Accepted for/Published in: JMIRx Med
Date Submitted: May 4, 2024
Open Peer Review Period: Aug 15, 2024 - Oct 10, 2024
Date Accepted: Jul 3, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Perceptions of White Spot Lesions and the Impact on young people: a mixed-methods study protocol
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.
Methods:
This protocol describes a mixed-methods study that aims to explore young people’s and their parents/ guardians’ perceptions, attitudes, and feelings towards WSLs. 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. Discussion: 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.
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