Prevalence of white spot lesions in children and adolescents across Northern, Central and Southern Italy: a multicenter cross-sectional study

Background – Early identification of carious lesions allows the implementation of remineralization strategies, combined with improved at-home oral hygiene and dietary modifications, to reverse the demineralization process and prevent progression to cavitation. In recent years, the prevalence of white spot lesions (WSLs) in pediatric populations has increased, highlighting the importance of their monitoring. Objective – The present multicenter cross-sectional study aimed to assess the prevalence of WSLs (ICDAS-II codes 1–2) among children and adolescents in northern (Trieste), central (Rome), and southern Italy (Palermo). Additionally, the study investigated socio-demographic factors and oral health-related habits, including dietary behaviors and at-home oral hygiene practices, among participants. Methods – 1, 089 healthy children and adolescents were enrolled at the 3 different Department and categorized into age quartiles: ≤8; 9; 10-11; ≥12 years of age. During the first visit, patients or their caregivers were asked to complete a questionnaire including information regarding epidemiological data, family background, oral health and hygiene habits, such as toothbrushing frequency, type of toothbrush, presence of orthodontic braces, dietary habits, history of use of sweetened pacifier and frequency of dental visits in the previous year. Moreover, intraoral examinations were performed to collect tooth-level information for each patient and dental lesions classified according to International Caries Detection and Assessment System (ICDAS-II) criteria. The presence of WSLs scored as ICDAS-II 1-2 was recorded; dental caries (ICDAS-II 3-6) were also evaluated. Results – Considering the presence of WSLs, a significant difference (p < 0.001) was found between participants from the three Centers, with higher percentages in Palermo (66.6%) and Rome (63.1%) than in Trieste (45.9%). A statistically significant increased risk of WSLs was reported for males and 9 years old subjects and was also related to the lower parents’ working status and education. In addition, a significant enhanced risk of WSLs was associated with frequent use of sweetened pacifier, presence of orthodontic braces and high frequency of dental visits. Conversely, the risk of WSLs was lower in subjects with a frequent snack intake or in case of increased number of caries, as the lesions had already progressed to more advanced stages Conclusions – This multicenter cross-sectional study represented the first national epidemiological investigation in Italy assessing the prevalence and distribution of WSLs, along with socio-demographic factors and oral health-related habits in children and adolescents. The high prevalence observed highlights the widespread nature of the problem and the importance of early diagnosis. Early detection allows timely, non-invasive interventions to reverse enamel demineralization and prevent caries development. Promoting preventive measures and healthy lifestyle habits is therefore essential to improve quality of life and reduce the economic burden on healthcare systems.