2012 Joint AAO-AAPD Conference - White Spot Lesions An Orthodontic Dilemma: What Can be Done?/The Role of Orthodontics in the Prevention and Management of Dental Trauma

White Spot Lesions An Orthodontic Dilemma: What Can be Done?

Fixed orthodontic treatment is often associated with white spot lesions that occur in otherwise well-treated cases. These unsightly scars are generally perceived to be evidence of poor oral hygiene practices during treatment but nevertheless must be dealt with by restorative dentists. Prevention of their occurrence, rather than restoration or remineralization, would be the ideal solution and may possibly prevent unwanted litigious activity. This presentation will make the case for prevention of white spot lesions during fixed orthodontic treatment using filled resin sealants on smooth enamel surfaces. Results of clinical and laboratory research will be shown to support the efficacy and efficiency of this line of study. Total prevention of white spot lesions/decalcification has been the goal of the research supporting this paper and should be the goal of every clinician who places fixed orthodontic appliances.

Learning Objectives:

• Attendees will be introduced to the use of filled resin sealants on smooth enamel surfaces for prevention of white spot lesions/decalcification during fixed orthodontic treatment.
• Supporting evidence of clinical and laboratory research findings in prevention of white spot lesions will be presented.
• The importance of the need for Specific Informed Consent for all patients and the need for Termination of Active Treatment in some patients will be discussed.

With tooth trauma there is stress and anxiety within the office. The patient is scared and worried what is going to happen and wonders if they will ever look normal again. Parents are dealing with guilt over the injury, concern about outcomes and making their child whole again. As dentists, we are concerned about providing the proper treatment and creating the best possible outcomes. This is complicated by the fact there are few protocols that are truly evidence-based and each injury is different. Prevention and management of dental trauma requires the pediatric dentist and orthodontist to work as a team to create the best possible outcome for their patients. Prevention of trauma begins in both offices with the recognition and treatment of orthodontic issues that may predispose teeth to trauma. Prevention also includes a heavy emphasis on the use of protective mouthguards.

This lecture will concentrate on the basic understanding of typical trauma outcomes for specific injuries. The pediatric dentist will learn how to incorporate orthodontic care into trauma management and the orthodontist will learn appropriate strategies to treat teeth that have had trauma prior to orthodontic treatment and teeth that sustain trauma during orthodontic treatment. A goals-oriented, team approach to trauma management gives patients the best chance for a successful and esthetic outcome.

Learning Objectives:

• Increase understanding of basic trauma prevention strategies.
• Learn the effect of trauma on orthodontic treatment and be prepared to act accordingly.
• Be able to use basic orthodontic principles in the management of dental trauma.