NEW YORK (Reuters Health)
— Adolescents may not be
able to get out of wearing braces, but using a high-fluoride
toothpaste for the duration could help them avoid white marks the
devices often leave behind, according to a new study from Sweden.
The special paste with almost four times the usual
fluoride content helped prevent about a third of the chalky-looking
spots among kids between the ages of 11 and 16 years old,
Past studies have shown that up to 85 percent of patients who wear
braces may develop these so-called white spot lesions, which
represent local tooth decay and tend to be permanent.
"To reduce this effect, several products are available on the
market, but evidence of the effectiveness of the products is
lacking," said Mikael Sonesson, lead author of the study and an
orthodontist at Malmö University.
To see whether a high-fluoride toothpaste that patients could use at
home would protect against the spots, more than 400 kids at five
dental practices who were scheduled to get braces were recruited
starting in 2008.
They were randomly divided into two groups, with about half
receiving a paste containing 5,100 parts per million fluoride to use
at home and the other half receiving paste that was similar in every
way, except it contained 1,450 ppm fluoride — the amount in most
standard commercial brands, according to the researchers.
Before getting their braces, all the youngsters had detailed photos
taken of their teeth and photos were taken again after the braces
were removed. The participants wore braces for an average of 1.8
years and received toothpaste supplies for as long as they did.
Two clinicians who did not know which fluoride paste the youngsters
had used evaluated all the before-and-after photos to assess the
presence and severity of white spots using a four-point scale.
About 10 percent of participants dropped out of the study for
various reasons, though no side effects of the toothpastes were
reported, Sonesson and his colleagues note in the European Journal
When the researchers analyzed results for the remaining
participants, they found that about 45 percent of patients who
brushed with regular toothpaste developed white spots, whereas only
34.6 percent of those who used the high-fluoride paste developed
spots. That translates to about 32 percent fewer white spots in the
The results were not surprising, given previous research on the use
of fluoride for preventing cavities, according to Nisreen Takulla, a
dentist in the Boston area.
"High-fluoride toothpastes are often prescribed for patients at a
high risk of dental caries, to be used once a day instead of regular
toothpaste, and topical fluorides have also been proven to be very
effective for caries control," said Takulla. Other ways to get
higher doses of fluoride include mouth rinses and gels applied to
To avoid white spots and cavities when wearing braces, the study's
authors recommend being extra careful with brushing and flossing and
avoiding a high-carbohydrate diet, which can be one factor that
promotes tooth decay.
Additional fluoride, such as high-fluoride toothpaste, could be
another important measure to prevent cavities, Sonesson said.
Such toothpastes should be used once a day in place of regular
toothpaste and should not be swallowed; users also should not eat or
drink for 30 minutes after brushing with high-fluoride paste.
But it's not just the toothpaste that's important, it's also the way
one brushes, according to Takulla.
"Using the right technique to brush, and ensuring all surfaces of
the teeth are cleaned, is as important (as the toothpaste used),"
Finally, in addition to home care, a dental exam and cleaning to
identify white spots as early as possible, along with the
application of a fluoride varnish, should be done every four to six
months, Takulla said.