The overall incidence of patients who developed at least one WSL during orthodontic treatment was 72.9% (N = 255; Table 1 and Fig. 3), while for newly developed cavitated lesions that were unrestored on the final record was 2.3%. Of the eight patients that developed cavitated lesions during orthodontic treatment, four (1.1%) developed one new cavitated lesion, three (0.9%) developed two new cavitated lesions and one (0.3%) developed four new cavitated lesions. Of the maximum 24 surfaces investigated per patient, on average 4.2 surfaces in each patient showed new WSL. The average of surfaces with new cavitations was only 0.04 and 0.05 with restorations. Even though infrequently, some early WSL regressed to sound (0.07 per patient). Demographic variables of gender and age at initiation of treatment were not related significantly to development of new decalcified or cavitated lesions. There was a significant relationship between increased treatment length and number of newly developed lesions (P = 0.03; Table 2). The mean number of labial surfaces per patient that developed new WSL was 3.01 for patients with a treatment length of less than 22 months. This increased to 5.28 teeth for patients with therapy longer than 33 months. The number of new cavitations, however, showed only a nonsignificant trend (P = 0.08) with increased treatment time. In addition, the number of newly developed lesions (both WSL and cavitations) showed no significant association with extraction or non-extraction treatment protocols (Table 3). Although no relationship was demonstrated between pretreatment oral hygiene scores and lesion development, the recorded number of oral hygiene discussions between provider and patient were associated significantly with development of both white-spot (P <0.0001) and cavitated (P = 0.0006) lesions. The mean number of new lesions for patients with whom oral hygiene discussions had never been noted in the chart was 3.08, while the mean number of decalcified lesions for patients who were given oral hygiene instruction on three or more occasions increased to 7.78. A similar increase was exhibited for the mean number of cavitated lesions for patients given three or more oral hygiene discussions (mean = 0.20) vs. those with whom oral hygiene was not discussed after initial instruction (mean = 0.01). Age group (P = 0.03), treatment length (P = 0.01) and number of oral hygiene discussions (P < 0.0001) were associated with development of WSL. There was a decrease in WSLs associated with increasing age group (regression coefficient = -0.59). An increase in WSLs was associated with both increased treatment time (regression coefficient = 0.07) and increased number of oral hygiene discussions (regression coefficient = 1.88).
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