Evaluation of the Remineralization Treatments of White Spot Lesions in Primary Teeth: A Systematic Review

Background: This study investigated the effect of the remineralization treatments on regression or disparition of white spot lesions (WSLs) in primary teeth. Materials and methods: Databases (Embase, MEDLINE, CENTRAL and CINAHL) were searched. The searches were limited to English and French languages publications and to within the abstract field. The searches were limited to the period from 01-12-2000 to 01-12-2018. Additional studies were identified by scanning the bibliographies of relevant reviews and full-text articles. Randomized controlled human clinical trials in which fluoride and non-fluoride agents were delivered by any method to treat white sopt lesions in primary teeth were considered. Results: Of the 2350 studies screened, 1706 full articles were scrutinized and 6 selected for inclusion in the final sample. Three chemical agents, namely fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and chlorhexidine were investigated in these included studies. There is evidence that fluoride varnish applications may be an effective measure in reversing active pit- and-fissure enamel lesions in the primary dentition, the combined application of chlorhexidine and fluoride varnish is more effective on plaque and remineralization of incipient caries after 3 months than the same agents applied separately and finaly the twice daily topical applications of CPP-ACP containing paste as an adjunct to a standard oral hygiene with fluoridated toothpaste, significantly improve the remineralisation of white spot lesions in primary teeth. However, quantitative synthesis could not be carried out because of the clinical and methodological heterogeneity of the included studies. Conclusion: A limited number of studies were included in this systematic review. Few of these has a low risk of bias, with most having high risk due to weaknesses in many quality items or due to other biases, such as problems associated with the evaluation method or inadequate study design. High quality human randomized controlled trials are needed in order to make a conclusive recommendation