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Quantitative Light-induced Fluorescence-Digital as an evaluation tool to assess plaque accumulation and enamel demineralization in orthodontics. Miller CM, Burnside G, Higham SM, Flannigan NL. Angle Orthodontist 2016;86(6):991–997. Introduction: The Quantitative Light-induced Fluorescence (QLF) technique involves taking photographic images of teeth using an SLR camera fitted with specialised light sources and filters. Demineralised enamel fluoresces less than normal enamel so the mean percentage fluorescence loss of a lesion can be measured (ΔF). Bacterial porphyrins also autofluoresce, which allows plaque accumulation to be measured. Aims: This study aimed to assess if there was a difference in demineralization or plaque accumulation in patients shown QLF or white light (WL) images of their teeth in order to demonstrate their current standard of oral hygiene (OH) and provide OH reinforcement. Methods: This was a prospective, randomised clinical trial. Consecutive patients, who were undergoing treatment with fixed appliances by a single clinician in a dental hospital setting, were invited to participate. It was conducted as a pilot study with a sample size of 30. QLF images were taken at baseline (T0) and participants were classified as high risk if there was at least one area of demineralization present and low risk if there were no areas present. Participants were randomised, with stratification according to risk, to receive oral hygiene reinforcement with either QLF or WL images at 4 consecutive appliance adjustment appointments approximately 6 weeks apart (T1-T4). QLF images were analysed by one clinician at least 1 week later. Participants also completed a questionnaire on their perception of being shown the images. Results: Thirty-three patients were recruited, 12 males and 21 females with a median age of 14.6 years. There were no significant differences between the WL and QLF groups from T0-T4 in terms of demineralization (P = 0.56) or plaque accumulation (P = 0.82). There was no significant reduction in demineralization ΔF in either group from T0-T4 (P > 0.05) but a significant reduction in plaque scores were seen for both groups (P < 0.05). All participants found being shown the images helpful and 100% of participants shown the QLF images thought it would be useful to be shown images throughout the entire treatment. Conclusion: QLF images can be used to detect and monitor plaque accumulation and enamel demineralization during orthodontics. Decreased plaque levels were seen following oral hygiene instruction and viewing of WL or QLF images. Neither group showed an improvement in demineralization. Comments: A major confounding factor in this study was variation in oral hygiene practice. No attempts were made to standardise products used or brushing immediately before appointments, which could have had a big influence on the plaque levels recorded. The oral hygiene instructions given were not described in the paper and are operator specific, which limits the generalisability of the findings. There was no comment on the length of time the participants had been in treatment and this may affect their demineralisation experience at baseline and also their motivation towards oral hygiene measures. Improvements in plaque levels could have been down to oral hygiene instruction alone. It would therefore have been useful to assess the differences in QLF reading between subjects shown images or not shown images. Participants in a trial may be more motivated towards oral hygiene than the general population due to the Hawthorne effect. Measuring the outline of