Study Year of
Number of
Treatment Study design Main findings
Baeshen et al. [5] 2011 37 DIAGNOdent pen Fluoridated miswaks (impregnated in 0.5% sodium fluoride) 5 times per day for 6 weeks after debonding. Double-blind, randomized, longitudinal trial Fluoridated miswaks had a remineralizing effect on WSLs (P < 0.0001).
et al. [8]
2013 115 Digital photographs 3 groups:
1) an 8-week regimen of MI Paste Plus;
2) a single application of PreviDent fluoride varnish;
3) Control group – home care with 1100 ppm of fluoride toothpaste.
Parallel-group randomized trial MI Paste Plus and PreviDent fluoride varnish do not appear to be more effective than normal home care for improving the appearance of WSLs over an 8-week period.
et al. [19]
2011 400 Digital photographs Special cleaning instructions:
daily use of fluoride toothpaste, fluoride mouth rinse, weekly use of products with a high-fluoride content (12.500 ppm of fluoride).
Cohort study New WSLs developed on 60.9 % of the patients in this survey despite the prevention measures.
Agarwal et al. [20] 2013 31 Clinical examination 2 groups:
1) fluoridated toothpaste three times a week;
2) nonfluoridated toothpaste.
Double-blind, randomized, longitudinal trial There were statistically significant differences between the test group (P < 0.0001), but not in the control group. Use of fluoridated toothpaste had a remineralizing effect on WSLs.
et al. [27]
2012 80 Clinical examination;
digital photographs
4 groups:
1) Control group;
2) fluoride rinse, neutral 0.025% sodium fluoride was used for 30 seconds twice daily;
3) CPP-ACP topical cream was applied to the tooth surfaces twice a day;
4) 45 microabrasion therapy sessions were done at an interval of 2 weeks.
Parallel-group randomized trial The use of CPP-ACP was more beneficial than fluoride rinse for postorthodontic remineralization (P < 0.05). There was no significant difference between the success rates of treatment with fluoride rinse and control group.
Du et al. [28] 2012 96 DIAGNOdent pen Fluoride varnish (5% sodium fluoride) or saline was applied onto tooth surfaces with WSLs every month during the first 6 months after debonding. Randomized controlled trial Topical fluoride varnish application is effective in reversing WSLs after debonding.
Bailey et al. [29] 2009 45 Quantitative light-induced fluorescence;
digital photographs.
Tooth Mousse/MI Paste. Randomized controlled trial WSLs had a significantly greater chance of regressing at 12 weeks in the remineralizing cream arm of the study (P < 0.05).
Richter et al. [30] 2011 350 Digital photographs 4 groups:
1) oral hygiene instructions for all 350 patients;
2) topical fluoride applications for 43 patients;
3) fluoride rinse for 42 patients.
Randomized controlled trial A significant association was with treatment duration (P < 0.01) and the number of oral hygiene discussions (P < 0.0001).
The preventive therapy was not effective.
Al Mulla et al. [31] 2010 10 Clinical examination;
radiographic examination
(bitewings taken with double film)
Colgate Max Cavity toothpaste (1450 ppm of fluoride). Longitudinal, randomized clinical trial The use of Colgate Max Cavity toothpaste significantly reduces the incidence of WSLs in orthodontic patients
(P < 0.001).
Robertson et al. [32] 2011 50 Digital photographs MI Paste Plus using it each day at night after brushing for 3 months. Prospective randomized controlled trial MI Paste Plus helped to prevent the development of WSLs and decreased the number of WSLs already present (P < 0.05).
Bröchner et al. [33] 2011 50 Quantitative light-induced fluorescence;
digital photographs
Topical applications of Tooth Mousse once daily for 4 weeks. Randomized controlled trial Topical treatment with a CPP-ACP agent significantly reduced area of the lesions after 4 weeks (P < 0.05).
Beerens et al. [34] 2010 54 Quantitative light-induced fluorescence MI Paste Plus used once a day at bedtime. Double-blind prospective randomized clinical trial No clinical advantage for use of the MI Paste Plus over the 12 weeks was found.