Do Fixed Orthodontic Appliances Trigger Initial Caries Lesions? Evidence, Risk Factors, and Preventive Strategies

Fixed orthodontic appliances increase the risk of developing initial caries lesions, particularly around brackets and along gingival margins, due to plaque accumulation and hindered oral hygiene. Biofilm retention leads to localised demineralisation, forming white spot lesions within weeks of appliance placement. Risk factors include poor oral hygiene, high-sugar diet, prolonged treatment duration, and low salivary flow. Early detection using visual-tactile methods and fluorescence imaging is crucial for prevention. Evidence supports fluoride varnishes, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) applications, and regular professional cleaning as effective strategies to minimise demineralisation. Patient education, diet counselling, and optimal brushing techniques remain cornerstones of preventive care. A multidisciplinary approach significantly reduces caries incidence during orthodontic treatment.

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