Lack of reliable evidence for the effectiveness of remineralizing agents for the treatment of post-orthodontic white spot lesions

iStock_000002551343XSmall colourful braces on teeth

White spot lesions (WSLs) are a common adverse effect of orthodontic treatment. The incidence of these lesions is high with some estimates as high as 97%.  The aim of this review was to assess the evidence regarding the effect of remineralizing agents on post-orthodontic WSLs and to evaluate which remineralizing agents are effective for the treatment of WSLs after orthodontic treatment

The PubMed, Medline, Web of Science and Cochrane library databases were searched for randomised controlled trials (RCTs) regarding the application of remineralizing agents for the treatment of post-orthodontic WSLs. studies in which the participants underwent any non-remineralizing therapy (eg, bleaching, enamel microabrasion, or restoration) were excluded. Selection and data extraction was conducted by two reviewers independently. Study quality was assessed using the Cochrane risk of bias approach.

  • Seven RCTs were included, All except one study ( medium risk) were considered to be at high risk of bias
  • Three studies evaluated fluoride preparations (50-ppm sodium fluoride mouth rinse, 5% sodium fluoride varnish, and 0.5% sodium fluoride chewing sticks).
  • Four compared remineralizing agents containing casein phosphopeptide amorphous calcium phosphate or casein phosphopeptide amorphous calcium fluoride phosphate
  • Qualitative analyses were performed because of the diversity of the interventions and outcome measures.

The authors concluded

Based on the literature, there is a lack of reliable evidence to support the effectiveness of remineralizing agents for the treatment of post-orthodontic white spot lesions.


We have previously highlighted two trials (Dental Elf 18th Jan 2013) that have looked at using MI paste to treat WSLs . The earlier study by Robertson et al ( Dental Elf  9th Nov 2011) was excluded from this review as it did not meet the population criteria and the newer study was published after the searches were completed.


Chen H, Liu X, Dai J, Jiang Z, Guo T, Ding Y. Effect of remineralizing agents  on white spot lesions after orthodontic treatment: A systematic review. Am J Orthod Dentofacial Orthop. 2013 Mar;143(3):376-382.e3. doi: 10.1016/j.ajodo.2012.10.013. PubMed PMID: 23452972.

Dental Elf Jan 18th 2013 – Trial suggests that regular brushing as effective as MI paste or fluoride varnish in reducing white spot lesions post orthodontic treatment

Dental Elf  9th Nov 2011 – MI Paste Plus helped prevent the development of new white spot lesions during orthodontic treatment


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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