Effect of Sealants on White Spot Lesions During Orthodontic Treatment

Objectives: To evaluate whether pit and fissure sealants placed on the labial surface of anterior teeth reduce white spot lesion (WSL) formation in adolescents undergoing treatment with fixed orthodontic appliances. Methods: A split-mouth design was used with 49 healthy patients; the sealant (Ultraseal XT® Plus Clear) was randomly allocated to either the right or left sides of the maxilla and mandible. The sealant was applied to the entire labial surfaces of the incisors and canines prior to bracket placement. The contralateral control teeth had the same brackets bonded in the same manner, with no sealant applied. A total of 294 maxillary teeth and 294 mandibular teeth were evaluated.  Pre- and post-treatment intraoral photographs were used to visually assess decalcification based on a modification of Gorelick's scoring system; 32 of the patients were recalled 3-24 months post-treatment to evaluate further changes in decalcification.  Decalcification was evaluated based on A) visual assessment of photographs and B) DIAGNOdent® recordings of each tooth.  Results:  Five (10.2%) of the patients in the larger sample developed WSL's; they were most common on the maxillary lateral incisors and mandibular canines. There were significantly (p=0.048) more teeth with WSL's on the side without (N=16) than with (N=11) sealants.  The WSL's on the side without sealants were also more extensive than on the sealed side, but the difference was not statistically significant.  The DIAGNOdent® recordings of the recalled patients showed no significant differences between sides for either the maxilla or mandible.  Conclusions: While sealants limit the development of WSL's during routine orthodontic treatment, and some remineralization occurs after treatment, more studies are needed to develop a method that prevents the permanent scars produced by white spot lesions. This research was partially supported by the Baylor Oral Health Foundation.