Effect of Nonfluoridated Dentifrices on White Spot Lesions in Fixed Orthodontic Patients: A Systematic Review of Randomized Controlled Trials

IntroductIonWhite spot lesions (WSLs) are the most frequently reported iatrogenic complication of fixed orthodontic therapy, with a pooled prevalence of approximately 55% among orthodontic patients. 1These early enamel opacities arise when cariogenic biofilm accumulates around brackets and auxiliary attachments, creating a prolonged acidic microenvironment that drives subsurface demineralization. 2,3 Beyond the obvious esthetic concern, WSLs herald the first stage of dental caries and may progress to cavitation when left unmanaged.Fluoride-containing dentifrices remain the cornerstone of WSL prevention because topical fluoride accelerates remineralization and enhances enamel resistance. 4 Nonetheless, their clinical success depends heavily on meticulous daily compliance, and high-strength formulations (5000 ppm) recommended for high-risk adolescents are contraindicated in children under 16 years. 5 Excess systemic or topical fluoride exposure can produce dental fluorosis, ranging from subtle white striae to severe brown mottling. 6 Young children are particularly vulnerable because they swallow a large proportion of the dentifrice; dosing studies show a 5-7-fold overdose relative to the grain-of-rice recommendation for ages 24 months. 7In response to these 1,