The effect of a mouthrinse containing chlorhexidine and fluoride on plaque and gingival bleeding

Abstract The aim of this study was to test the effect of a rinse with 0.05% sodium fluoride and 0.05% chlorhexidine on plaque and gingival inflammation compared with a placebo without these agents. In a double-blind study, 47 adults with >20 teeth and a CPITN score >1 but <4 were randomised into test and control groups. After baseline assessments for plaque, bleeding and stain, teeth were professionally cleaned. Subjects were asked to rinse for 30 s with 10 ml of the respective test or placebo rinse after normal oral hygiene for 8 weeks. 39 subjects completed the study. There was no significant difference in the 2 groups at baseline with respect to cither plaque or bleeding scores. After scaling and 8 weeks use of the test rinse, there were significant reductions (p <0.001) in both plaque and bleeding. The control group showed no significant reduction in plaque scores after 8 weeks, but a significant (p <0.05) reduction in bleeding. However, this reduction was significantly greater (p <0.001) in the test group than in the control. The test group had a significantly greater (p <0.05) stain score than the control at baseline. After scaling and rinsing for 8 weeks, stain scores were lower for both groups compared to baseline but reached significance (p <0.05) only for the control group. It is concluded that, as an adjunct to normal oral hygiene, the chlorhexidine/fluoride rinse had a significant inhibitory effect on plaque and bleeding but its effect on staining is uncertain.     

Short term clinical effectiveness of a 0.07% cetylpyridinium chloride mouth rinse in patients undergoing fixed orthodontic appliance treatment

Objectives

To test the short term clinical effectiveness of commercially available 0.07%.cetylpyridinium chloride mouth rinse in patients undergoing fixed orthodontic treatment as compared to a placebo mouth rinse and patients using toothbrush and toothpaste.

Method

Forty-five subjects for this double blind study were assigned randomly into three groups of 15 each. Gingival inflammation, plaque accumulation, and bleeding on probing, were recorded at baseline (10 days after prophylaxis), and at the end of one month in all the three groups and compared.

Results

Paired t test showed significant differences in bleeding index for pre and post treatment recordings for cetylpyridinium group. Modified gingival index showed no significant difference in the cetylpyridinium group. For plaque index significant difference was found for cetylpyridinium and control groups.

Conclusion

Cetylpyridinium mouth rinse 0.7% was found to be effective in reducing the bleeding and plaque index scores. It was not effective in reducing the modified gingival index scores. Cetylpyridinium mouth rinse 0.07% improves the oral hygiene of orthodontic patients when used as an adjunct to normal oral hygiene measures.     

Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment

A sanguinaria-containing toothpaste and oral rinse regimen was evaluated during a 6-month period to determine its effectiveness in controlling plaque, gingival inflammation, and sulcular bleeding. Oral hygiene instructions and a 1-month prestudy brushing period failed to produce a significant improvement in health among the 24 subjects as determined by the three evaluation parameters. After the oral hygiene period, the subjects were randomly assigned to the active treatment (marketed Viadent toothpaste and oral rinse) or the placebo treatment (same base formulas without sanguinaria). Treatments were evaluated using the L?e and Silness gingival index, the Silness and L?e plaque index, and the Mühlemann and Son sulcular bleeding index at baseline and monthly through 6 months. The sanguinaria regimen reduced plaque by 57%, gingival inflammation by 60%, and sulcular bleeding by 45% from baseline compared with placebo group reductions of 27% (plaque) and 21% (gingival inflammation), and an increase of 30% in bleeding index. Repeated-measures analysis of covariance with baseline scores used as covariates showed statistically significant differences at 6 months for plaque (active 0.39; placebo 0.68, p less than 0.01), gingival inflammation (active 0.32; placebo 0.76, p less than 0.001), and sulcular bleeding (active 0.34; placebo 0.70, p less than 0.002). Results of this study demonstrated that the combined use of the sanguinaria-containing toothpaste and oral rinse controls and reduces plaque and gingival inflammation in an orthodontic population.     

氟涂料用于固定矫治后釉质脱矿再矿化治疗的效果

目的评价氟浓度为2.26 mg/mL的氟涂料应用于正畸固定矫治后釉质脱矿再矿化治疗的临床效果。方法对正畸固定矫治结束并拆除托槽的患者进行牙釉质脱矿状况检查,选择符合纳入标准的110例受试者,随机分为2组,试验组在脱矿牙面上涂布氟涂料,对照组在脱矿牙面上涂布蒸馏水,每个月1次,持续6个月,在拆除托槽当天（基线）和拆除托槽3个月、6个月分别对唇颊面釉质脱矿区域进行临床视诊检查,使用临床视诊指数进行评分。结果基线、3个月、6个月时试验组的视诊指数分别为（2.22±0.42）分、（2.18±0.43）分、（2.15±0.41）分;对照组的视诊指数分别为（2.15±0.36）分、（2.14±0.38）分、（2.14±0.38）分。基线（t=2.470,P=0.228）、拆除托槽3个月（t=0.651,P=0.516）及6个月（t=0.149,P=0.882）试验组与对照组的差异均没有统计学意义。试验组的临床视诊指数在拆除托槽3个月、6个月与基线比较差异均有统计学意义（P＆lt;0.05）,但第3个月与第6个月的差异没有统计学意义（t=1.860,P=0.083）。结论应用2.26 mg/mL的氟涂料对固定矫治后出现的釉质脱矿进行再矿化治疗后,牙釉质脱矿程度有所降低,但再矿化效果不够显著。     

Methods used for prevention of white spot lesion development during orthodontic treatment with fixed appliances

Abstract Objectives: The aim of this study was to survey methods that Dutch orthodontists use to prevent development or progression of enamel decalcifications during orthodontic treatment. Materials and methods: A pre-tested questionnaire was sent by post to all orthodontists in the Netherlands with a private practice (n = 189). Results: The response rate was 81%. At the start of orthodontic treatment a basic practice protocol for prevention of enamel demineralization was used by 93% of the orthodontists. This included oral hygiene instructions (92%) and the advice for additional use of a fluoride mouth rinse (64%). Other preventive measures were rarely prescribed. About 85% of those who prescribed a fluoride mouth rinse advised to rinse once a day, directly after evening tooth brushing. Conclusions: The results suggest that the commonly used practice of fluoride mouth rinsing directly after evening tooth brushing by orthodontic patients during fixed appliance treatment ignores actual evidence of preventive advices. This study recommends mouth rinsing at another moment than after evening tooth brushing, thus increasing the frequency of fluoride intakes, which might enhance the effectiveness in preventing WSL development or progression during orthodontic treatment.     

酪蛋白磷酸肽-无定形磷酸钙对正畸术后釉质再矿化的效果评价

目的: 比较含氟漱口水、护牙素即酪蛋白磷酸肽-无定形磷酸钙（casein phosphopeptide calcium phosphate complex,CPP-ACP）对正畸治疗后发生釉质脱矿的再矿化效果。方法: 应用Image J图像分析技术观察正畸治疗后釉质的再矿化。将固定矫治器正畸治疗后发生牙釉质脱矿的21例患者（女13例,男8例,84颗患牙）分为3组,每组28颗患牙。对照组仅用含氟牙膏每天刷牙2次,每次3 min。氟化物组用含氟牙膏每天刷牙2次,每次3 min,同时使用20 mL 0.01%氟化物冲洗牙2次。CPP-ACP组用含氟牙膏每天刷牙2次,每次3 min。同时按要求使用CPP-ACP 2次,3组均持续使用6个月。采用SPSS17.0软件包对数据进行统计学分析。结果: 正畸治疗后6个月,3组牙釉质脱矿白斑区域面积均有不同程度减少,3组治疗前、后均有显著差异（P<0.05）。CPP-ACP组效果尤为明显（51.68%）,显著高于氟化物组（44.42%）和对照组（42.71%）。结论: 正畸治疗后6个月内,正确刷牙、氟化物漱口、配合护牙素的使用,对正畸治疗中脱矿牙的再矿化均有一定效果, 而且CPP-ACP可以更有效地减小牙釉质脱矿白斑区域面积。     

Can white spot lesions be treated effectively?

Abstract Objective: To compare the effects of sodium fluoride mouth rinse, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and the microabrasion technique in treating white spot lesions. Materials and Methods: The study population consisted of 80 patients (46 females, 34 males; 966 affected teeth) who had developed multiple decalcified enamel lesions after fixed orthodontic therapy. The study population was divided into four groups of 20 patients each. The control group (group I) participants were to just brush their teeth, the fluoride group (group II) participants were instructed to use 20?ml of neutral 0.025% sodium fluoride rinse, the participants in the CPP-ACP group (group III) were instructed to use tooth mousse twice a day in addition to fluoride toothpaste for 6?months, and the participants in the microabrasion group (group IV) were to undergo treatment by the microabrasion technique, which is a commonly used mixture of 18% hydrochloric acid. Data were analyzed with the generalized linear mixed model and Tukey HSD at the P < .05 level. Results: The area of the white spot lesions decreased significantly in all groups. Inter group differences in the treatment success rates were significant. The highest success rate was observed for group IV (97%). The success rate of group III (58%) was significantly higher than that of groups II (48%) and I (45%). Conclusions: The use of CPP-ACP can be more beneficial than fluoride rinse for postorthodontic remineralization. Microabrasion is an effective treatment for cosmetic improvement of long-standing white spot lesions.     

Methods used for prevention of white spot lesion development during orthodontic treatment with fixed appliances

Abstract

Objectives: The aim of this study was to survey methods that Dutch orthodontists use to prevent development or progression of enamel decalcifications during orthodontic treatment. Materials and methods: A pre-tested questionnaire was sent by post to all orthodontists in the Netherlands with a private practice (n = 189). Results: The response rate was 81%. At the start of orthodontic treatment a basic practice protocol for prevention of enamel demineralization was used by 93% of the orthodontists. This included oral hygiene instructions (92%) and the advice for additional use of a fluoride mouth rinse (64%). Other preventive measures were rarely prescribed. About 85% of those who prescribed a fluoride mouth rinse advised to rinse once a day, directly after evening tooth brushing. Conclusions: The results suggest that the commonly used practice of fluoride mouth rinsing directly after evening tooth brushing by orthodontic patients during fixed appliance treatment ignores actual evidence of preventive advices. This study recommends mouth rinsing at another moment than after evening tooth brushing, thus increasing the frequency of fluoride intakes, which might enhance the effectiveness in preventing WSL development or progression during orthodontic treatment.     

氟化泡沫预防固定正畸患者牙釉质脱矿的临床研究

目的研究1.23%氟化泡沫对固定正畸患者牙釉质脱矿的预防作用。方法按随机、双盲、安慰剂对照的原则将100例即将开始固定正畸治疗的患者分为试验组和对照组,每组50例,在正畸开始前和正畸过程中每隔3个月使用1次1.23%的氟化泡沫（试验组）或不含氟的安慰剂泡沫（对照组）,每次4 min,采用临床视诊的方法对两组进行对比观察。结果正畸结束时,试验组的临床视诊指数明显低于对照组,两者之间的差异有统计学意义（P﹤0.01）;试验组的釉质脱矿发生率比对照组低25.78%,两组的釉质脱矿率差异有统计学意义（P﹤0.01）。结论 1.23%的氟化泡沫对预防固定矫治过程中发生的釉质脱矿效果显著。     

The effect of a dentifrice and mouth rinse combination containing amine fluoride/stannous fluoride on plaque and gingivitis: a 6-month field study

AIM: To examine the effect of amine fluoride/stannous fluoride (AmF/SnF(2))-containing dentifrice and mouth rinse on plaque formation and gingivitis as compared with habitual oral hygiene procedures with a regular sodium fluoride (NaF) dentifrice. MATERIAL AND METHODS: In total, 22 general practices participated in this research project. The participants (N=281) were randomly assigned into two groups: the test group received an AmF/SnF(2) dentifrice-mouth rinse combination and the control group received a NaF-containing dentifrice. The patients were requested to brush twice daily for approximately 2 min. The subjects of the test group had to rinse additionally in the evening for 30 s with 10 ml of the mouth rinse. RESULTS: Both groups started with comparable scores of plaque, bleeding and staining. At 6 months, the plaque scores were 0.95 for the AmF/SnF(2) group and 0.99 for the NaF group (decrease of 16% and 10%, respectively). Bleeding scores, although significantly different from baseline, did not show differences between the two regimes. At the end of the experimental period, the overall staining was more pronounced in the AmF/SnF(2) group (41%) than the NaF group (26%). Both plaque reduction and increase in staining seemed to be correlated to the amount of mouth rinse used in the test group. CONCLUSION: In instruction-resistant patients recruited from dental practices, the combined use of AmF/SnF(2) did not decrease gingivitis at a significant level in comparison with the regular regime of two times daily brushing with an NaF-containing dentifrice. However, the above-mentioned combination resulted in greater plaque reduction than that observed with the use of the conventional dentifrice. When used according to the manufacturer's instructions, this effect on plaque scores was more pronounced.     

The effects of a potassium citrate, cetylpyridinium chloride, sodium fluoride mouthrinse on dentine hypersensitivity, plaque and gingivitis

Abstract. Home-use studies on dentine hypersensitivity have most commonly involved toothpastes and rarely have mouthrinses been employed. Potassium and/or fluoride toothpastes have been shown effective in the treatment of dentine hypersensitivity The aim of this study was to evaluate the effectiveness of a total formulation, containing potassium citrate, sodium fluoride, cetylpyridinium chloride mouthrinse compared to the base rinse minus actives in the reduction of dentine hypersensitivity. The study was a randomised placebo controlled, double blind parallel design. At a screening visit, 90 adult subjects were recruited who were suffering from dentine hypersensitivity from at least 1 tooth responding to tactile stimulation (45gm pressure) and had at least 2 teeth responding to evaporative stimulation (air blast). During a washout period of 28 days and throughout the 56-day study period, subjects used a soft filament toothbrush and standard fluoride toothpaste. At baseline (day 1), threshold sensitivities to incremental tactile (10 g to 70 g) and evaporative stimuli were determined. Gingival health was assessed by recording bleeding on probing at 25 g pressure at mesiobuccal and lingual sites. Plaque scores from buccal and lingual surfaces of disclosed teeth were also measured. Subjects then used the prescribed rinse. 10 ml for at least 30 s after brushing 2× per day returning on days 28 and 56 for rescoring of sensitivity, gingivitis and plaque. Data from 88 subjects were used with the intent to treat analyses and 83 in the completely evaluable analyses. Groups were well balanced for demographic data and product returns suggested good compliance. Both groups showed highly significant improvements in tooth sensitivity. The pattern was for greater improvement in the test compared to the control group (statistically significant for the plaque score), whereas bleeding scores, already low, showed no change in either group. By definition, the placebo rinse could not have exerted any therapeutic action; the study therefore provides clear direct evidence as to the magnitude (30%-40%) of the little studied, but assumed, placebo response in dentine hypersensitivity trials.     

Effect of toothbrushing with 0.4% stannous fluoride and 0.22% sodium fluoride gel on gingivitis for 18 months

This study determined the effect of brushing with 0.4% stannous fluoride (SnF2) or 0.22% sodium fluoride (NaF) on clinical and microbial parameters associated with gingivitis. The study included three groups of 281 subjects. Subjects in all three groups were instructed to brush twice daily with an ADA-accepted fluoride dentifrice, rinse their mouths with water, and subsequently brush with 0.4% SnF2, 0.22% NaF, or a fluoridefree placebo gel. More stain was detected in the SnF2 group than in the other two groups at all periods except at baseline. However, no differences were observed in gingivitis, bleeding, or mean proportions of microbial forms in the SnF2 or NaF groups when compared with the placebo group at 18 months. Results indicate that 0.4% SnF2, or 0.22% NaF is no more effective than a placebo in reducing gingivitis.     

Efficacy of ozonated water over chlorhexidine mouth rinse in chronic gingivitis patients – A comparative clinical study

AimThis study aimed to compare the efficacy of ozonated water mouth rinse over chlorhexidine mouth rinse against the accumulation of plaque in chronic gingivitis patients.Materials and methodsA total of 30 patients with chronic generalized gingivitis were choosen for the study. The duration of this study was 15 days and was divided into three groups. Group 1 patients were advised to rinse with ozonated water¸ group 2 with a chlorhexidine mouth rinse and group 3 with water for 15 days. The clinical parameters like plaque index, gingival index, and bleeding index were recorded at baseline, 7th, and 15th day respectively. Saliva samples were collected for microbial culture at baseline that is before mouth rinse and on the 15th day that is after using mouth rinse from each patient.ResultsThe statistical analysis was performed by using ANOVA and Bonferroni’s Post Hoc test on 30 patients at the end of the 15^thday. There was a significant decrease in mean plaque, gingival, and bleeding scores in group 2 patients that are chlorhexidine mouth rinse. There was also a decrease in the microbial culture at the end of the 15th day in patients with chlorhexidine mouth rinse compared to ozonated water.ConclusionThe results of this study demonstrate that ozonated water was less effective compared to chlorhexidine mouth rinse in reducing plaque in gingivitis patients. But ozonated water can be used as an alternative to CHX.     

Reducing white spot lesions in orthodontic populations with fluoride rinsing.

A clinical study was conducted to determine if rinsing frequency with a neutral 0.05% sodium fluoride rinse influenced white spot lesion formation associated with orthodontic brackets. Patients from two private orthodontic practices participated. Each received home-care instructions and were told to use 10 ml of sodium fluoride rinse daily before bedtime. The rinse was supplied free of charge to determine if this affected compliance with its prescribed use. Compliance was measured by recording the number of bottles used by each patient. As assessment of oral hygiene status was conducted, and at the time of debonding, white spot lesions were recorded. Only 13% of the 206 participants fully complied with the rinse protocol; 42% of the subjects used 10 ml approximately every other day; and 45% used the rinse less frequently. A significant dose response relationship was noted in which those who rinsed at least once every other day had fewer lesions (21%) than those who rinsed less frequently (49%). It was concluded that a significant reduction in enamel white spot lesions can be achieved during orthodontic therapy through the use of a 10 ml neutral sodium fluoride rinse. The more closely patients complied with the prescribed use, the more likely they could expect a decrease in the occurrence of lesions.     

Combined fluoride therapies

A 6-yr double-blind study was undertaken to compare the caries inhibiting-effectiveness of (a) 1 mgF- tablets (daily at school) plus fortnightly rinsing at school with 1000 ppmF-; (b) 1 mgF- tablets plus placebo rinsing; and (c) placebo tablets plus 1000 ppmF- rinsing. Participants were aged 4.5-5 yr at outset of the trial. At baseline, and annually thereafter, clinical caries and bitewing X-ray examinations were undertaken, hence ethical approval for a negative control was not feasible. Fissure sealant presence was also recorded. Initially, 192 children from predominantly low socio-economic backgrounds were enrolled, and baseline analyses showed no significant differences between groups with respect to primary caries prevalence. After 6 yr, 112 children remained, by which time no significant differences were noted between DMFT and DMFS values for those in the active tablet/active rinse group, as compared to those in the placebo tablet/active rinse group. However, in relation to both indices, in permanent first molars, the effectiveness of the active tablet/placebo rinse regime appeared to be significantly poorer than the placebo tablet/active rinse programme. For the active tablet/active rinse group, the DMFT difference was significantly less than the active tablet/placebo rinse group (37.9%), although for the DMFS difference, significance was not achieved. Similar trends were noted when DMFT and DMFS values for all permanent teeth were considered. The occlusal caries prevalence in permanent first molars followed the DMFT pattern, but differences between combined tablet/rinsing children and tablet-only children could be ascribed solely to the effectiveness of sealant presence.(ABSTRACT TRUNCATED AT 250 WORDS)     

西吡氯铵含漱液预防正畸早期牙龈炎的临床疗效

目的:观察西吡氯铵含漱液预防正畸患者早期牙龈炎的临床疗效。方法:选取正畸患者40例,随机分成试验组(使用西吡氯铵含漱液和常规口腔卫生保健措施)和对照组(常规口腔卫生保健措施),每组20例,正畸治疗开始后试验组使用西吡氯铵含漱液进行含漱。观察患者正畸治疗前和治疗后1、2、3个月牙龈炎的发生情况,分别测定各指数牙的牙龈指数(GI)、菌斑指数(PLI)以及龈沟出血指数(SBI),并进行统计学分析。结果:正畸治疗前,试验组和对照组患者牙龈状况良好,牙周各临床指标值GI、PLI、SBI相比均无统计学意义;正畸治疗1、2个月后复查,试验组和对照组牙周各临床指标值均较治疗前上升,但对照组上升更明显,与试验组相比均有统计学意义(P<0.05),并且治疗2个月后试验组SBI值与对照组相比有显著性差异(P<0.01);正畸治疗3个月后复查,试验组和对照组牙周各临床指标值继续上升,两组相比均有显著性差异(P<0.01)。结论:西吡氯铵含漱液能有效减缓正畸患者早期牙龈炎的发生。     

Effects of self-applied topical fluoride preparations in orthodontic patients

The purpose of this study was to compare the effectiveness of toothbrushing followed by fluoride rinsing, fluoride gel brushing, or fluoride gel dentifrice brushing alone in controlling the demineralization that often follows orthodontic treatment. Seventy-eight consecutive adolescent patients undergoing orthodontic care were divided into 3 groups: group 1 (control) used a low-potency, high-frequency fluoride rinse; group 2 used a high-potency, high-frequency fluoride brush-on gel; and group 3 used a high-potency, high-frequency fluoride gel dentifrice. When pretreatment levels of demineralization were subtracted from posttreatment values, both gel groups displayed a significant difference (P < .05) in smooth surface demineralization sites when compared to controls. Reversal of white-spot lesions occurred in 15% of sites that exhibited pathology as a result of the fluoride and preventive regimen. These results indicate that a daily use of a 5000-ppm fluoride gel along with toothbrushing with a fluoride paste or brushing twice daily with a 5000-ppm fluoride dentifrice alone provides greater protection beyond that of tooth-brushing with a fluoride paste (1000 ppm) and rinsing with a 0.05% sodium fluoride rinse.     

Effects on gingivitis of daily rinsing with 1.5% H202

The purpose of this study was to compare 2 groups of adolescents undergoing orthodontic treatment with fixed appliances to determine whether once daily use of a mouthrinse containing 1.5% H2O2 along with toothbrushing would be better than toothbrushing alone in maintaining their periodontal health. The 2 groups of subjects were selected non-randomly but were matched for age and sex. The control group (N = 34) used toothbrushing and a mint-flavored 0.05% NaF mouthrinse once daily, while the treatment group (N = 25) used toothbrushing and a once daily rinse with a preparation containing 0.05% NaF and 1.5% H2O2 (Orthoflur). 2 calibrated clinical examiners made single-blind clinical assessments of the plaque index, gingival index, and bleeding tendency in 6 standard sites per subject. They also noted any generalized mucosal irritations or staining of the teeth or tongue. Assessments were made before appliances were placed (baseline) and 1, 3, 6, 9, 12 and 18 months after appliances were placed. Results indicated that although there were no significant differences at baseline, the Orthoflur group had significantly fewer study sites with gingival indes or bleeding tendency scores greater than 1 than the control group from the 1-month through the 18-month examinations (P less than 0.01), and significantly fewer sites with plaque index greater than 1 and bleeding tendency scores of 2 or more from the 3-month through the 18-month examinations (P less than 0.02 and 0.01, respectively). No generalized mucosal irritations or clinically significant staining of the tongue or teeth were noted in either group during the study.     

Caries-preventive effectiveness of a fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances

The aim was to evaluate the efficacy of topical fluoride varnish applications on white spot lesion (WSL) formation in adolescents during treatment with fixed orthodontic appliances. The study design was a double-blinded randomized placebo-controlled trial with two parallel arms. The subjects were 273 consecutive 12- to 15-year-old children referred for maxillary treatment with fixed orthodontic appliances. The patients were randomly assigned to a test or a control group with topical applications of either a fluoride varnish (Fluor Protector) or a placebo varnish every 6th week during the treatment period. The outcome measures at debonding were incidence and progression of WSL on the upper incisors, cuspids and premolars as scored from digital photographs by 2 independent examiners. The attrition rate was 5%. The mean number of varnish applications was 10 (range 4-20) in both groups. The incidence of WSL during the treatment with fixed appliances was 7.4% in the fluoride varnish compared to 25.3% placebo group (p < 0.001). The mean progression score was significantly lower in the fluoride varnish group than in the placebo group, 0.8 +/- 2.0 vs. 2.6 +/- 2.8 (p < 0.001). The absolute risk reduction was 18% and the number needed to treat was calculated to 5.5. The results from the present study strongly suggest that regular topical fluoride varnish applications during treatment with fixed appliances may reduce the development of WSL adjacent to the bracket base. Application of fluoride varnish should be advocated as a routine measure in orthodontic practice.