Assessment of Bacterial Load and White Spot Lesion Incidence in Orthodontic Subjects Using a 4-Hydroxycinnamic Acid Dentifrice: An In Vivo Assessment

IntroductIonWhite spot lesions (WSLs) represent early carious changes in enamel, marked by subsurface porosity due to demineralization. 1,2SLs are among the most common complications during orthodontic treatment, which appear as opaque, chalky areas of enamel demineralization that arise from the prolonged presence of acidic byproducts produced by cariogenic bacteria. 3These lesions appear as opaque areas with reduced mineral content and reduced fluorescence when compared to healthy enamel, and the affected surface is slightly softer than adjacent sound enamel. 4Fixed orthodontic appliances pose unique challenges to maintaining oral hygiene.These appliances introduce new retention areas for plaque accumulation, leading to significant alterations in the oral microbiome. 5,6The presence of orthodontic appliances, especially brackets and bands, creates irregular surfaces that hinder the natural self-cleansing effects of saliva and oral muscle movements. 7The resulting environment fosters the proliferation of sulfate-reducing bacteria, 8 acidogenic and aciduric bacteria, particularly Streptococcus mutans and lactobacilli, which are strongly implicated in the development of WSLs. 9,10WSLs can become noticeable around the brackets of fixed appliances within 1 month of bracket placement. 11Epidemiological studies have reported a wide variation in the prevalence of these lesions, ranging from 2 to 97%. 12,13 Current methods for the prevention of WSLs during orthodontic treatment emphasize a multifaceted approach involving patient 1,