Longitudinal evaluation of salivary biomarkers and white spot lesion development in patients undergoing fixed orthodontic treatment: A prospective cohort study - 27/03/26
, Rahul Tiwari 5, Niti Dharmendra Shah 6Highlights |
• | In this prospective cohort of 56 orthodontic patients, 39% developed white spot lesions (WSLs) over 12 months. |
• | Repeated-measures analysis showed steeper longitudinal declines in salivary pH and fluoride in the WSL-present group. |
• | Greater 12-month declines in salivary pH and fluoride levels were independently associated with WSL development in multivariable logistic regression. |
• | Monitoring salivary pH and fluoride changes may support adjunctive risk stratification and targeted preventive strategies during fixed orthodontic treatment. |
Summary |
Background |
This prospective study aimed to evaluate the longitudinal changes in salivary biomarkers in relation to white spot lesion (WSL) development during fixed orthodontic treatment.
Methods |
This prospective longitudinal cohort study enrolled 56 systemically healthy patients (aged 18–30 years) with mild Class I malocclusion undergoing non-extraction-fixed orthodontic treatment. The participants were classified into two groups based on the development of incident white spot lesions (WSL-present vs. WSL-absent) over a 12-month period. Unstimulated whole saliva was collected at baseline, 6 months, and 12 months to measure pH; buffering capacity; calcium, phosphate, and fluoride concentrations; and counts of mutans streptococci and Lactobacillus spp. Between-group comparisons were performed using repeated-measure mixed models. Associations with WSL development were examined using univariate and multivariate logistic regression with least absolute shrinkage and selection operator (LASSO) variable selection.
Results |
Over 12 months, 22 patients (39%) developed WSLs (112 lesions in total) predominantly affecting the maxillary lateral incisors and canines. Baseline characteristics were comparable between the groups (all P > 0.05). Repeated-measures analysis showed significant group × time interactions for salivary pH (F = 40.09, P < 0.001), fluoride (F = 10.27, P < 0.001), calcium (F = 5.14, P = 0.009), and phosphate (F = 11.78, P < 0.001), indicating a steeper decline in the WSL-present group. Multivariable logistic regression of longitudinal changes revealed that greater declines in pH and fluoride levels were independently associated with WSL development. No significant associations were observed for buffering capacity, calcium, phosphate, or microbial count.
Conclusion |
Longitudinal decreases in salivary pH and fluoride levels were independently associated with WSL development during fixed orthodontic treatment. Monitoring these non-invasive parameters may support risk stratification and targeted preventive care.
Ethical approval |
This study was conducted in the Department of Orthodontics, Kothiwal Dental College and Research Centre, Moradabad, India in accordance with ethical guidelines and was approved by the Institutional Ethical Review Board (KDCRC/IERB/SS/2023/06).
Le texte complet de cet article est disponible en PDF.Keywords : Biomarkers, Fixed orthodontic treatment, PH, Salivary, White spot lesions
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Vol 24 - N° 3
Article 101163- septembre 2026 Retour au numéro
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