Enamel Demineralization in Adolescents Undergoing Fixed Orthodontic Treatment: Pathogenesis, Digital Detection, and Emerging Preventive Strategies

Enamel demineralization is a common complication of fixed orthodontic treatment in adolescents. It usually appears as chalky white spot lesions on the tooth surface, most visibly around bracket margins. These lesions are not merely cosmetic. If left untreated, they may develop into caries and may interfere with the long-term goals of orthodontic treatment. Clinicians can choose among several standard approaches, such as plaque-control routines, various fluoride formulations, and calcium-phosphate remineralizing agents. Even so, clinical outcomes vary. Compliance differs from patient to patient, lesions are at different stages, and individual risk factors can push results in opposite directions. This review brings together current understanding of orthodontically induced enamel demineralization, covering how it develops, what drives it, and where conventional treatment falls short. It also looks at the role of digital detection tools and risk prediction models in earlier diagnosis, and reviews newer remineralizing, antibacterial, and stimuli-responsive materials. Finally, it considers why these newer options have not yet entered routine clinical use, and provides practical guidance for screening, risk stratification, and tailored intervention.