Care of dental enamel for the orthodontic patient

One of the many responsibilities of the orthodontist is to minimise the risk of dental caries development as a consequence of orthodontic treatment. Patients receiving orthodontic treatment are commonly at an age when many newly erupted teeth are present. Newly erupted teeth are particularly vulnerable to dental caries initiation but are also very responsive to topical fluoride therapy. For these reasons orthodontic patients should be exposed to preventive measures to protect enamel. A number of home care procedures and topical fluoride procedures appropriate to each phase of orthodontic treatment can be utilised to impart caries resistance.

Within two weeks of band placement, a general topical fluoride application with SnF₂ solution or APF solution should be carried out. Newly erupted teeth or surfaces with early lesions can be treated with a prolonged fluoride application procedure. While fixed appliances are in place, the referring general practitioner should continue semi-annual topical applications of 2% NaF or APF solutions. As a part of home care, patients may use NaF mouthrinses daily or weekly or, as an alternative, use a self-applied 5% MFP paste weekly. If areas of enamel decalcification are apparent after band removal, a number of effective chemical treatments can be performed to promote remineralisation and to prevent further caries progression. The importance of sensible diet and good oral hygiene should be stressed for orthodontic patients. A number of plaque control measures are available but thorough toothbrushing is the most practical and acceptable method.