The effect of fluoride varnish and chlorhexidine gel on white spots and gingival and plaque indices in fixed orthodontic patients: A placebo‑controlled study

Abstract

Background: Difficulties to maintain good oral hygiene during orthodontic treatment can
cause prolonged accumulation of dental plaque, thereby increasing the risk of developing gingival
inflammation and periodontal disease as well as enamel demineralization and caries. The purpose
of this study was to determine the effect of chlorhexidine (CHX) gel and fluoride varnish versus
placebo and control groups on plaque and gingival indices as well as their influence on enamel
demineralization prevention in orthodontic patients with fixed appliances.
Materials and Methods: In this clinical trial, forty patients with fixed orthodontic appliances
were participated and were divided into control, CHX gel (0.2%), fluoride varnish (5%), and placebo
groups. The parameters evaluated in this research were dental plaque index (DPI), index of gingival
inflammation, and white spot lesion (WSL) index. For all the patients, each index was scored at the
beginning of orthodontic treatment, then 3 months, 6 months, and 9 months afterward. Data were
analyzed using Kruskal–Wallis and Mann–Whitney tests. The level of significance was set at 0.05.
Results: All the scores showed statistically significant differences (P < 0.05) between the four
groups for each of the three time points. A statistically significant decrease of DPI, WSL index, and
gingival index was observed 9 months after treatment in fluoride and CHX groups.
Conclusion: Adding CHX gel and fluoride varnish to the patients’ oral hygiene regimen can reduce
the development of plaque and gingivitis and decrease WSLs in orthodontic patients.
Key Words: Chlorhexidine, dental plaque index, orthodontic appliance, periodontal index,white spot