Res. 2005;\n39:41\u201347."},{"key":"i1945-7103-93-6-621-b15","series-title":"J Int Soc Prev Community Dent","first-page":"433","article-title":"Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: a meta-analysis","volume":"5","author":"Sundararaj","year":"2015","unstructured":"Sundararaj\n D,\n \n \n Venkatachalapathy\n S,\n \n \n Tandon\n A,\n \n \n Pereira\n A.\n \n \n Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: a meta-analysis. J Int Soc Prev Community Dent. 2015;\n5:433\u2013439."},{"key":"i1945-7103-93-6-621-b16","series-title":"Int J Paediatr Dent","first-page":"473","article-title":"Prevention of demineralization during multi-bracketed fixed orthodontic treatment: an overview of systematic reviews","volume":"32","author":"Sardana","year":"2022","unstructured":"Sardana\n D,\n \n \n Manchanda\n S,\n \n \n Ekambaram\n M,\n \n \n Yang\n Y,\n \n \n McGrath\n CP,\n \n \n Yiu\n CKY.\n \n \n Prevention of demineralization during multi-bracketed fixed orthodontic treatment: an overview of systematic reviews. Int J Paediatr Dent. 2022;\n32:473\u2013502."},{"issue":"11","key":"i1945-7103-93-6-621-b17","series-title":"Cochrane Database Syst Rev","first-page":"CD003809","article-title":"Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment","volume":"2019","author":"Benson","year":"2019","unstructured":"Benson\n PE,\n \n \n Parkin\n N,\n \n \n Dyer\n F,\n \n \n Millett\n DT,\n \n \n Germain\n P.\n \n \n Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment. Cochrane Database Syst Rev. 2019;\n2019(11):CD003809."},{"key":"i1945-7103-93-6-621-b18","series-title":"Eur J Orthod","article-title":"Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review","author":"Sonesson","year":"In press","unstructured":"Sonesson\n M,\n \n \n Twetman\n S.\n \n \n Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review. Eur J Orthod. In press."},{"key":"i1945-7103-93-6-621-b19","series-title":"Pediatr Dent","first-page":"430","article-title":"Prevention of demineralization around orthodontic brackets using sealants: a systematic review and meta-analysis","volume":"41","author":"Sardana","year":"2019","unstructured":"Sardana\n D,\n \n \n Manchanda\n S,\n \n \n Ekambaram\n M,\n \n \n Yang\n Y,\n \n \n McGrath\n CP,\n \n \n Yiu\n CKY.\n \n \n Prevention of demineralization around orthodontic brackets using sealants: a systematic review and meta-analysis. Pediatr Dent. 2019;\n41:430\u2013531."},{"key":"i1945-7103-93-6-621-b20","series-title":"Eur J Orthod","first-page":"661","article-title":"Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review","volume":"41","author":"Sardana","year":"2019","unstructured":"Sardana\n D,\n \n \n Manchanda\n S,\n \n \n Ekambaram\n M,\n \n \n Yang\n Y,\n \n \n McGrath\n CP,\n \n \n Yiu\n CKY.\n \n \n Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review. Eur J Orthod. 2019;\n41:661\u2013668."},{"key":"i1945-7103-93-6-621-b21","series-title":"Clin Oral Investig","first-page":"3691","article-title":"When to intervene in the caries process? An expert Delphi consensus statement","volume":"23","author":"Schwendicke","year":"2019","unstructured":"Schwendicke\n F,\n \n \n Splieth\n C,\n \n \n Breschi\n L,\n \n et al.\n \n When to intervene in the caries process? An expert Delphi consensus statement. Clin Oral Investig. 2019;\n23:3691\u20133703."},{"key":"i1945-7103-93-6-621-b22","series-title":"Caries Res","first-page":"297","article-title":"How to intervene in the caries process in children: a joint ORCA and EFCD Expert Delphi consensus statement","volume":"54","author":"Splieth","year":"2020","unstructured":"Splieth\n CH,\n \n \n Banerjee\n A,\n \n \n Bottenberg\n P,\n \n et al.\n \n How to intervene in the caries process in children: a joint ORCA and EFCD Expert Delphi consensus statement. Caries Res. 2020;\n54:297\u2013305."},{"key":"i1945-7103-93-6-621-b23","series-title":"Health Technol Assess","first-page":"i","article-title":"Consensus development methods, and their use in clinical guideline development","volume":"2","author":"Murphy","year":"1998","unstructured":"Murphy\n MK,\n \n \n Black\n NA,\n \n \n Lamping\n DL,\n \n et al.\n \n Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;\n2:i\u2013iv, 1\u201388."},{"key":"i1945-7103-93-6-621-b24","series-title":"Nurs Res","first-page":"382","article-title":"Determination and quantification of content validity","volume":"35","author":"Lynn","year":"1986","unstructured":"Lynn\n MR.\n \n \n Determination and quantification of content validity. Nurs Res. 1986;\n35:382\u2013385."},{"key":"i1945-7103-93-6-621-b25","series-title":"Nursing Research: Design Statistics and Computer Analysis","author":"Waltz","year":"1981","unstructured":"Waltz\n CF,\n \n \n Bausell\n BR.\n \n \n \n Nursing Research: Design Statistics and Computer Analysis\n . Philadelphia, Penn: Davis FA; 1981."},{"key":"i1945-7103-93-6-621-b26","series-title":"Res Nurs Health","first-page":"269","article-title":"Selection and use of content experts for instrument development","volume":"20","author":"Grant","year":"1997","unstructured":"Grant\n JS,\n \n \n Davis\n LL.\n \n \n Selection and use of content experts for instrument development. Res Nurs Health. 1997;\n20:269\u2013274."},{"key":"i1945-7103-93-6-621-b27","series-title":"Res Nurs Health","first-page":"489","article-title":"The content validity index: are you sure you know what's being reported? Critique and recommendations","volume":"29","author":"Polit","year":"2006","unstructured":"Polit\n DF,\n \n \n Beck\n CT.\n \n \n The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;\n29:489\u2013497."},{"key":"i1945-7103-93-6-621-b28","series-title":"Educ Med J","first-page":"49","article-title":"ABC of content validation and content validity index calculation","volume":"11","author":"Yusoff","year":"2019","unstructured":"Yusoff\n MS.\n \n \n ABC of content validation and content validity index calculation. Educ Med J. 2019;\n11:49\u201354."},{"key":"i1945-7103-93-6-621-b29","series-title":"Am J Orthod Dentofacial Orthop","first-page":"123","article-title":"Orthodontic appliances and enamel demineralization. Part 2. Prevention and treatment of lesions","volume":"94","author":"Ogaard","year":"1988","unstructured":"Ogaard\n B,\n \n \n R\u00f8lla\n G,\n \n \n Arends\n J,\n \n \n ten Cate\n JM.\n \n \n Orthodontic appliances and enamel demineralization. Part 2. Prevention and treatment of lesions. Am J Orthod Dentofacial Orthop. 1988;\n94:123\u2013128."},{"key":"i1945-7103-93-6-621-b30","series-title":"Angle Orthod","first-page":"449","article-title":"The effects of soft drinks on etched and sealed enamel","volume":"66","author":"Steffen","year":"1996","unstructured":"Steffen\n JM.\n \n \n The effects of soft drinks on etched and sealed enamel. Angle Orthod. 1996;\n66:449\u2013456."},{"key":"i1945-7103-93-6-621-b31","series-title":"Eur J Orthod","first-page":"117","article-title":"Caries incidence in orthodontic patients with high levels of Streptococcus mutans","volume":"9","author":"Lundstrom","year":"1987","unstructured":"Lundstrom\n F,\n \n \n Krasse\n B.\n \n \n Caries incidence in orthodontic patients with high levels of Streptococcus mutans. Eur J Orthod. 1987;\n9:117\u2013121."},{"key":"i1945-7103-93-6-621-b32","series-title":"Oral Surg Oral Med Oral Pathol","first-page":"658","article-title":"A study of the effects of orthodontic appliances on the oral microbial flora","volume":"17","author":"Bloom","year":"1964","unstructured":"Bloom\n RH,\n \n \n Brown\n LR\n Jr\n \n . A study of the effects of orthodontic appliances on the oral microbial flora. Oral Surg Oral Med Oral Pathol. 1964;\n17:658\u2013671."},{"key":"i1945-7103-93-6-621-b33","series-title":"PLoS One","first-page":"e0188420","article-title":"Prevalence of fimA genotypes of Porphyromonas gingivalis in adolescent orthodontic patients","volume":"12","author":"Pan","year":"2017","unstructured":"Pan\n S,\n \n \n Liu\n Y,\n \n \n Si\n Y,\n \n et al.\n \n Prevalence of fimA genotypes of Porphyromonas gingivalis in adolescent orthodontic patients. PLoS One. 2017;\n12:e0188420."},{"key":"i1945-7103-93-6-621-b34","series-title":"Am J Orthod Dentofacial Orthop","first-page":"35","article-title":"Salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment","volume":"100","author":"Rosenbloom","year":"1991","unstructured":"Rosenbloom\n RG,\n \n \n Tinanoff\n N.\n \n \n Salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment. Am J Orthod Dentofacial Orthop. 1991;\n100:35\u201337."},{"key":"i1945-7103-93-6-621-b35","series-title":"PLoS One","first-page":"e0228798","article-title":"Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: an observational study","volume":"15","author":"Mummolo","year":"2020","unstructured":"Mummolo\n S,\n \n \n Nota\n A,\n \n \n Albani\n F,\n \n et al.\n \n Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: an observational study. PLoS One. 2020;\n15:e0228798."},{"key":"i1945-7103-93-6-621-b36","series-title":"Orthod Craniofac Res","first-page":"251","article-title":"Short-term variation in the subgingival microbiota in two groups of patients treated with clear aligners and vestibular fixed appliances: a longitudinal study","volume":"24","author":"Lombardo","year":"2021","unstructured":"Lombardo\n L,\n \n \n Palone\n M,\n \n \n Scapoli\n L,\n \n \n Siciliani\n G,\n \n \n Carinci\n F.\n \n \n Short-term variation in the subgingival microbiota in two groups of patients treated with clear aligners and vestibular fixed appliances: a longitudinal study. Orthod Craniofac Res. 2021;\n24:251\u2013260."},{"key":"i1945-7103-93-6-621-b37","series-title":"Int J Environ Res Public Health","first-page":"13459","article-title":"Does early childhood caries increase caries development among school children and adolescents? A systematic review and meta-analysis","volume":"19","author":"Lam","year":"2022","unstructured":"Lam\n PPY,\n \n \n Chua\n H,\n \n \n Ekambaram\n M,\n \n \n Lo\n ECM,\n \n \n Yiu\n CKY.\n \n \n Does early childhood caries increase caries development among school children and adolescents? A systematic review and meta-analysis. Int J Environ Res Public Health. 2022;\n19:13459."},{"key":"i1945-7103-93-6-621-b38","series-title":"Understanding Dental Caries","first-page":"3","article-title":"Understanding dental caries\u2014from pathogenesis to prevention and therapy","author":"Pitts","year":"2016","unstructured":"Pitts\n N.\n \n \n Understanding dental caries\u2014from pathogenesis to prevention and therapy. In: GoldbergM, ed. Understanding Dental Caries. Cham, UK: Springer; 2016:3\u20139."},{"key":"i1945-7103-93-6-621-b39","series-title":"J Dent","first-page":"1","article-title":"Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: a systematic review and meta-analysis","volume":"82","author":"Sardana","year":"2019","unstructured":"Sardana\n D,\n \n \n Zhang\n J,\n \n \n Ekambaram\n M,\n \n \n Yang\n Y,\n \n \n McGrath\n CP,\n \n \n Yiu\n CKY.\n \n \n Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: a systematic review and meta-analysis. J Dent. 2019;\n82:1\u201310."},{"key":"i1945-7103-93-6-621-b40","series-title":"Sci Rep","first-page":"16556","article-title":"Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis","volume":"11","author":"Kamber","year":"2021","unstructured":"Kamber\n R,\n \n \n Meyer-Lueckel\n H,\n \n \n Kloukos\n D,\n \n \n Tennert\n C,\n \n \n Wierichs\n RJ.\n \n \n Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis. Sci Rep. 2021;\n11:16556."},{"key":"i1945-7103-93-6-621-b41","series-title":"Angle Orthod","first-page":"483","article-title":"Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: a systematic review and meta-analysis","volume":"88","author":"Lima","year":"2018","unstructured":"Lima\n IFP,\n \n \n de Andrade Vieira\n W,\n \n \n de Macedo Bernardino\n \u00cd,\n \n et al.\n \n Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: a systematic review and meta-analysis. Angle Orthod. 2018;\n88:483\u2013493."},{"key":"i1945-7103-93-6-621-b42","series-title":"Am J Orthod Dentofacial Orthop","first-page":"423","article-title":"Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment","volume":"96","author":"Ogaard","year":"1989","unstructured":"Ogaard\n B.\n \n \n Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofacial Orthop. 1989;\n96:423\u2013427."},{"key":"i1945-7103-93-6-621-b01","series-title":"Am J Orthod","first-page":"93","article-title":"Incidence of white spot formation after bonding and banding","volume":"81","author":"Gorelick","year":"1982","unstructured":"Gorelick\n L,\n \n \n Geiger\n AM,\n \n \n Gwinnett\n AJ.\n \n \n Incidence of white spot formation after bonding and banding. Am J Orthod. 1982;\n81:93\u201398."},{"key":"i1945-7103-93-6-621-b02","series-title":"Am J Orthod Dentofacial Orthop","first-page":"423","article-title":"Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment","volume":"96","author":"Ogaard","year":"1989","unstructured":"Ogaard\n B.\n \n \n Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofacial Orthop. 1989;\n96:423\u2013427."},{"key":"i1945-7103-93-6-621-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"188","article-title":"Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances","volume":"138","author":"Chapman","year":"2010","unstructured":"Chapman\n JA,\n \n \n Roberts\n WE,\n \n \n Eckert\n GJ,\n \n \n Kula\n KS,\n \n \n Gonz\u00e1lez-Cabezas\n C.\n \n \n Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2010;\n138:188\u2013194."},{"key":"i1945-7103-93-6-621-b04","series-title":"Angle Orthod","first-page":"206","article-title":"Prevalence of white spot lesions during orthodontic treatment with fixed appliances","volume":"81","author":"Tufekci","year":"2011","unstructured":"Tufekci\n E,\n \n \n Dixon\n JS,\n \n \n Gunsolley\n JC,\n \n \n Lindauer\n SJ.\n \n \n Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011;\n81:206\u2013210."},{"issue":"suppl 1","key":"i1945-7103-93-6-621-b05","series-title":"Oral Health Prev Dent","first-page":"259","article-title":"The caries balance: the basis for caries management by risk assessment","volume":"2","author":"Featherstone","year":"2004","unstructured":"Featherstone\n JD.\n \n \n The caries balance: the basis for caries management by risk assessment. Oral Health Prev Dent. 2004;\n2(suppl 1):259\u2013264."},{"issue":"suppl 1","key":"i1945-7103-93-6-621-b06","series-title":"BMC Oral Health","first-page":"S14","article-title":"Dental plaque as a biofilm and a microbial community\u2014implications for health and disease","volume":"6","author":"Marsh","year":"2006","unstructured":"Marsh\n PD.\n \n \n Dental plaque as a biofilm and a microbial community\u2014implications for health and disease. BMC Oral Health. 2006;\n6(suppl 1):S14."},{"key":"i1945-7103-93-6-621-b07","series-title":"J Dent Res","first-page":"1065","article-title":"The exopolysaccharide matrix: a virulence determinant of cariogenic biofilm","volume":"92","author":"Koo","year":"2013","unstructured":"Koo\n H,\n \n \n Falsetta\n ML,\n \n \n Klein\n MI.\n \n \n The exopolysaccharide matrix: a virulence determinant of cariogenic biofilm. J Dent Res. 2013;\n92:1065\u20131073."},{"key":"i1945-7103-93-6-621-b08","series-title":"Trends Microbiol","first-page":"76","article-title":"Solving the etiology of dental caries","volume":"23","author":"Sim\u00f3n-Soro","year":"2015","unstructured":"Sim\u00f3n-Soro\n A,\n \n \n Mira\n A.\n \n \n Solving the etiology of dental caries. Trends Microbiol. 2015;\n23:76\u201382."},{"key":"i1945-7103-93-6-621-b09","series-title":"Nat Rev Dis Primers","first-page":"17030","article-title":"Dental caries","volume":"3","author":"Pitts","year":"2017","unstructured":"Pitts\n NB,\n \n \n Zero\n DT,\n \n \n Marsh\n PD,\n \n et al.\n \n Dental caries. Nat Rev Dis Primers. 2017;\n3:17030."},{"key":"i1945-7103-93-6-621-b10","series-title":"Am J Orthod Dentofacial Orthop","first-page":"835","article-title":"Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting","volume":"163","author":"Sharab","year":"2023","unstructured":"Sharab\n L,\n \n \n Loss\n C,\n \n \n Jensen\n D,\n \n \n Kluemper\n GT,\n \n \n Alotaibi\n M,\n \n \n Nagaoka\n H.\n \n \n Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting. Am J Orthod Dentofacial Orthop. 2023;\n163:835\u2013842."},{"key":"i1945-7103-93-6-621-b11","series-title":"Angle Orthod","first-page":"641","article-title":"Prevalence of white spot lesion formation during orthodontic treatment","volume":"83","author":"Julien","year":"2013","unstructured":"Julien\n KC,\n \n \n Buschang\n PH,\n \n \n Campbell\n PM.\n \n \n Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod. 2013;\n83:641\u2013647."},{"key":"i1945-7103-93-6-621-b12","series-title":"J Conserv Dent","first-page":"104","article-title":"Prevalence of white spot lesion in a section of Indian population undergoing fixed orthodontic treatment: an in vivo assessment using the visual International Caries Detection and Assessment System II criteria","volume":"15","author":"Sagarika","year":"2012","unstructured":"Sagarika\n N,\n \n \n Suchindran\n S,\n \n \n Loganathan\n S,\n \n \n Gopikrishna\n V.\n \n \n Prevalence of white spot lesion in a section of Indian population undergoing fixed orthodontic treatment: an in vivo assessment using the visual International Caries Detection and Assessment System II criteria. J Conserv Dent. 2012;\n15:104\u2013108."},{"key":"i1945-7103-93-6-621-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"29","article-title":"The effect of a fluoride program on white spot formation during orthodontic treatment","volume":"93","author":"Geiger","year":"1988","unstructured":"Geiger\n AM,\n \n \n Gorelick\n L,\n \n \n Gwinnett\n AJ,\n \n \n Griswold\n PG.\n \n \n The effect of a fluoride program on white spot formation during orthodontic treatment. Am J Orthod Dentofacial Orthop. 1988;\n93:29\u201337."},{"key":"i1945-7103-93-6-621-b14","series-title":"Caries Res","first-page":"41","article-title":"Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors","volume":"39","author":"Boersma","year":"2005","unstructured":"Boersma\n JG,\n \n \n van der Veen\n MH,\n \n \n Lagerweij\n MD,\n \n \n Bokhout\n B,\n \n \n Prahl-Andersen\n B.\n \n \n Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors. Caries Res. 2005;\n39:41\u201347."},{"key":"i1945-7103-93-6-621-b15","series-title":"J Int Soc Prev Community Dent","first-page":"433","article-title":"Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: a meta-analysis","volume":"5","author":"Sundararaj","year":"2015","unstructured":"Sundararaj\n D,\n \n \n Venkatachalapathy\n S,\n \n \n Tandon\n A,\n \n \n Pereira\n A.\n \n \n Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: a meta-analysis. J Int Soc Prev Community Dent. 2015;\n5:433\u2013439."},{"key":"i1945-7103-93-6-621-b16","series-title":"Int J Paediatr Dent","first-page":"473","article-title":"Prevention of demineralization during multi-bracketed fixed orthodontic treatment: an overview of systematic reviews","volume":"32","author":"Sardana","year":"2022","unstructured":"Sardana\n D,\n \n \n Manchanda\n S,\n \n \n Ekambaram\n M,\n \n \n Yang\n Y,\n \n \n McGrath\n CP,\n \n \n Yiu\n CKY.\n \n \n Prevention of demineralization during multi-bracketed fixed orthodontic treatment: an overview of systematic reviews. Int J Paediatr Dent. 2022;\n32:473\u2013502."},{"issue":"11","key":"i1945-7103-93-6-621-b17","series-title":"Cochrane Database Syst Rev","first-page":"CD003809","article-title":"Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment","volume":"2019","author":"Benson","year":"2019","unstructured":"Benson\n PE,\n \n \n Parkin\n N,\n \n \n Dyer\n F,\n \n \n Millett\n DT,\n \n \n Germain\n P.\n \n \n Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment. Cochrane Database Syst Rev. 2019;\n2019(11):CD003809."},{"key":"i1945-7103-93-6-621-b18","series-title":"Eur J Orthod","article-title":"Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review","author":"Sonesson","year":"In press","unstructured":"Sonesson\n M,\n \n \n Twetman\n S.\n \n \n Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review. Eur J Orthod. In press."},{"key":"i1945-7103-93-6-621-b19","series-title":"Pediatr Dent","first-page":"430","article-title":"Prevention of demineralization around orthodontic brackets using sealants: a systematic review and meta-analysis","volume":"41","author":"Sardana","year":"2019","unstructured":"Sardana\n D,\n \n \n Manchanda\n S,\n \n \n Ekambaram\n M,\n \n \n Yang\n Y,\n \n \n McGrath\n CP,\n \n \n Yiu\n CKY.\n \n \n Prevention of demineralization around orthodontic brackets using sealants: a systematic review and meta-analysis. Pediatr Dent. 2019;\n41:430\u2013531."},{"key":"i1945-7103-93-6-621-b20","series-title":"Eur J Orthod","first-page":"661","article-title":"Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review","volume":"41","author":"Sardana","year":"2019","unstructured":"Sardana\n D,\n \n \n Manchanda\n S,\n \n \n Ekambaram\n M,\n \n \n Yang\n Y,\n \n \n McGrath\n CP,\n \n \n Yiu\n CKY.\n \n \n Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review. Eur J Orthod. 2019;\n41:661\u2013668."},{"key":"i1945-7103-93-6-621-b21","series-title":"Clin Oral Investig","first-page":"3691","article-title":"When to intervene in the caries process? An expert Delphi consensus statement","volume":"23","author":"Schwendicke","year":"2019","unstructured":"Schwendicke\n F,\n \n \n Splieth\n C,\n \n \n Breschi\n L,\n \n et al.\n \n When to intervene in the caries process? An expert Delphi consensus statement. Clin Oral Investig. 2019;\n23:3691\u20133703."},{"key":"i1945-7103-93-6-621-b22","series-title":"Caries Res","first-page":"297","article-title":"How to intervene in the caries process in children: a joint ORCA and EFCD Expert Delphi consensus statement","volume":"54","author":"Splieth","year":"2020","unstructured":"Splieth\n CH,\n \n \n Banerjee\n A,\n \n \n Bottenberg\n P,\n \n et al.\n \n How to intervene in the caries process in children: a joint ORCA and EFCD Expert Delphi consensus statement. Caries Res. 2020;\n54:297\u2013305."},{"key":"i1945-7103-93-6-621-b23","series-title":"Health Technol Assess","first-page":"i","article-title":"Consensus development methods, and their use in clinical guideline development","volume":"2","author":"Murphy","year":"1998","unstructured":"Murphy\n MK,\n \n \n Black\n NA,\n \n \n Lamping\n DL,\n \n et al.\n \n Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;\n2:i\u2013iv, 1\u201388."},{"key":"i1945-7103-93-6-621-b24","series-title":"Nurs Res","first-page":"382","article-title":"Determination and quantification of content validity","volume":"35","author":"Lynn","year":"1986","unstructured":"Lynn\n MR.\n \n \n Determination and quantification of content validity. Nurs Res. 1986;\n35:382\u2013385."},{"key":"i1945-7103-93-6-621-b25","series-title":"Nursing Research: Design Statistics and Computer Analysis","author":"Waltz","year":"1981","unstructured":"Waltz\n CF,\n \n \n Bausell\n BR.\n \n \n \n Nursing Research: Design Statistics and Computer Analysis\n . Philadelphia, Penn: Davis FA; 1981."},{"key":"i1945-7103-93-6-621-b26","series-title":"Res Nurs Health","first-page":"269","article-title":"Selection and use of content experts for instrument development","volume":"20","author":"Grant","year":"1997","unstructured":"Grant\n JS,\n \n \n Davis\n LL.\n \n \n Selection and use of content experts for instrument development. Res Nurs Health. 1997;\n20:269\u2013274."},{"key":"i1945-7103-93-6-621-b27","series-title":"Res Nurs Health","first-page":"489","article-title":"The content validity index: are you sure you know what's being reported? Critique and recommendations","volume":"29","author":"Polit","year":"2006","unstructured":"Polit\n DF,\n \n \n Beck\n CT.\n \n \n The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;\n29:489\u2013497."},{"key":"i1945-7103-93-6-621-b28","series-title":"Educ Med J","first-page":"49","article-title":"ABC of content validation and content validity index calculation","volume":"11","author":"Yusoff","year":"2019","unstructured":"Yusoff\n MS.\n \n \n ABC of content validation and content validity index calculation. Educ Med J. 2019;\n11:49\u201354."},{"key":"i1945-7103-93-6-621-b29","series-title":"Am J Orthod Dentofacial Orthop","first-page":"123","article-title":"Orthodontic appliances and enamel demineralization. Part 2. Prevention and treatment of lesions","volume":"94","author":"Ogaard","year":"1988","unstructured":"Ogaard\n B,\n \n \n R\u00f8lla\n G,\n \n \n Arends\n J,\n \n \n ten Cate\n JM.\n \n \n Orthodontic appliances and enamel demineralization. Part 2. Prevention and treatment of lesions. Am J Orthod Dentofacial Orthop. 1988;\n94:123\u2013128."},{"key":"i1945-7103-93-6-621-b30","series-title":"Angle Orthod","first-page":"449","article-title":"The effects of soft drinks on etched and sealed enamel","volume":"66","author":"Steffen","year":"1996","unstructured":"Steffen\n JM.\n \n \n The effects of soft drinks on etched and sealed enamel. Angle Orthod. 1996;\n66:449\u2013456."},{"key":"i1945-7103-93-6-621-b31","series-title":"Eur J Orthod","first-page":"117","article-title":"Caries incidence in orthodontic patients with high levels of Streptococcus mutans","volume":"9","author":"Lundstrom","year":"1987","unstructured":"Lundstrom\n F,\n \n \n Krasse\n B.\n \n \n Caries incidence in orthodontic patients with high levels of Streptococcus mutans. Eur J Orthod. 1987;\n9:117\u2013121."},{"key":"i1945-7103-93-6-621-b32","series-title":"Oral Surg Oral Med Oral Pathol","first-page":"658","article-title":"A study of the effects of orthodontic appliances on the oral microbial flora","volume":"17","author":"Bloom","year":"1964","unstructured":"Bloom\n RH,\n \n \n Brown\n LR\n Jr\n \n . A study of the effects of orthodontic appliances on the oral microbial flora. Oral Surg Oral Med Oral Pathol. 1964;\n17:658\u2013671."},{"key":"i1945-7103-93-6-621-b33","series-title":"PLoS One","first-page":"e0188420","article-title":"Prevalence of fimA genotypes of Porphyromonas gingivalis in adolescent orthodontic patients","volume":"12","author":"Pan","year":"2017","unstructured":"Pan\n S,\n \n \n Liu\n Y,\n \n \n Si\n Y,\n \n et al.\n \n Prevalence of fimA genotypes of Porphyromonas gingivalis in adolescent orthodontic patients. PLoS One. 2017;\n12:e0188420."},{"key":"i1945-7103-93-6-621-b34","series-title":"Am J Orthod Dentofacial Orthop","first-page":"35","article-title":"Salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment","volume":"100","author":"Rosenbloom","year":"1991","unstructured":"Rosenbloom\n RG,\n \n \n Tinanoff\n N.\n \n \n Salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment. Am J Orthod Dentofacial Orthop. 1991;\n100:35\u201337."},{"key":"i1945-7103-93-6-621-b35","series-title":"PLoS One","first-page":"e0228798","article-title":"Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: an observational study","volume":"15","author":"Mummolo","year":"2020","unstructured":"Mummolo\n S,\n \n \n Nota\n A,\n \n \n Albani\n F,\n \n et al.\n \n Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: an observational study. PLoS One. 2020;\n15:e0228798."},{"key":"i1945-7103-93-6-621-b36","series-title":"Orthod Craniofac Res","first-page":"251","article-title":"Short-term variation in the subgingival microbiota in two groups of patients treated with clear aligners and vestibular fixed appliances: a longitudinal study","volume":"24","author":"Lombardo","year":"2021","unstructured":"Lombardo\n L,\n \n \n Palone\n M,\n \n \n Scapoli\n L,\n \n \n Siciliani\n G,\n \n \n Carinci\n F.\n \n \n Short-term variation in the subgingival microbiota in two groups of patients treated with clear aligners and vestibular fixed appliances: a longitudinal study. Orthod Craniofac Res. 2021;\n24:251\u2013260."},{"key":"i1945-7103-93-6-621-b37","series-title":"Int J Environ Res Public Health","first-page":"13459","article-title":"Does early childhood caries increase caries development among school children and adolescents? A systematic review and meta-analysis","volume":"19","author":"Lam","year":"2022","unstructured":"Lam\n PPY,\n \n \n Chua\n H,\n \n \n Ekambaram\n M,\n \n \n Lo\n ECM,\n \n \n Yiu\n CKY.\n \n \n Does early childhood caries increase caries development among school children and adolescents? A systematic review and meta-analysis. Int J Environ Res Public Health. 2022;\n19:13459."},{"key":"i1945-7103-93-6-621-b38","series-title":"Understanding Dental Caries","first-page":"3","article-title":"Understanding dental caries\u2014from pathogenesis to prevention and therapy","author":"Pitts","year":"2016","unstructured":"Pitts\n N.\n \n \n Understanding dental caries\u2014from pathogenesis to prevention and therapy. In: GoldbergM, ed. Understanding Dental Caries. Cham, UK: Springer; 2016:3\u20139."},{"key":"i1945-7103-93-6-621-b39","series-title":"J Dent","first-page":"1","article-title":"Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: a systematic review and meta-analysis","volume":"82","author":"Sardana","year":"2019","unstructured":"Sardana\n D,\n \n \n Zhang\n J,\n \n \n Ekambaram\n M,\n \n \n Yang\n Y,\n \n \n McGrath\n CP,\n \n \n Yiu\n CKY.\n \n \n Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: a systematic review and meta-analysis. J Dent. 2019;\n82:1\u201310."},{"key":"i1945-7103-93-6-621-b40","series-title":"Sci Rep","first-page":"16556","article-title":"Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis","volume":"11","author":"Kamber","year":"2021","unstructured":"Kamber\n R,\n \n \n Meyer-Lueckel\n H,\n \n \n Kloukos\n D,\n \n \n Tennert\n C,\n \n \n Wierichs\n RJ.\n \n \n Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis. Sci Rep. 2021;\n11:16556."},{"key":"i1945-7103-93-6-621-b41","series-title":"Angle Orthod","first-page":"483","article-title":"Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: a systematic review and meta-analysis","volume":"88","author":"Lima","year":"2018","unstructured":"Lima\n IFP,\n \n \n de Andrade Vieira\n W,\n \n \n de Macedo Bernardino\n \u00cd,\n \n et al.\n \n Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: a systematic review and meta-analysis. Angle Orthod. 2018;\n88:483\u2013493."},{"key":"i1945-7103-93-6-621-b42","series-title":"Am J Orthod Dentofacial Orthop","first-page":"423","article-title":"Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment","volume":"96","author":"Ogaard","year":"1989","unstructured":"Ogaard\n B.\n \n \n Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofacial Orthop. 1989;\n96:423\u2013427."}],"container-title":["The Angle Orthodontist"],"original-title":[],"link":[{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/93\/6\/article-p621.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/meridian.allenpress.com\/angle-orthodontist\/article-pdf\/93\/6\/621\/3284414\/i1945-7103-93-6-621.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/93\/6\/article-p621.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/93\/6\/article-p621.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:24:08Z","timestamp":1780064648000},"score":1,"resource":{"primary":{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/93\/6\/article-p621.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":84,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.2319\/062523-440.1","relation":{},"ISSN":["1945-7103","0003-3219"],"issn-type":[{"value":"1945-7103","type":"electronic"},{"value":"0003-3219","type":"print"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}