Indagine conoscitiva sull’approccio alle lesioni bianche dello smalto post-ortodontiche

OBJECTIVESWhite enamel lesions (WSLs) are an increasingly present clinical occurrence, not infrequently observed at the end of orthodontic treatment. Their presence observed during the removal of orthodontic devices raises perplexities of an aesthetic nature and puts clinicians in front of the doubt on how to intervene from a therapeutic point of view since it seems no standardized protocols still exist. Consequently, aim of this work was to evaluate the knowledge, therapeutic and informative approach of the dental team on WSLs after orthodontic treatment.MATERIALS AND METHODSAn electronic survey (Qualtrics) of 21 multiple choice questions was sent via email and social networks (Facebook, WhatsApp) to various professionals usually involved in the management of WSLs, including general dentists, pedodontists, orthodontists and hygienists. Participation was voluntary, anonymous and unpaid. The survey was divided into four macro-sections: 1) demography; 2) vocational training; 3) knowledge of WSLs; 4) methods of treatment (therapeutic and informative).RESULTSOf the 248 who completed the interview, 81% were female and aged between 22-50 years, with a prevalence between 22-35 years. Of these, 38% were hygienists, 26% students, 20% dentists practicing orthodontics, 8% dentists specializing in orthodontics, 6% pedodontists and 2% general dentists not practicing orthodontics. Most of the clinicians interviewed (73%) stated that a diagnosis of WSLs was made at the end of the orthodontic treatment. Inadequate home oral hygiene, incorrect diet, quality and quantity of saliva, susceptibility and age have been considered the risk factors that can most influence their onset. 33% of the clinicians interviewed believed that the identification/management of these lesions is the task of hygienists. 57% of those interviewed tend to inform patients/parents/guardians about the possibility of developing WSLs during orthodontic treatments, against 16% who are not in the habit of informing patients about these important side effects of the therapy. The most widely used therapeutic approach for the treatment of WSLs involves regular reminders of professional oral hygiene, treatment with toothpaste or fluoride varnishes and instructions on an adequate diet. Only 4% of those interviewed used resin infiltration or microabrasion to reduce the aesthetic problem associated with WSLs, considered by many therapy professionals to be unpredictable or of which they report lack of adequate knowledge.CONCLUSIONSWSLs are an ever-present topic. The results of the study showed that there is no one-way line for the management of this clinical eventuality, requiring greater collaboration between all healthcare professionals involved in the treatment of the orthodontic patient. Due to an incomplete familiarity with some therapeutic approaches (such as resin infiltration and microabrasion), these are not considered for the treatment of WSLs, possibly limiting operative practices.CLINICAL SIGNIFICANCEGreater attention must be paid to the interception of WSLs by all professionals involved in the management of the orthodontic patient. This provides for more adequate communication between the various operators and pushes for the establishment of a common operating protocol.