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Limited evidence indicates fluoride may prevent demineralized white lesions during orthodontic treatment

Linda L. Cheng, DDS, FAGD, ABGD .


Systematic Review Conclusion

For the 3 studies identified on 3 modes of fluoride application for preventing white spots, only 1 was a well-conducted randomized clinical trial (RCT), which reported applications of fluoride varnish every 6 weeks during fixed orthodontic treatment may reduce the risk of developing demineralized white lesions (DWLs).

Critical Summary Assessment

A well-conducted systematic review of 3 RCTs, with 1 each at low, unclear, and high risk of bias, found moderate-quality evidence in 1 well-designed study indicating 1 specific mode of fluoride delivery—the use of fluoride varnish—may decrease the incidence of DWLs in orthodontic patients.

Evidence Quality Rating

Limited Evidence

This summary is published in the Journal of the American Dental Association and can be accessed at:

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019