Impact of Fluoride-Free Dentifrices on White Spot Lesions in Patients Undergoing Orthodontic Treatment

Abstract

White spot lesions are a clinically significant complication of fixed orthodontic treatment, arising from enamel demineralization associated with dental plaque accumulation around orthodontic brackets. Fluoride-free dentifrices have attracted interest as alternative oral-care products because of their potential to support enamel protection through nonfluoride mechanisms. However, their comparative effectiveness in preventing white spot lesions requires careful assessment of clinical outcomes, product composition, patient adherence, and the quality of available evidence. This review examines the conceptual basis for using fluoride-free dentifrices during orthodontic treatment, emphasizing enamel demineralization and remineralization, plaque-related risk, and the distinction between preventing new lesions and managing established lesions. The supplied literature provides important background on dental hard-tissue changes, diagnostic assessment, and oral health-related quality of life, while a directly relevant systematic review by Bhate et al. (2026) provides the central reference for the review question. The available reference information does not provide sufficient trial-level data to establish the superiority of a particular fluoride-free formulation or to quantify its preventive effect. Accordingly, this article presents a critical, evidence-oriented synthesis rather than a new systematic review or an independently conducted clinical trial. It highlights the need for standardized lesion assessment, clearly defined comparators, adequate follow-up, and transparent reporting of adverse outcomes and adherence. Fluoride-free dentifrices should be evaluated according to demonstrated clinical effectiveness rather than product claims alone, and their use should be considered in the context of individualized caries-risk assessment and established preventive care.