Abstract Background White spot lesions (WSLs) are a common and aesthetically concerning side-effect of orthodontic treatment with fixed appliances. Despite their high prevalence, the impact of adolescent awareness on caries preventive behaviour remains poorly understood. Purpose This study investigated associations between WSL awareness, perceived annoyance with WSLs, adherence to caries-related clinical practice guidelines (CPGs), and patient characteristics amongst adolescents receiving orthodontic fixed appliance treatment. Methods This cross-sectional study included 393 orthodontic patients aged 12–17 years from ten orthodontic practices. Participants completed an electronic survey assessing WSL awareness, participant characteristics, perceived annoyance (score range: 3–15), and adherence to six CPG behaviours (participants brushed 2 times/day (1), for 2 min (2), using fluoride toothpaste (3), cleaning interdentally (4), yearly dental visits (5), their food and drink intake ≤ 7 times/day (6); score range: 1–6). Results Of the 329 valid responses, 38% reported prior awareness of WSLs. These participants had significantly higher annoyance scores compared to those without awareness (median 13) compared to those not aware of WSLs (median 12, p = 0.004). However, awareness was not associated with treatment duration or level of CPG adherence. Annoyance was associated with CPG adherence (Spearman’s ρ = 0.149, p = 0.003). No significant associations were found between annoyance and participant characteristics. Conclusions Although prior WSL awareness was associated with greater perceived annoyance, it was not associated with better adherence to caries preventive measures. These findings suggest that whilst adolescents may recognise the aesthetic impact of WSLs, current educational approaches are insufficient to translate concern into patient actions. Additional efforts are needed to promote sustained adherence during orthodontic treatment.
Doornik et al. (2026) studied this question.