JMIR Publications

ABSTRACT

Background:

White spot lesions (WSLs) are white marks that can form on teeth during orthodontic treatment with fixed appliances (FA) and become apparent once they are removed. About half of people who have FA treatment get WSLs. They are usually caused by poor tooth-brushing around the brace. Several studies explore the prevention and/or treatment of WSL. However, there remain uncertainties about what young people and their parents/guardians know or feel about WSL. A Cochrane review concluded that patient-reported outcomes have been overlooked in WSL prevention studies.

Objective:

This protocol describes a mixed-methods study that aims to explore young people’s and their parents/ guardians’ perceptions, attitudes, and feelings towards WSLs.

Methods:

Participants will be recruited from children aged 11-15, undergoing orthodontic treatment at Liverpool University Dental Hospital and their parents/guardians. Part 1 (quantitative) will use a questionnaire and images of pre-treatment malocclusions and post-orthodontic WSLs of varying severity (mild, moderate, severe). Part 2 (qualitative) will involve one-to-one, semi-structured interviews, using open-ended questions with young people and their parents/ guardians. A sample size of 200 survey respondents for Part 1 and 30 interviewees for Part 2 will be undertaken. The responses for the questionnaire use a Likert scale with the option of free text comments. The qualitative research will be analysed using a modified framework analysis approach; the outcomes will be presented as themes.

Results:

As of September 2024, we have secured funding from the Royal College of Surgeons, England and British Orthodontic Society. We have also completed sponsor approval with the University of Liverpool. We received an outcome of favourable opinion, pending minor issues from the Health Research Authority regarding our ethics application; we are awaiting the outcome of the submitted response to this.

Conclusions:

WSLs can be highly visible when smiling or speaking. Aesthetic defects, caused by WSLs, may expose young people to oral health related stigma and discrimination e.g., bullying or teasing and impact on self-esteem. WSLs may also have cost consequences for patients and NHS dental services, for example, the costs of professionally applied fluoride, restorations, and their maintenance. This study is important for understanding the impact WSLs have on oral health-related quality of life and the decision making of young people and their parents/ guardians.