Leeper, Danielle Kristen (2018-04). White Spot Lesion Risk Assessments in Orthodontic Patients - with an Emphasis on Salivary Cariogenic Bacterial Activity Levels. Master's Thesis.
Thesis
Purpose The purpose of this study was to evaluate whether risk factors that have been shown to increase caries susceptibility, including cariogenic bacterial levels and salivary factors, can be used to identify orthodontic patients who have developed white spot lesions. Materials and Methods This prospective case-control study included 50 orthodontic patients, ages 11-17, recruited at the Texas A&M University Graduate Orthodontic Clinic. The controls consisted of 25 patients who did not develop new WSLs or increase the severity of existing WSLs during orthodontic treatment. The cases included 25 patients who developed new WSLs or increased the severity of existing WSLs during orthodontic treatment. WSLs, pre-treatment and post-treatment oral hygiene, change in oral hygiene, and fluorosis were evaluated from initial and final intraoral photographs. Risk factors, including snacking frequency, oral hygiene, and fluoride utilization were evaluated using surveys. Salivary buffer, flow rate, bacterial levels, and bacteria activity levels were also evaluated using salivary samples. Results There were no between-group pretreatment differences in WSLs (p=.252). The cases reported eating sugary foods significantly (p=.001) more often than the controls, while only 4% of the cases reported eating sugary foods only with meals, compared to 44% of the controls. Most patients had good pretreatment oral hygiene, but only 12% had good posttreatment oral hygiene, representing a significant (p?.001) decline during treatment that was not significantly different between groups (p=.631). There were no significant between-group differences in the amount of saliva, buffer, ATP bioluminescence, and bacterial levels. However, both groups showed lower than normal buffer capacity and high bacterial levels. There also was no statistically significant difference in the number of maxillary or mandibular teeth affected by WSLs (p=0.115). The most commonly affected tooth was the maxillary canine at 38%, followed by maxillary laterals at 28%, and the maxillary and mandibular molars at 26% and 24%, respectively. Conclusions Oral hygiene declined during treatment, bacterial levels were high and salivary buffer was low. Cases had greater sugar intake between meals than controls. ATP bioluminescence with Cariscreen, S. Mutans levels with Saliva Check Mutans, and salivary factors do not accurately identify which patients develop WSLs.
