Effect of Hydroxyapatite Toothpaste and Mouthwash in Preventing White Spot Lesions During Orthodontic Treatment

NCT ID: NCT07325643

Last Updated: 2026-01-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-11-20

Study Completion Date

2026-12-20

Brief Summary

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This study aims to evaluate the effect of hydroxyapatite-containing toothpaste and mouthwash in preventing white spot lesions in patients undergoing orthodontic treatment.

Participants: 75 patients will be divided into three groups:

* Group A: Participants will brush their teeth three times a day using hydroxyapatite toothpaste and rinse twice a day with a placebo mouthwash.
* Group B: Participants will brush their teeth three times a day using fluoride toothpaste and rinse twice a day with hydroxyapatite mouthwash.
* Group C (Control Group): Participants will brush their teeth three times a day using fluoride toothpaste and rinse twice a day with a placebo mouthwash.

Patients will be followed during their orthodontic treatment to assess the development of white spot lesions.

The study is safe and involves no surgical procedures or risky medications, and will be conducted under the supervision of Principal Investigator Heba Masri after obtaining ethical approval.

Detailed Description

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This randomized, three-group study aims to evaluate the effectiveness of hydroxyapatite in preventing white spot lesions during orthodontic treatment in patients who initially do not have these lesions.

Study Design:

* Total Participants: 75 patients (25 per group)
* Duration: Throughout orthodontic treatment
* Groups:
* Group A: Brush teeth three times daily with hydroxyapatite toothpaste and rinse twice daily with placebo mouthwash.
* Group B: Brush teeth three times daily with fluoride toothpaste and rinse twice daily with hydroxyapatite mouthwash.
* Group C (Control): Brush teeth three times daily with fluoride toothpaste and rinse twice daily with placebo mouthwash.

Outcome Assessments:

All assessments of white-spot lesions will be performed using Diagnodent Pen, Gorlick index (GI), digital photographs, Gingival Bleeding Index (GBI), Plaque Index (PI), and salivary pH measurements.

Ethical Considerations:

* All participants will sign informed consent prior to joining the study.
* The study was approved by the Ethics Committee, College of Dentistry, University of Baghdad.
* This study involves low-risk interventions (toothpaste and mouthwash) and does not use U.S. FDA-regulated drugs or devices.

Study Objective:

* To determine whether hydroxyapatite-containing toothpaste and/or mouthwash is more effective than conventional products in preventing white spot lesions during orthodontic treatment.

Conditions

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Prevention of White Spot Lesions in Patients Undergoing Orthodontic Treatment

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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HAp toothpaste + placebo mouth wash

HAp toothpaste + placebo mouthwash

* Arm Description: Participants will brush their teeth three times daily with hydroxyapatite toothpaste and rinse twice daily with a placebo mouthwash.

Group Type EXPERIMENTAL

Hydroxyapatite Toothpaste

Intervention Type DIETARY_SUPPLEMENT

Participants will brush their teeth three times daily with hydroxyapatite-containing toothpaste to evaluate its effect on preventing white spot lesions during orthodontic treatment.

HAp mouthwash + fl toothpaste

Fluoride toothpaste + HAp mouthwash

* Arm Description: Participants will brush their teeth three times daily with fluoride toothpaste and rinse twice daily with HAp mouthwash.

Group Type EXPERIMENTAL

Hydroxyapatite Mouthwash

Intervention Type DIETARY_SUPPLEMENT

Participants will rinse their mouth twice daily with hydroxyapatite-containing mouthwash to assess its preventive effect on white spot lesions in orthodontic patients.

Fluoride toothpaste + placebo mouthwash

Fluoride toothpaste + placebo mouthwash

* Arm Description: Participants will brush their teeth three times daily with fluoride toothpaste and rinse twice daily with a placebo mouthwash.

Group Type PLACEBO_COMPARATOR

Fluoride Toothpaste + Placebo Mouthwash

Intervention Type OTHER

Participants will brush their teeth three times daily with fluoride toothpaste and rinse twice daily with placebo mouthwash, serving as the control group for comparison with hydroxyapatite interventions.

Interventions

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Hydroxyapatite Toothpaste

Participants will brush their teeth three times daily with hydroxyapatite-containing toothpaste to evaluate its effect on preventing white spot lesions during orthodontic treatment.

Intervention Type DIETARY_SUPPLEMENT

Hydroxyapatite Mouthwash

Participants will rinse their mouth twice daily with hydroxyapatite-containing mouthwash to assess its preventive effect on white spot lesions in orthodontic patients.

Intervention Type DIETARY_SUPPLEMENT

Fluoride Toothpaste + Placebo Mouthwash

Participants will brush their teeth three times daily with fluoride toothpaste and rinse twice daily with placebo mouthwash, serving as the control group for comparison with hydroxyapatite interventions.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Complete permanent dentition up to the first premolar, with no intended extractions in orthodontic treatment plan.
2. Good overall health.
3. Good oral hygiene: full-mouth plaque score \< 20%.
4. No bleeding upon probing after 30 seconds.
5. Discontinuous band of plaque at the gingival margin.
6. Normal stimulated salivary flow rate.
7. Normal buffer capacity (final pH between 6.0 and 7.0) -

Exclusion Criteria

* 1\. History of previous orthodontic treatment. 2. Bleaching or topical fluoridation within the last six months. 3. Severely rotated any of the study teeth (limiting the appearance of facial surfaces).

4\. Visible signs of caries, fluorosis, hypocalcification, or other developmental defects. 5. Restoration on the labial surface of the study teeth. 6. Systemic or endocrine conditions (e.g., cardiac pacemakers, diabetes mellitus).

7\. Craniofacial anomalies and clefts.
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Heba Tahseen Almasri

OTHER

Sponsor Role lead

Responsible Party

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Heba Tahseen Almasri

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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University of Baghdad - College of Dentistry / Orthodontic Clinic

Baghdad, , Iraq

Site Status RECRUITING

Countries

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Iraq

Central Contacts

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Heba Tahseen Almasri, BSc, MSc (candidate)

Role: CONTACT

009647810440125

Facility Contacts

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Heba Tahseen Almasri, BSc, MSc (candidate)

Role: primary

009647810440125

References

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Farook, F.F., 2023. The efficacy of manual toothbrushes in patients with fixed orthodontic appliances: a randomized clinical trial. BMC Oral Health, 23(1), p.35 Gorelick, L., Geiger, A.M. & Gwinnett, A.J., 1982. Incidence of white spot formation after bonding and banding. Am J Orthod, 81(2), pp.93-98 Banks, P. & Richmond, S., 1994. Enamel sealants: a clinical evaluation of their value during fixed appliance therapy. Eur J Orthod, 16(1), pp.19-25 Silness, J. & Löe, H., 1964. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand, 22(1), pp.121-135 Löe, H. & Silness, J., 1963. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand, 21(6), pp.533-551 Du, M., Cheng, N., Tai, B., Jiang, H., Li, J. & Bian, Z., 2011. Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. Clin Oral Investig, 16(2), pp.463-468. https://doi.org/10.1007/s00784-011-0520-4 Gohar, R.A.A.E.G., Ibrahim, S.H. & Safwat, O.M., 2023. Evaluation of the remineralizing effect of biomimetic self-assembling peptides in post-orthodontic white spot lesions compared to fluoride-based delivery systems: randomized controlled trial. Clin Oral Investig, 27(2), pp.613-624. doi:10.1007/s00784-022-04757-7 Campus, G., Cocco, F., Wierichs, R.J., Wolf, T.G., Salerno, C., Arghittu, A., Dettori, M. & Cagetti, M.G., 2024. Effects of Hydroxyapatite-Containing Toothpastes on Some Caries-Related Variables: A Randomised Clinical Trial. Int Dent J, 74(6), pp.754-761. https://doi.org/10.1016/j.identj.2024.01.028 Alkarad, L., Alkhouli, M. & Dashash, M., 2023. Remineralization of teeth with casein phosphopeptide-amorphous calcium phosphate: analysis of salivary pH and the rate of salivary flow. BDJ Open, 9(1), p.16. doi:10.1038/s41405-023-00141-z

Reference Type BACKGROUND

Paszyńska, E., Górska, R., Kaczmarek, U., et al., 2023. Caries-preventing effect of a hydroxyapatite-toothpaste in adults: A randomized, double-blind, clinical trial. Frontiers in Public Health, 11, p.1199728. https://doi.org/10.3389/fpubh.2023.1199728 BMC Oral Health, 2022. Effects of hydroxyapatite toothpaste on tooth whitening and enamel remineralization: Clinical evaluation. BMC Oral Health, 22, p.345. https://doi.org/10.1186/s12903-022-02266-3 Saliasi, I., Llodra, J.C., Bravo, M., Tramini, P., Dussart, C., Viennot, S. & Carrouel, F., 2018. Effect of a Toothpaste/Mouthwash Containing Carica papaya Leaf Extract on Interdental Gingival Bleeding: A Randomized Controlled Trial. Int J Environ Res Public Health, 15(12), p.2660. https://doi.org/10.3390/ijerph15122660 Araujo, M.W.B., Charles, C.A., Weinstein, R.B., Parikh-Das, A.M., Zhang, J., & Gunsolley, J.C., 2015. Meta-analysis of the effect of an essential oil-containing mouthrinse on gingivitis and plaque. J Am Dent Assoc, 146(8), pp.610-622. https://doi.org/10.1016/j.adaj.2015.05.007 Hoffman, D.A., Clark, A.E., Rody Jr., W.J., McGorray, S.P. & Wheeler, T.T., 2015. A prospective randomized clinical trial into the capacity of a toothpaste containing NovaMin to prevent white spot lesions and gingivitis during orthodontic treatment. Progress in Orthodontics, 16:25

Reference Type BACKGROUND

Kouskoura, T., Ochsner, T., Verna, C., Pandis, N. & Kanavakis, G., 2022. The effect of orthodontic treatment on facial attractiveness: a systematic review and meta-analysis. European Journal of Orthodontics, 44(6), pp.636-649. doi:10.1093/ejo/cjat064 Kozak, U., Lasota, A. & Chałas, R., 2021. Changes in distribution of dental biofilm after insertion of fixed orthodontic appliances. Journal of Clinical Medicine, 10(23), p.5638. doi:10.3390/jcm10235638 Lopes, P.C. et al., 2024. White Spot Lesions: Diagnosis and Treatment - A Systematic Review. BMC Oral Health, 24(1), pp.1-10. doi:10.1186/s12903-023-03720-6 Choi, A.L., Sun, G., Zhang, Y. & Grandjean, P., 2012. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environmental Health Perspectives, 120(10), pp.1362-1368. doi:10.1289/ehp.1104912 Amaechi, B.T., AbdulAzees, P.A., Alshareif, D.O., Shehata, M.A., Lima, P.P.C.S., Abdollahi, A., Samadi Kalkhorani, P. & Evans, V., 2019. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open, 5:18

Reference Type BACKGROUND

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Informed Consent Form

View Document

Related Links

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https://doi.org/10.1186/s12903-023-03720-6

Systematic review on white spot lesions: diagnosis and treatment

https://doi.org/10.1038/s41405-023-00141-z

Study on remineralization of teeth with CPP-ACP and salivary pH analysis

https://doi.org/10.1016/j.identj.2024.01.028

Randomized clinical trial on hydroxyapatite-containing toothpastes and caries-related variables

Other Identifiers

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WLS-HA-Ortho-2025

Identifier Type: -

Identifier Source: org_study_id

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