Patient-centred, evidence-based orthodontics
Patient-centred, evidence-based orthodontics
Having braces - known as fixed orthodontic appliances - is a familiar step for many young people on the way to a healthy and attractive smile. However, treatment with fixed appliances also carries certain risks. Two of the most common side effects are small early areas of decay appearing as white spots on the teeth (white spot lesions, WSLs) and root shortening (external apical root resorption, EARR).
White spot lesions appear when plaque builds up around orthodontic brackets due to inadequate brushing, leading to enamel demineralisation. These WSLs can develop within just a few weeks and often remain visible even after the braces have been removed. Root resorption means that the tip of a tooth root becomes slightly shorter during treatment. In most cases, this has no lasting consequences, but in severe cases, it can weaken the tooth’s anchorage in the jawbone.
This thesis of Sebastiaan van Doornik investigated how these risks can be reduced in everyday orthodontic practice. A survey among almost 400 adolescents with fixed appliances showed that only a small proportion followed all oral hygiene recommendations precisely. Boys and older teenagers tended to be less compliant. Young people who already knew what white spot lesions were found them more bothersome than those without prior knowledge, yet this awareness did not result in better brushing behaviour.
A toothpaste designed to temporarily colour dental plaque – making it easier to see while brushing – was also tested. Although participants reported feeling that they brushed more effectively, there was no measurable difference in plaque levels compared with those using a regular fluoride toothpaste.
Finally, we examined how orthodontists applied the professional guidelines for managing root resorption. Almost all orthodontists in the Netherlands now consistently follow this guideline, resulting in more standardised and safer orthodontic care.
Adolescents, on the other hand, still find it difficult to fully comply with the guidelines for preventing white spot lesions. Additional education, motivation, and support are therefore essential to make treatment with fixed braces as safe and healthy as possible. At the same time, the study shows that orthodontists in the Netherlands adhere well to the guidelines on root resorption, contributing to more uniform and high-quality orthodontic care.