Article

Effect of orthodontic therapy with fixed and removable appliances on oral microbiota: A six-month longitudinal study

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Abstract

The present study evaluated microbiological and clinical changes occurring during the first six months of orthodontic therapy with fixed and removable appliances and the consequent risk for gingivitis and periodontal disease. This study was justified by the disagreement among different authors: only some of them reported gingivitis development and changes in dental plaque composition during orthodontic therapy with fixed appliances, others did not. Thirty, 7-to-15-year-old children, fifteen with fixed and fifteen with removable appliances, previously motivated to oral hygiene, completed the study. They were clinically examined by a dentist at baseline and at the end of the study. Three supra and subgingival microflora samples were collected from the first molars, when the appliances were inserted (T0), 6-8 weeks later (T1) and 6-7 months later (T2). Microflora was examined using dark-field and light microscopes and cultural methods. An indicator of healthy status (percentage of Gram positive cocci in total bacterial count) and some risk indicators for gingivitis (bacterial count evaluated with light microscope, percentage of Gram negative rods) and for periodontitis (motile rod and spirochete percentages, presumptive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis prevalence) were investigated. Patients with fixed appliances were clinically healthy at T2; yet they showed significantly increased counts, motile rods, subgingival spirochetes and a decrease of Gram positive cocci. At T2, patients with removable appliances were clinically healthy and the only significant microbiological changes were supragingival motile rods and subgingival spirochetes. These data suggest that in the oral hygiene motivated patients of the present study, gingivitis and periodontitis do not occur, during the first six months of treatment: the significant modification of oral microbiota, shown by subjects with fixed appliances, however, suggests that the risk for gingivitis in the following months of therapy is still high and the risk for periodontitis cannot be excluded.

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... The following data was then collected from each included study: author/year publication, study design, sample size, sample/age/sex, type of appliance, collection time, collection method of analysis, microbial analysis outcome, and quality of the study (Table 1) [11,[37][38][39][40][41][42][43]. ...
... From the initial 184 articles, 8 were selected as showed in the PRISMA flow diagram (Figure 1) [11,[37][38][39][40][41][42][43]. ...
... Five of the eight chosen articles presented a moderate methodological quality [11,37,39,40,42]: the major concern regarding these studies is the lack of blinded outcome assessment, diagnostic reliability tests, and reproducibility tests. One article had a high quality [36] and the remaining two were classified as having a low quality [41,43]. ...
Article
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Background (1): Removable orthodontic appliances may favor plaque accumulation and oral microbe colonization. This might be associated with intraoral adverse effects on enamel or periodontal tissues. The proposed systematic review was carried out to evaluate qualitatively and quantitatively the microbiological changes occurring during orthodontic therapy with removable orthodontic appliances. Methods (2): PubMed, Cochrane Library, Embase, Web of Science, Scopus, Ovid Medline, and Dentistry and Oral Sciences Source were searched. The research included every article published up to January 2020. The Preferred Reporting Items for Reporting Systematic reviews and Meta Analyses (PRISMA) protocol and the "Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies" (SBU) method were adopted to conduct this systematic review. Results (3): The current study has a moderate evidence, demonstrating that removable appliances do influence the oral microbiota. Significant alterations occur just 15 days after the beginning of therapy, independently from the type of appliance. Furthermore, the levels of oral pathogens decrease significantly or even returned to pre-treatment levels several months later the therapy end. Conclusions (4): This review suggests that orthodontic treatment with removable appliances induces changes to oral microflora, but these alterations might not be permanent.
... From the initial 184 articles, 8 were selected [10,[35][36][37][38][39][40][41]. ...
... According to the SBU criteria, the evidence of the selected sample is of medium-high level due to the lack of error of measurements analysis for the collection of material from oral sites. Four of the eight articles chosen presented a moderate methodological quality [10,37,38,40]: the major concern regarding these studies is the lack of blinded outcome assessment, diagnostic reliability tests and reproducibility tests. According to the PRISMA method, two articles had a high quality [35,36] and the remaining two were classified as having a low quality [39,41]. ...
... Among periodontitis risk indices, only supragingival m rods and subgingival Spirochetes significantly increased at 6-7 months. Aggregatibacter actinomycetemcomitans (Aa) prevalence was near zero [40]. ...
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Background Removable orthodontic appliances due to plaque accumulation and oral microbe colonization, might be associated with intraoral adverse effects on enamel or periodontal tissues. The present systematic review was carried out to evaluate both qualitatively and quantitatively the microbiological changes occurring during orthodontic therapy with removable orthodontic appliances. Methods PubMed, Cochrane, EMBASE, Web of Science, Scopus, Ovid Medline, Dentistry & Oral Sciences Source and Vita-Salute San Raffaele University databases were searched. The research included every article published up to December 2018. The Preferred Reporting Items for Reporting Systematic reviews and Meta Analyses (PRISMA) protocol and the ‘Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies’ (SBU) method were adopted to conduct this systematic review. Results The current study has moderate/high evidence, according with SBU method. It demonstrates that removable appliances do influence the oral microbiota, with significant alterations just 15 days after the beginning of therapy, independently from the type of appliance. Furthermore, the levels of oral pathogens decrease significantly or even returned to pre-treatment levels several months later the therapy end. Conclusions This review suggests that orthodontic treatment with removable appliances might not induce permanent changes to oral microflora. Protocol: PROSPERO database registration number CRD42019121762.
... However, in addition to their usefulness, they may cause undesired side efects. The use of either ixed or removable orthodontic appliance may afect the quantitative and qualitative distribution of the oral microbiota [5,8]. After the insertion into the mouth, the salivary proteins will adsorb on the surfaces of orthodontic appliances, which play a considerable role in microbial adhesion. ...
... No such risk was observed in removable orthodontic appliances. Instead, it was found to be safer, especially in patients with poor oral hygiene control [8]. ...
... Compared to removable ones, ixed appliances pose a signiicant risk due to the changes in the normal lora of oral cavity. It is noteworthy that plaque accumulation is greater in individuals treated with ixed orthodontic appliances compared to those treated with removable ones [5,8,11]. ...
... Counts of oral microbiota peak at about three months after insertion of a fixed appliance [3,[27][28][29][30]. Although most studies [3,[28][29][30] reported a slight decrease thereafter, Arslan et al. [27] found a consistent increase in Candida, S. mutans, and Lactobacilli counts up to 12 months of treatment. ...
... Counts of oral microbiota peak at about three months after insertion of a fixed appliance [3,[27][28][29][30]. Although most studies [3,[28][29][30] reported a slight decrease thereafter, Arslan et al. [27] found a consistent increase in Candida, S. mutans, and Lactobacilli counts up to 12 months of treatment. Despite the slight decrease reported by the other studies, patients showed consistently higher counts of oral microbiota compared with pretreatment [28][29][30]. ...
... Although most studies [3,[28][29][30] reported a slight decrease thereafter, Arslan et al. [27] found a consistent increase in Candida, S. mutans, and Lactobacilli counts up to 12 months of treatment. Despite the slight decrease reported by the other studies, patients showed consistently higher counts of oral microbiota compared with pretreatment [28][29][30]. In the present patient sample, the mean treatment duration at the study appointment ranged between 13.4 and 19.6 months with a significantly longer treatment time in the POH/WSL group, which was far longer than that in all other studies in the literature. ...
Article
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Background The present study aimed to investigate the prevalence of oral microbiota (Candida species (spp.), Streptococcus mutans, and Lactobacilli) in patients with multibracket (MB) appliances in relation to the quality of oral hygiene. Saliva and plaque samples were collected from three groups of 25 patients each (good oral hygiene (GOH), poor oral hygiene (POH), and poor oral hygiene with white spot lesions (POH/WSL)). Counts of colony forming units (CFU) of the investigated oral microbiota were compared using Chi-square and Mann–Whitney U tests. Results Both saliva and plaque samples showed a high prevalence of Candida spp. in all patients (saliva: 73.4 %, plaque: 60.9 %). The main Candida species was C. albicans. The salivary CFU of Candida spp. in the GOH group was significantly lower than that in the POH group (p = 0.045) and POH/WSL group (p = 0.011). S. mutans was found in the saliva and plaque samples of all patients. Lactobacilli were found in the saliva samples of all patients and in 90.7 % of the plaque samples. In the saliva samples, the CFU of Lactobacilli were more numerous in the POH and POH/WSL groups than in the GOH group (p = 0.047). Conclusions The investigated sample of patients showed a high carriage of oral Candida spp. Patients with WSL formation during MB appliance treatment exhibited higher counts of Candida and Lactobacilli compared with patients with good oral hygiene. Independent of oral hygiene quality, S. mutans was detected in all patients.
... Płytka bakteryjna wokół i na aparatach stałych może wywołać zapalenie przyzębia brzeżnego nie tylko jako biomasa, ale także jako rezerwuar swoistych gatunków periodontopatogennych. Petti et al. [62] donoszą o zmianach w mikroflorze poddziąsłowej już po 6-8 tygodniach od założenia aparatu. w badaniach mikroskopowych w ciemnym polu widzenia Huser et al. [1] zauważyli od chwili założenia pierścieni na zębach trzonowych zwiększenie się liczby ziarenkowców, pałeczek i wrzecionowców, a po 47. dniu również znaczne zwiększenie się liczby krętków, ruchomych pałeczek, bakterii nitkowatych i wrzecionowatych oraz zmniejszenie się liczby ziarenkowców. ...
... w badaniach mikroskopowych w ciemnym polu widzenia Huser et al. [1] zauważyli od chwili założenia pierścieni na zębach trzonowych zwiększenie się liczby ziarenkowców, pałeczek i wrzecionowców, a po 47. dniu również znaczne zwiększenie się liczby krętków, ruchomych pałeczek, bakterii nitkowatych i wrzecionowatych oraz zmniejszenie się liczby ziarenkowców. Potwierdzają to badania Petti et al. [62], którzy również obserwowali wzrost tych bakterii (przypuszczalnie A. actinomycetemcomitans i P. gingivalis) oraz zmniejszenie się liczby ziarenkowców gram--dodatnich. de Jacoby i Müller [63] także wykryli więcej krętków i wrzecionowców u pacjentów leczonych aparatami stałymi. ...
... Trossello i gianelly [53] obserwowali zwiększone ryzyko resorpcji korzeni (17 vs 2%), szczególnie zębów siecznych, a alstad i Zachrisson [75] stwierdzili po dwóch latach u 10% z 38 dzieci obniżenie przyczepu łącznotkankowego o 1-2 mm. autorzy większości publikacji wyciągnęli jednak wniosek, że leczenie ortodontyczne w niewielkim stopniu wpływa na przyszły stan przyzębia [62,76,77]. destrukcję przyzębia należy przypisać nie tyle zmianom mikrobiologicznym, ile długotrwałemu mechanicznemu drażnieniu tkanek przyzębia przez elementy aparatu (pierścienie) lub odpryski materiałowe [2,80]. ...
Article
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Fixed orthodontic appliances in the mouth create a high number of plaque-retentive sites and impede plaque removal. An increased biofilm accumulation is associated with the shift of oral microbiological balance. This article reviews the qualitative and quantitative changes of cariogenic, and periodontopathogenic bacteria, as well as opportunistic microbes, including fungi. Furthermore, bacterial adhesion to different orthodontic materials is discussed with regard to their surface properties that influence microbial colonisation. On the basis of literature review it has been concluded that, in most cases, microbial changes are temporary. They may lead to complications. When a proper oral hygiene is maintained, the effect on periodontal health is transient, and gingivitis may occur. Microbial change have a little long-term detrimental impact on periodontal structures. Nevertheless, white spot lesions may remain as visible enamel scars or, if not treated, progress to cavitated lesions requiring restorative treatment.
... The introduction of orthodontic appliances, which are increasingly in demand today due to aesthetic needs and a greater awareness of oral health, can lead to imbalances in the oral ecosystem [5][6][7]. In particular, greater plaque accumulation was found in patients with fixed orthodontic appliances and greater colonization by pathogenic bacteria such as Streptococcus mutans and Lactobacilli due to the difficulty in maintaining good oral hygiene [8,9]. ...
... However, it has also been seen that the use of orthodontic equipment is able to complicate daily oral hygiene maneuvers, modifying the patient's oral microbiota and predisposing him to the development of future oral diseases affecting dental or periodontal tissues [5][6][7]. ...
Article
Full-text available
The purpose of this study is to analyze the microbiota of patients undergoing orthodontic treatment with multibrackets and transparent aligners. The second goal is to evaluate the effectiveness of the oral irrigator on the oral hygiene and periodontal health of orthodontic patients. Fifty patients (27 F, 23 M; mean age 21.5 years) were recruited for the study, then divided into two groups. Group A underwent fixed orthodontic therapy with multibracket, and a home protocol that included manual orthodontic toothbrush, interdental brushes, and one-tuft brushes. Group B used transparent aligners for 22 h a day and a home protocol that included a manual brush with soft bristles and dental floss. After 3 months, all patients of the two groups, A and B, underwent plaque evaluation with a phase-contrast microscope. If the test result showed non-pathogenic bacterial flora, the subject continued with the traditional home oral-hygiene protocol. If the test detected pathogenic flora, the subject changed the home protocol, with a sonic toothbrush and oral irrigator, while the microbiological analysis continued to be performed after 3 months. After 3 months, 10 out of 25 patients treated with multibrackets (group A) and only 3 out of 25 patients with aligners (group B) passed from non-pathogenic flora to pathogenic flora. After 6 months, using the oral irrigator and a sonic toothbrush for 3 months, all subjects returned to non-pathogenic flora. This study confirms that in patients treated with multibrackets, the risk of developing unfavorable microbiota increases compared to those treated with clear aligners. The use of an oral irrigator combined with the sonic toothbrush seems to be able to restore good oral hygiene in subjects with pathogenic flora and therefore to be effective at reducing the risk of caries and gingivitis in orthodontic patients.
... Previous studies have reported that the use of fixed orthotics can stimulate the growth of subgingival plaques, which trigger adverse reactions and increase the discomfort of patients. [6][7][8] Therefore, the use of an alternate removable orthodontic device is expected to facilitate convenience and better healing for patients requiring urgent interventions. [8][9][10] In the recent years, a large number of studies have been reported on times health identity of patients treated with concentrating and removable appliances. ...
... [6][7][8] Therefore, the use of an alternate removable orthodontic device is expected to facilitate convenience and better healing for patients requiring urgent interventions. [8][9][10] In the recent years, a large number of studies have been reported on times health identity of patients treated with concentrating and removable appliances. [11][12][13][14][15][16][17][18][19][20][21][22][23] However, the inference derived from these papers remains controversial. ...
Article
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Background: Although several researchers have analyzed the dental identity of patients experience with corrective methods using fixed and removable appliances, the consequences stay debatable. This meta-analysis intended to verify whether the periodontal status of removable appliances is similar to that of the conventional fixed appliances. Methods: Relevant literature was retrieved from the database of Cochrane library, PubMed, EMBASE, and CNKI until December 2019, without time or language restrictions. Comparative clinical studies assessing periodontal conditions between removable appliances and fixed appliances were included for analysis. The data was analyzed using the Stata 12.0 software. Results: A total of 13 articles involving 598 subjects were selected for this meta-analysis. We found that the plaque index (PLI) identity of the removable appliances group was significantly lower compared to the fixed appliances group at 3 months (OR = -0.57, 95% CI: -0.98 to -0.16, P = .006) and 6 months (OR = -1.10, 95% CI: -1.60 to -0.61, P = .000). The gingival index (GI) of the removable appliances group was lower at 6 months (OR = -1.14, 95% CI: -1.95 to -0.34, P = .005), but the difference was not statistically significant at 3 months (OR = -0.20, 95% CI: -0.50 to 0.10, P = .185) when compared with that of the fixed appliances group. The sulcus probing depth (SPD) of the removable appliances group was lower compared to the fixed appliances group at 3 months (OR = -0.26, 95% CI: -0.52 to -0.01, P = .047) and 6 months (OR = -0.42, 95% CI: -0.83 to -0.01, P = .045). The shape of the funnel plot was symmetrical, indicating no obvious publication bias in the Begg test (P = .174); the Egger test also indicated no obvious publication bias (P = .1). Conclusion: Our meta-analysis demonstrated that malocclusion patients treated with the removable appliances demonstrated a better periodontal status as compared with those treated with fixed orthodontic appliances. However, the analyses of more numbers of clinical trials are warranted to confirm this conclusion.
... Studies have shown that patients under Invisalign treatment significantly have better gingival health‚ lower periodontal indices and better oral hygiene, due to the ability of patients to maintain ideal oral hygiene (53)(54)(55)(57)(58)(59)(60). Also, it has been shown that fixed appliances change the subgingival microflora and cause the growth of periopathogenic bacteria such as Porphyromonas gingivalis ‚ Prevotella intermedia‚ Bacteroides forsythus ‚ Actinobacillus actinomycetem-comitans‚ Fusobacterium nucleatum and Treponema denticola and showed a significant change in the aerobe∕anaerobe ratio (46,61,62). However, studies on patients with Invisalign stated no significant change in subgingival microflora (55,58). ...
... W badaniach wykazano, że pacjenci poddawani leczeniu Invisalign mają znacznie lepszy stan zdrowia dziąseł, niższe wskaźniki periodontologiczne i lepszą higienę jamy ustnej, dzięki temu, że mogą utrzymać idealną higienę jamy ustnej (53)(54)(55)(57)(58)(59)(60). Wykazano również, że aparaty stałe zmieniają mikroflorę poddziąsłową i powodują namnażanie się bakterii periopatogennych, takich jak Porphyromonas gingivalis‚ Prevotella intermedia‚ Bacteroides forsythus‚ Actinobacillus actinomycetem-comitans‚ Fusobacterium nucleatum i Treponema denticola , a także wykazano znaczną zmianę stosunku bakterii tlenowych do beztlenowych (46,61,62). Jednakże w badaniach przeprowadzonych z udziałem pacjentów stosujących Invisalign nie wykazano istotnych zmian w mikroflorze poddziąsłowej (55,58). ...
Article
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Aim: Patients’ attitudes have changed and this led to high esthetic demands and promotion of clear aligners. In 1997, Align Technology Inc (Santa Clara‚ CA‚USA) introduced Invisalign Technology. All of the designing procedure was conducted on the computer by 3D model and aligners were manufactured using computer-aided design and manufacture (CAD-CAM) technology. The purpose of this review was to investigate the efficacy of orthodontic treatment using the Invisalign® system and its related complications. Materials and Methods: A comprehensive electronic search was conducted in MEDLINE, PubMed, and EMBASE from Jan 2013 to July 2019. “Invisalign” as the sole search term was used in this process and PRISMA guideline was applied for data extraction. Results: Fourteen studies were included in this study which analyzed treatment outcomes in extraction/non-extraction therapies, discomfort, complications, and patients’ opinion regarding the Invisalign system. Invisalign has a lesser treatment duration and similar root resorption. Finishing the treatment with Invisalign may require additional appliances. Patients with Invisalign experience lesser pain and eating difficulties but more speech and swallowing difficulties. Overall, studies stated that fixed treatment improved malocclusions more effectively. Invisalign can perform crown tipping, bodily and torque movements as well as a fixed appliance. Conclusions: It was found that no strong conclusions could be made regarding the treatment effects of Invisalign appliances. Future clinical trials with sound scientific evidence are required to support the claims about Invisalign’s treatment effects. Clinicians will have to rely on their clinical experience, opinions of experts and the limited published evidence when using Invisalign appliances.
... Some previous studies have found that treating with fixed orthodontic appliances will stimulate the growth of a subgingival plaque, thus leading to some adverse effects, and then increase the discomfort of those patient. [4][5][6] Therefore, using an alternative removable orthodontic appliances may allow those patients to maintain an adequate oral hygiene, and then reduce the risk for negative dental and periodontal complications. [6][7][8] The Invisalign system (Align Technology, Santa Clara, CA), a new generation of removable, clear semi elastic polyurethane aligners, was first introduced into orthodontics in 1999. ...
... [4][5][6] Therefore, using an alternative removable orthodontic appliances may allow those patients to maintain an adequate oral hygiene, and then reduce the risk for negative dental and periodontal complications. [6][7][8] The Invisalign system (Align Technology, Santa Clara, CA), a new generation of removable, clear semi elastic polyurethane aligners, was first introduced into orthodontics in 1999. [9] It based on a polymer composed by a chain of organic units joined with urethane links and are made from a thin, transparent plastic that fits over the buccal, lingual/palatal, and occlusal surfaces on the teeth, which was formerly a computer designed [10] and could gradually move the teeth into an ideal position. ...
Article
Full-text available
Background: At present, many scholars have studied the periodontal health status of patients undergoing orthodontic treatment with fixed appliances and invisalign. However, those results are inconsistent. Therefore, we conducted this meta-analysis, and then provide reference for clinical treatment. Methods: Most databases, such as the Cochrane Library, EMBASE, PubMed, Medline, Chinese Biomedical Literature Database, CNKI, and Wan Fang Data were retrieved for related articles from the establishment of the database to October 2017. Meanwhile, we also searched the references of the related literatures manually, in order to increase the included literatures. Two researchers screened the related literatures according to the inclusion criteria and exclusion criteria. Stata 12.0 software was used for data analysis, and results are estimated by odds ratio (OR) and 95% confidence interval (CI). Results: Finally, 7 articles, including 368 patients, were included into our meta-analysis. Meta-analysis results showed that there was no statistically significant difference of gingival index (GI) and sulcus probing depth (SPD) status between the invisalign group and the control group, including at 1, 3, and 6 months (all P > .05). When compared with the control group, the invisalign group presented a lower plaque index (PLI) and sulcus bleeding index (SBI) status at 1 month (OR = -0.53, 95% CI: -0.89 to -0.18; OR = -0.44, 95% CI: -0.70 to -0.19, respectively), 3 months (OR = -0.69, 95% CI: -1.12 to -0.27; OR = -0.49, 95% CI: -0.93 to -0.05, respectively), and 6 months (OR = -0.91, 95% CI: -1.47 to -0.35; OR = -0.40, 95% CI: -0.63 to -0.07, respectively). Subgroup analysis showed that the SPD status was lower in the invisalign group at 6 months when measured the teeth using Ramfjord index (OR = -0.74, 95% CI: -1.35 to -0.12). However, there was no statistically significant difference between the 2 groups when using other measure methods (OR = 0.12, 95% CI: -0.26 to 0.17). Conclusion: Our meta-analysis suggests that comparing with the traditional fixed appliances, patients treated with invisalign have a better periodontal health. However, more studies are needed to confirm this conclusion in the future.
... Wyniki badań prowadzonych w różnych ośrodkach wykazały wzajemną zależność między leczeniem ortodontycznym a częstszym występowaniem bakterii próchnicotwórczych z grupy Streptococcus mutans oraz z rodzaju Lactobacillus [43,81,98]. Stwierdzano obecność bakterii Actinobacillus actinomycetemcomitans, które wymienia się jako charakterystyczne dla pewnych chorób przyzębia, a także wzrost liczby beztlenowych i względnie beztlenowych bakterii oraz form ruchomych [72,82]. ...
... Wystąpieniu kandydozy mogą też sprzyjać czynniki miejscowe: zła higiena jamy ustnej, mikrourazy, obecność ciał obcych (szczególnie oddziałujących na powierzchniach ściśle przylegających do błony śluzowej) -akrylowych uzupełnień protetycznych (stomatopatia protetyczna) czy aparatów ortodontycznych [61,66,82,90]. Inwazja grzybów z jamy ustnej do dalszych części przewodu pokarmowego oraz innych narządów drogą krwi przebiegać może szczególnie łatwo, ponieważ na błonie śluzowej często występują otarcia i mogą pojawiać się ubytki powierzchni. ...
Article
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The oral cavity is an open system with complex and dynamic relations between the human host and the microbiota. Stomatognathic disorders, cleft lip and palate are the most common congenital malformations. Incidence varies from 1/500 to 1/2500 live births. In Poland, it appears every year in 800 newborns, as a single disorder or in syndromes. The environmental and hereditary factors, both have influence on the development of this pathology. Treatment of patients with cleft malformations is comprehensive and long-lasting, and includes orthodontic treatment. Both the malformation and the use of orthodontic appliances change significantly the condition of the patients' oral cavities. Such changes have an impact on the oral cavity microbiota, shifting the composition of physiological microorganisms and evoking the appearance of opportunistic and potentially pathogenic bacteria, fungi and/or protists. Analysis of the available literature implicates that co-infections with different opportunistic/pathogenic strains are potentially serious risk factors of local and general complications in patients with various congenital malformations. It should be emphasized that the human oral cavity may act as a major, yet poorly known, reservoir of microorganisms that can induce clinically important infections. However, there are scarce data concerning the presence of opportunistic bacteria, fungi and protists in patients with congenital cleft malformations, thus, further studies are highly important to decrease a risk of medical complications.
... Parallel to clinical investigations of periodontal indices, microbiological studies of the composition of subgingival dental plaque in patients with fixed orthodontic brackets reveal significant changes, suggesting that such treatment may stimulate the growth of a subgingival flora where some periodontopathogenic bacterial strains are prevalent, such as Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum and Treponema denticola [18,23]. ...
... Parallel zu klinischen Auswertungen parodontaler Indizes haben auch mikrobiologische Studien gezeigt, dass Patienten mit Brackets eine stark veränderte Zusammensetzung der subgingivalen Plaque zeigen und solche Behandlungen somit möglicherweise das Wachstum einer subgingivalen Mikroflora fördern, in der Parodontalkeime, wie etwa Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum oder Treponema denticola, die vorherrschenden Bakterienstämme bilden [18,23]. ...
Article
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The purpose of this study was to explore the microbiological and periodontal changes occurring in adolescents during 12 months of orthodontic therapy with removable aligners and with fixed appliances. During the years 2012-2013, 50 teenagers aged 10-18 years with similar initial orthodontic conditions participated in this trial in a university clinic in northern Italy. After receiving professional oral hygiene and instructions on a standardized oral hygiene protocol, the adolescents were randomly assigned to either orthodontic treatment with traditional fixed brackets (n = 25) or to treatment with Invisalign® aligners (n = 25). Subgingival microbiological samples, probing depth (PD), plaque index (PI), and bleeding on probing (BOP) were obtained and documented from the mesiovestibular subgingival sulcus of the upper right first molar and left central incisor at the beginning of treatment and 3, 6, and 12 months later. Compliance with oral hygiene procedures, full mouth plaque score (FMPS), and full mouth bleeding score (FMBS) were assessed at the beginning of treatment and 12 months later. Two sample independent t-tests and the χ(2) test were used to study whether the indices of periodontal health differed in the teenagers due to the experimental conditions. None of the patients was positive for the periodontal anaerobes analyzed. The PI, PD, BOP, FMPS, and FMBS scores were significantly lower and compliance with oral hygiene was significantly higher in the group treated with Invisalign® than in the group treated with fixed brackets. Teenagers treated with removable appliances display better compliance with oral hygiene, less plaque, and fewer gingival inflammatory reactions than their peers with fixed appliances.
... Sunkiai pasiekiamose vietose kaupiasi dantų apnašas, todėl ortodontiškai gydomiems pacientams didėja ėduonies, gingivito ir periodontito išsivystymo rizika [6,7]. Tyrimų duomenimis, gydymas fiksuota breketų sistema skatina podanteninio apnašo kaupimąsi, kuriame vyrauja periodonto audiniams patogeniškos Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum ir Treponema denticola bakterijų padermės [8][9][10]. Kaupiantis dantų apnašui, iš pradžių dantenų uždegiminis atsakas pasireiškia dantenų kraujavimu, dantenų padidėjimu, padidėja kišenės zondavimo gylis, tačiau nestebimas periodonto jungties praradimas [11]. ...
Article
Ortodontinis gydymas fiksuota breketų sistema sunkina pacientų individualios burnos higienos galimybes, todėl skatinamas podanteninio apnašo kaupimasis, didinantis periodonto ligų išsivystymo riziką. Prieš du dešimtmečius buvo pasiūlyta ortodontinio gydymo fiksuota breketų sistema alternatyva − gydymas skaidriomis išimamomis kapomis. Šis metodas įgalina pacientą efektyviau atlikti individualią burnos higieną, tačiau skaidrios kapos didžiąją paros dalį dengia visa danties vainiko paviršių bei dalį kraštinių dantenų, todėl gali prastinti periodonto būklę. Tyrimo tikslas – išanalizuoti ir palyginti kapomis ir fiksuota breketų Sistema gydomų pacientų periodonto būklę. Mokslinių straipsnių paieška atlikta Pubmed (Medline), Cochrane ir Science Direct duomenų bazėse. Šioje apžvalgoje išanalizuoti 6 viso teksto moksliniai straipsniai, atitikę atrankos kriterijus. Straipsnių analizės rezultatų duomenimis, nėra bendrosios nuomonės, jog kapomis gydomų pacientų periodonto būklė būtų geresnė, nei taikant ortodontinį gydymą fiksuota breketų sistema. Kapomis gydomų pacientų periodonto būklė yra geresnė, nei gydant fiksuota breketų sistema, arba skirtumo tarp šiomis sistemomis gydomų pacientų nestebima, tačiau patikimesnėms išvadoms reikalingos tolesnės, ilgesnio stebėjimo period bei didesnės apimties studijos.
... 14 It has been established that the presence of orthodontic appliances alters the oral environment, resulting in the presence of atypical flora. 31,32 Nonetheless, propolis reduced this bacterial flora. ...
Article
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Background: Research has revealed that periodontal diseases are caused by inflammation that results from a dysbiosis of the oral microbiome where oral bacteria multiply into larger communities referred to as dental biofilm. To help control this overgrowth of bacteria, a variety of toothpastes, dentifrices, and mouthwashes have been developed. Although not as common in North American toothpastes, propolis as an active ingredient in dentifrices has begun to emerge, as laboratory studies have suggested it has anti-inflammatory, immunomodulatory, antioxidant, antimicrobial, and antidiabetic properties. The purpose of this scoping review was to explore the literature on the effectiveness of propolis in maintaining oral health. Methods: This review used the following criteria: Population: studies involving healthy humans; Intervention: propolis in the form of toothpaste, dentifrice, and mouthwash; Comparison: fluoride, chlorohexidine, and placebo; Outcomes: plaque and gingival indices, improvement in oral hygiene, and inhibition of bacteria. Relevant research articles were selected from Web of Science, PubMed, MEDLINE, and Scopus databases using the search parameter "propolis[tw] AND (toothpaste*[tw] OR dentifrice*[tw] OR mouthwash*[tw])". Only original articles published after 2009 and written in the English language were included. Results: A total of 19 original papers met the criteria and showed varying levels of success achieved with the use of propolis. It was responsible for a significant lowering of specific plaque and gingival indices, inhibited the growth of bacteria, reduced oral flora diversity, and consistently improved periodontal condition, oral hygiene, and oral health. Conclusion: Propolis may play a role in initiating, sustaining, and maintaining oral health as its desirable properties have the potential to improve various oral hygiene related indices.
... During orthodontic treatment, maintaining oral hygiene becomes difficult due to the placement of bands, brackets, and ligatures in the oral cavity. 1 It was previously reported that permanent orthodontic treatment led to dense plaque formation and an increase in cariogenic and periodontal bacterial growth. 2 Throughout treatment, the presence of plaque at the gingival border was accepted as the main etiological factor in periodontal diseases, whereas increased plaque accumulation around orthodontic brackets is known to result in white-spot lesions 164 and in severe cases of tooth decay, which negatively affect the quality of life. 3,4 Enamel demineralization, which results in whitespot formation, is observed due to the increase in the number and volume of acid-producing bacteria, and the decrease in pH because of the glucose metabolized by these cariogenic bacteria. ...
Article
Objective: To compare Streptococcus mutans colonization between low-friction elastomeric ligatures and to correlate microbial colonization levels with the surface roughness status. Methods: The study included 160 premolars of 10 patients. During the study period, which consisted of 4 sessions each lasting 4 weeks, the ligature types Slide™ Low-Friction Ligature (Leone, Firenze, Italy), Tough-O Energy™ (Rocky Mountain Orthodontics, Denver, USA), and Sili Ties™ (Dentsply Sirona, Surrey KT13 0NY, UK), and steel ligatures (American Orthodontics, Sheboygan, USA) as a control, were fixed to the premolar teeth by clockwise rotation among the jaw quadrants. The plaque index (PI) and gingival index (GI) were obtained before bonding (T0), 6 weeks after bonding (T1), and subsequently every 4 weeks (T2, T3, T4). Presence of S. mutans was analyzed by real-time polymerase chain reaction at T1, T2, T3, T4. Surface roughness was evaluated with Atomic Force Microscopy (AFM) before ligation (Ra0) and after (Ra1) ligation. The paired t-test, ANOVA, repeated measures of ANOVA, and the Kruskal-Wallis test were used for the statistical analysis. Results: S. mutans colonization was significantly higher on the Slide group (P < .05). The lowest Ra0 was seen in Slide and the highest was seen in the Tough-O Energy group. There was no correlation between S. mutans colonization and Ra1 parameters of elastomeric groups (P > .05). Conclusion: S. mutans colonization showed variations in low-friction elastomeric ligatures independent of surface roughness. Ringshaped low-friction elastomeric ligatures were not different from the steel ligature in terms of S. mutans colonization.
... 20 Substantial agitations in the oral environment, including pH changes, disrupt the microbial homeostasis, and promote pathological conditions, such as dental caries and periodontitis. 20,[23][24][25] Moreover, orthodontic appliances, [26][27][28][29] degree of dentition, 30-32 denture wearing, 32-34 periodontitis, 35 dental caries, 36 dental eruption, 37 exfoliation, 38 diet, [39][40][41][42] pregnancy, 43 and use of antibiotics [44][45][46] are also known to influence this homeostasis. ...
Article
Full-text available
The oral cavity harbors a multitude of commensal flora, which may constitute a repository of antibiotic resistance determinants. In the oral cavity, bacteria form biofilms, and this facilitates the acquisition of antibiotic resistance genes through horizontal gene transfer. Recent reports indicate high methicillin-resistant Staphylococcus aureus (MRSA) carriage rates in the oral cavity. Establishment of MRSA in the mouth could be enhanced by the wide usage of antibiotic prophylaxis among at-risk dental procedure candidates. These changes in MRSA epidemiology have important implications for MRSA preventive strategies, clinical practice, as well as the methodological approaches to carriage studies of the organism.
... In addition to a reduced pH and increased amounts of calcium, phosphate, and carbohydrates, the plaque is characterized by larger numbers of bacterial counts leading to the development of gingivitis [8], [9], [10]. Several studies showed that even patients with good oral hygiene who are treated with fixed orthodontic appliances may develop gingivitis [11], [12]. Bacterial metabolic products were able to penetrate the epithelium and disturb its functional and structural integrity [13], [14]. ...
Article
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AIM: The aim of this study was to compare the effect of low level laser therapy (LLLT) with non-LLLT as an adjunct to mechanical debridement in patients who develop gingival inflammation during fixed orthodontic treatment. MATERIALS AND METHODS: Thirty subjects undergoing comprehensive fixed orthodontic treatment were randomly allocated. Split mouth design was applied for each patient, where the four quadrants were randomly allocated to receive full mouth debridement. The test group (quadrant) received three laser sessions (days 1, 3, and 5) besides debridement while the control group (quadrant) received debridement only. Both bleeding index (BI) and plaque index (PI) were measured after 1 and 3 months, while the total colony forming units (CFU) were measured after 2 and 6 weeks. RESULTS: Clinical assessments (BI and PI) showed a statistically significant decrease at the first follow-up (after 1 month) and a slight increase in the second (after 3 months) that did not reach the base line. While, the total CFU showed a significant decrease in both follow-ups. CONCLUSION: Laser showed superior results in the treatment of gingival inflammation induced by fixed orthodontic appliances other than debridement only.
... The use of orthodontic appliances is however, well known for making it difficult to maintain an optimal level of oral hygiene. Furthermore, the presence of orthodontic appliances has been also associated with alterations in the oral microbiota (Löe and Morrison, 1986;Diamanti-Kipioti et al., 1987;Naranjo et al., 2006; A large number of studies have shown that full-fixed orthodontic appliances might lead to negative changes in clinical and/or microbiological periodontal parameters, even in periodontally-healthy patients (Diamanti-Kipioti et al., 1987;Petti et al., 1997;Perinetti et al., 2004;Naranjo et al., 2006;van Gastel et al., 2008;Thornberg et al., 2009;Liu et al., 2011;Karkhanechi et al., 2013;Ghijselings et al., 2014). Nonetheless, only one of these studies evaluated adult patients. ...
Article
Aims: The purpose of this study was to evaluate the impact of fullfixed orthodontic appliances on the periodontium in adult patients. Methods: Seventeen periodontally and systemically healthy subjects were selected from the Periodontal Clinic of Guarulhos University, 7 males and 10 females (mean age: 38.3 ± 6.3 years). The patients undergoing orthodontic treatment were submitted a clinical examination, a cone beam computed tomography at baseline and after 12 months of treatment. Subgingival biofilm samples were analyzed by Checkerboard DNA-DNA hybridization. Statistical analysis was performed by a Wilcoxon test. Results: The percentage of sites with visible plaque increased (p =0.003), but no significant reduction in marginal bone was observed. The mean periodontal pocket depth was reduced (p=0.001) and the clinical attachment level significantly improved (p =0.001). There was a significant reduction in the mean proportions of the Actinomyces sp and an increase in the orange complex species. The proportions of the red complex species remained unchanged. Conclusions: In spite of increase in plaque accumulation no significant clinical or tomographic iatrogenic changes in periodontally healthy adults undergoing orthodontic full-fixed appliance treatment could be detected. The microbiological changes did not affect the periodontal parameters in monitored adult patients that received short period of orthodontic treatment.
... FAs, and only one study compared FAs to removable-type devices, but these were not well specified. 31 Moreover, the majority of studies investigated only TBL and P gingivalis, while we assessed levels of several periodontal pathogens known to be responsible for periodontal disease. 9 ...
Article
Full-text available
Objective: To evaluate the subgingival microbiological changes during the first six months of therapy with clear aligners (CAs) and fixed appliances (FAs). The null hypothesis was that there would be no microbiological differences between the two. Setting/sample: Two groups of patients to be treated, respectively, with CAs (14 patients; 9 females and 5 males; mean age 21 years ± 0.25) and FAs (13 patients; 8 females and 5 males; mean 14 years ± 0.75), were consecutively recruited. Materials and methods: Subgingival microbiological samples were obtained at the right upper central incisor and right first molar at four different time-points: before appliance fitting (T0), and at 1 month (T1), 3 months (T3) and 6 months (T6) thereafter. Total bacterial load (TBL) and counts of the bacteria Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum, Campylobacter rectus, Treponema denticola and Tannerella forsythia were determined using real time PCR. Results: TBL did not vary in the CA group, while a significant increase was detected after 3 and 6 months of treatment in the FA group. Unlike red complex species, C. rectus and F. nucleatum were often detected: levels remained stable in the CA group but increased progressively in the FA group. Conclusion: The type of orthodontic appliance influences the subgingival microbiota. TBL increased in the FA group but not in the CA group, although the levels of the individual periodontal pathogenic bacteria species did not significantly increase during the observation period.
... Human oral microflora is highly diverse and may be changed by several endogenous and exogenous factors [6]. Literature shows that presence of fixed or removable orthodontic appliances in the oral cavity provides retentive spaces for accumulation of microbial plaque and initiation of caries, which in turn compromise oral health and result in subsequent periodontal infection [7][8][9][10][11]. Isolation of aerobic and anaerobic bacteria from blood samples of patients with orthodontic appliances highlighted the role of dental biofilm accumulated on these appliances in this respect [12]. ...
... It has been documented that aligners retain less plaque and have lower incidence of gingival inflammatory reactions compared to fixed appliances (Abbate et al., 2015;Jiang et al., 2018). Nevertheless, it has been postulated that significantly supragingival microbiological changes occur in the presence of fixed and removable appliances (Petti et al., 1997). The issue of bio-adhesion and the resultant pellicle and plaque formation are mainly dependent on surface morphology, surface chemistry and surface charge, with the latter having negligible influence under physiologic ionic conditions (Baier, 1988). ...
Article
Objective The characterisation of surface roughness and energy of contemporary thermoplastic materials used in manufacturing of orthodontic aligners. Design In vitro, laboratory study. Materials and methods Four commercially available thermoplastic materials were selected (CA-medium/CAM, Essix-copopyester/COP, Duran/DUR and Erkodur/ERK). Five disks from each, as received, material were tested and subjected to: (1) reflected light microscopy; (2) optical profilometry for the estimation of Sa, Sz, Sq, Sdr, Sc, Sv surface roughness parameters (n = 5); and (3) contact angle measurements with a Zisman series of liquids for the estimation of critical surface tension (γ C ), total work of adhesion (W A ), as well as the work of adhesion due to polar (W P ) and dispersion (W D ) components employing the Zisman method (n = 5/liquid). Thermoformed disks were prepared against a dental stone model and the roughness parameters were calculated again Statistical analysis was performed by one-way ANOVA/ Tukey multiple comparison test and t-test (a = 0.05). Results Microscopic and profilometric analyses revealed a smooth surface texture in the as-received materials, but a very rough texture after thermoforming, with insignificant differences within each state. Significant differences in the as-received state were found in the surface energy parameters; CAM showed the lowest γ C and the highest W A , W P , W D , whereas ERK with the highest γ C demonstrated lower W A . COP and DUR were ranked in an intermediate group regarding γ C , with a statistically significant difference in W A between them, mainly attributed to the lower W P of the former. Conclusion Given the differences in surface energy parameters and the lack of roughness differences within the as received or thermoformed groups, it may be concluded that variations in the plaque retaining capacity are anticipated, determined by γ C , W A and the W P , W D components.
... Despite that, like any other treatment, the orthodontic treatment can be associated with undesirable side effects [2]. Fixed orthodontic appliances mostly induce increasing in the volume of dental plaque, [3] resulting from complex components and accessories of fixed appliances would anchorage retention of bacterial plaque and impede maintenance of good oral hygiene [4,5]. These factors responsible of pathogenic bacterial colonization, which in O role lead to gingival inflammation, periodontal support destruction [4][5][6][7]. ...
Article
Full-text available
Fixed orthodontic appliances consider as a host for dental plaque accumulations which lead to subsequent gingivitis. O’Leary plaque index and gingival index by Löe and Silness of 60 repeated observations (before and after first stage of orthodontic treatment) which taken from 30 patients (13 male & 17 female) with age range (17-30) years old. According to ANOVA, there was highly significant difference in plaque index before and after treatment in both males (p value=0.00) and females (p value=0.00), but there was no gender difference in plaque index before and after treatment. The present study showed that there was highly significance difference in the gingival index before and after treatment in both males (p value=0.00) and females (p value=0.00). Plaque accumulation and gingival inflammation obviously increased in orthodontic patients, so good oral hygiene program must be followed during orthodontic treatment in order to overcome these side effects. Key Words: dental plaque, gingivitis, gender, fixed orthodontic appliances
... It has been shown that using a fixed orthodontic appliance can change oral microbial flora which often leads to an increase in the levels of subgingival and supragingival pathogens in dental plaque (3). Several studies have reported an increase in Streptococcus mutans (S. mutans) levels in saliva and dental plaque of patients with orthodontic appliances (4)(5)(6). ...
... In fact, several studies demonstrated that fixed orthodontic appliance makes the oral hygiene more difficult determine a consequent plaque accumulation around bands, brackets and archwires. A fixed appliance may also change the bacterial composition, reduce self-clean process, facilitate the bacterial plaque retention and can provoke gingival inflammation or enamel decalcification with soft tissue recession and teeth abrasion (1)(2)(3). Different devices are used to maintain an adequate oral hygiene in orthodontic patients starting with manual or electric toothbrush associated with toothpaste, up to dental floss and brushes for the interproximal hygiene. Some hygienists also propose the use of the dental water jet (DWJ) for the oral hygiene. ...
Article
Full-text available
Background: Different studies assess the role of fixed orthodontic appliances in supragingival plaque accumulation. In patients wearing fixed orthodontic appliances a good management of oral hygiene is required in order to prevent complication like as decay, enamel demineralization, gingivitis, gingival hyperplasia and periodontitis. The aim of this Randomized Controlled Trial (RCT) is to evaluate the efficacy of the use of a DWJ in patients under orthodontic treatment with fixed multibracket appliance. Material and methods: The study design was single-blinded RCT with a split mouth protocol. Each patient followed a personal cleaning protocol using a DWJ in addition to traditional brushing only on one side while just brushing on the control side. The side on which was decided to use the DWJ was chosen randomly and the dental hygienist who took the measurements was blind. Plaque and gingival indexes were evaluated at baseline and at one, three and six-months follow-up. Results: It did not emerge any difference in the plaque and gingival indexes trend between the two groups. Patients initially reported an worsening of the indexes at one month evaluation, then they set at baseline levels at three and six months. Conclusions: The dental water jet does not improve significantly the efficacy of home oral hygiene in orthodontic patients wearing a multi-bracket fixed appliance. Patients did not show the traditional worsening during the whole orthodontic therapy. Key words:Dental water jet, fixed orthodontics, plaque index, gingival index.
... Many clinical studies have reported that plaque accumulation and gingivitis increased during orthodontic treatment [26]. The composition and types of oral bacteria were altered as a result of orthodontic treatment [27], [28]. Recent animal studies suggested that orthodontic tooth movement had a synergistic effect on the periodontium by increasing the presence of Il-1 β and TNF-α [29]. ...
Article
Full-text available
BACKGROUND: The advanced periodontal disease is characterised by a strongly pronounced loss of attachment and reduction of the alveolar bone support, which leads to luxation, migration of the teeth, functional discomfort and poor facial aesthetics. CASE PRESENTATION: The aim of this paper is to present the case of a 26-year-old female patient, registered at the Clinic of Periodontology with highly expressed gingivitis, unsatisfactory periodontal status, presence of diastemas between the frontal teeth and attachment loss of 5-6 millimetres in different areas. We conducted a thorough classic periodontal treatment, as well as training for proper maintenance of oral hygiene, with frequent professional oral-prophylactic sessions, complemented with orthodontic treatment. Fixed orthodontic appliances were installed, and mild forces were applied for gradual levelling of the teeth, with constant control of the periodontal status. After 20 months of treatment, the patient was in retention. CONCLUSION: Orthodontic therapy of periodontally-affected teeth can begin only after exhaustive administration of a periodontal treatment. Orthodontic treatment as an addition to the periodontal restoration must be gradual with mild forces for an optimal dental response, thus helping to improve function, facial aesthetics and psychological confidence of adult patients.
... Third, white spot lesions can be studied most effectively by performing a histosection of the tooth enamel, but this process involves sacrificing teeth and precludes a clinical study with live patients [38]. Because orthodontic treatment can affect the equilibrium of oral microflora by increasing the bacterial retention, a shift in bacterial composition and type can be expected [39]. To verify the ecology of oral microbiome associated with gingival health by using different dentifrices, the evaluation of species composition and level of supragingival plaque may be considered. ...
Article
Full-text available
Plaque accumulation and white spot lesions are common adverse effects of fixed orthodontic appliance use. This study compared the effects between enzyme-containing and conventional dentifrices on orthodontic patients. This double-blind randomized controlled trial included 42 orthodontic patients (25 women and 17 men: 22.7 ± 4.2 years) from Taipei Medical University Hospital between 2017 and 2018. The patients were randomly divided into three groups and assigned to dentifrice use during the first 3 months of the orthodontic treatment: group 1 used dentifrices containing enzymes including amyloglucosidase and glucose oxidase, group 2 used dentifrices containing 1450 ppm fluoride, and group 3 used natural dentifrices containing no chemical agent. White spot lesion index (WSL), gingival bleeding index (GBI), and visible plaque index (VPI) were recorded and analyzed. WSL, GBI, and VPI values exhibited no significant difference among the three groups. WSL increased significantly in group 3, GBI decreased significantly in all groups, and VPI decreased significantly in groups 1 and 2. No significant difference was observed between the use of enzyme-containing and conventional dentifrices after fixed orthodontic appliance placement.
... 17 Immediately after the installation of the orthodontic appliances we can observe unfavorable changes in the subgingival microbiota leading to the development of gingivitis and possibly even periodontitis. 7, 12,[24][25][26][27] These changes, in addition to being related to the deficiency in oral hygiene, 25,26 are also directly related to the quantitative and qualitative changes of the microbiota located around orthodontic accessories, causing inflammation and tissue damage. In this sense, Perinetti et al. 10 and Naranjo et al. 25 asserted that the worsening of the periodontal conditions due to biofilm accumulation can be attributed to the difficulty of oral hygiene around the brackets, leading to an increase in gingival volume due to the inflammatory process. ...
... Although most studies have suggested that permanent periodontal injuries rarely occur after orthodontic treatment, periodontal inflammation during orthodontic treatment, such as gingival hyperplasia and recession, is a common complication [8,21]. The placement of the bracket and band promote plaque accumulation and influence plaque maturation [1,14,24]. ...
Article
Full-text available
Although periodontal diseases during fixed appliance treatment are a common issue, few studies have focused on the clinical and microbial factors associated with orthodontic appliances. Hence, we investigated changes in the subgingival microbial community and their association with periodontal changes at the early stage of fixed appliance treatment. Subgingival plaques from ten female patients with fixed appliances were obtained at three time points: before, 1 month and 3 months after the placement of the brackets (T0, T1 and T2). The 16S rRNA gene sequencing was used to analyze the microbial community of the subgingival plaque. The Plaque Index (PI) and Gingival Bleeding Index (GBI) were also recorded. The GBI significantly increased at T2, and the PI showed a temporary increase without a significant difference. The alpha diversity indices were stable. However, the beta diversity was significantly higher at T2 compared to T0 and T1. The relative abundance of core microbiomes at the genus level was relatively stable. Four periodontal pathogens at the species level, including Prevotella intermedia (Pi), Campylobacer rectus (Cr), Fusobacterium nucleatum (Fn), and Treponema denticola (Td), increased without significant differences. The subgingival microbial community affected by fixed appliance treatment might cause transient mild gingival inflammation.
... [1][2][3][4] Increases in periodontal pathogens and the incidence of gingivitis have also been observed in patients wearing fixed orthodontic appliances. [5][6][7] Other factors affecting oral hygiene during treatment include discomfort associated with orthodontic-related gingivitis and the fact that most orthodontic care occurs in adolescents aged 9 to 14 years, an age when noncompliance is common. 8,9 Oral hygiene product manufacturers have incorporated special design features for plaque removal around fixed orthodontic appliances. ...
Article
Full-text available
Objective: To compare the plaque removal efficacy of an oscillating-rotating electric toothbrush with an orthodontic brush head versus a sonic toothbrush in adolescent patients with fixed orthodontic appliances. Materials and methods: This was a randomized, examiner-blind, replicate single-use, two-treatment, four-period, crossover study with a washout period between visits of approximately 24 hours. Forty-four adolescent patients with fixed orthodontic appliances in both arches were randomized based on a computer-generated randomization schedule to one of four toothbrush treatment sequences. The primary outcome was plaque score change from baseline, measured using digital plaque imaging analysis. Results: Baseline plaque levels for both brush treatments were high, covering more than 50% of the tooth area. Effective plaque removal was observed with both brush treatments (P < .001); however, the reduction in plaque with the oscillating-rotating toothbrush was statistically significantly greater (P = .017) compared with the sonic toothbrush. Conclusions: The study provides evidence for more effective plaque-removing efficacy of the oscillating-rotating toothbrush versus the sonic toothbrush among orthodontic patients.
... con Naranjo 2006 x fix quant %proport. con con con con con con con Petti 1997 x fix quant %proport. Shi 2013 ...
Article
The aim of this systematic review was to assess qualitative changes induced by fixed appliance orthodontic treatment on the subgingival microbiota. Seven databases were searched up to August 2017 for randomized and nonrandomized clinical studies assessing the effect of orthodontic appliances on the subgingival bacteria in human patients. After elimination of duplicate studies, data extraction and risk of bias assessment according to the Cochrane guidelines, random‐effects meta‐analyses of relative risks (RR) and their 95% confidence intervals (CIs) were performed. According to controlled studies, the presence of Aggregatibacter actinomycetemcomitans in the subgingival crevicular fluid of orthodontic patients was increased 3‐6 months after fixed appliance insertion compared to untreated patients (2 studies; RR = 15.54; 95% CI = 3.19‐75.85). There was still increased subgingival prevalence of Aggregatibacter actinomycetemcomitans (3 studies; RR = 3.98; 95% CI = 1.23‐12.89) and Tannerella forsythia in orthodontic patients up to 6 months after appliance removal compared to untreated patients. However, caution is warranted due to high risk of bias and imprecision. Insertion of orthodontic fixed appliances seems to be associated with a qualitative change of subgingival microbiota, which reverts to some extent back to normal in the first months after appliance removal. However, there is limited evidence on the timing and extent of these changes.
... bands, brackets, wires) which create retention areas for dental plaque because of their irregular surfaces as well as making chance to elongate the retention of plaque on surfaces of teeth. [2][3][4][5][6] This elongation of plaque retention along with acidogenic bacteria such as streptococcus mutans, and various lactobacilli play a momentous role in the development of enamel demineralization or white spot lesion. [7][8] Previous clinical study showed WSLs occurrence highly increase in first 6 months of treatment and continuing slowly up to 12 months, for this reason appropriate maintenance of oral hygiene is consulted at the starting of the orthodontic treatment. ...
... [14][15][16] The composition and types of oral bacteria were altered as a result of orthodontic treatment. 1,17,18 Recent animal studies suggested that orthodontic tooth movement had a synergistic effect on periodontitis by increasing the presence of IL-1b and TNF-a. 19 DNA probe analysis revealed that periodontal pathogens increased after 6 months of orthodontic treatment but decreased to the level of pretreatment after 12 months of therapy. ...
Article
Full-text available
Objective: To investigate the association between orthodontic treatment and periodontitis in a nationally representative sample of South Korea. Materials and methods: Data from the Fifth and Sixth Korean National Health and Nutrition Examination Survey (KNHANES V, VI-1, and VI-2), conducted from 2012 to 2014, were used in this study. The final sample size consisted of 14,693 adults aged ≥19 years. Logistic regression analysis was performed to assess the association between orthodontic treatment and periodontitis. Results: The orthodontic treatment group exhibited a lower prevalence of periodontitis compared with the nonorthodontic treatment group. The adjusted odds ratios for periodontitis in subjects with a history of orthodontic treatment compared with those with no history of orthodontic treatment were 0.553, 0.614, and 0.624, when adjusted for various confounding variables (P < .0001). The subjects with periodontitis were of higher age, body mass index, waist circumference, and white blood cell counts compared with the subjects without periodontitis regardless of history of orthodontic treatment. Conclusions: History of orthodontic treatment was associated with a decreased rate of periodontitis.
... Some studies have reported microbial changes in the subgingival plaques of orthodontic patients, and found that the content of periodontopathogens in the subgingival plaques was significantly altered [4,[6][7][8]. Orthodontic appliances generally increased the level of periodontopathogens in subgingival plaques [9][10][11][12], even though Speer et al. [13] reported that the level of periodontopathogens decreased during the orthodontic treatment due to metal corrosion, which imposed toxic effects on the microorganism. However, the results are inconsistent in the scientific literature regarding a certain periodontopathogen. ...
Article
Full-text available
Background Orthodontic treatment was found to have an impact on the quantity and constitution of subgingival microbiota. However, contradictory findings regarding the effects of fixed appliances on microbial changes were reported. The aim of this systematic review was to investigate the microbial changes in subgingival plaques of orthodontic patients. Methods The PubMed, Cochrane Library, and EMBASE databases were searched up to November 20, 2016. Longitudinal studies observing microbial changes in subgingival plaques at different time points of orthodontic treatment are included. The methodological quality of the included studies was assessed by Methodological index for non-randomized studies (MINORS). The studies that reported the frequency of subgingival periodontopathogens were used for quantitative analysis. Other studies were analysed qualitatively to describe the microbial changes during orthodontic treatment. Results Thirteen studies were selected, including two controlled clinical trials, three cohort studies and eight self-controlled studies. Four periodontopathogens, including Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi) and Tannerella forsythia (Tf), were analysed. Following orthodontic appliance placement, the frequencies of Pg and Aa showed no significant change (P = 0.97 and P = 0.77), whereas the frequency of Tf significantly increased (P < 0.01) during short-term observation (0–3 months). The frequency of Pi showed a tooth-specific difference, as it presented no significant difference (P = 0.25) at the site of the first molar but was significantly increased (P = 0.01) at the incisor. During long-term observation (> = 6 months), two studies reported that the levels of subgingival periodontopathogens exhibited a transient increase but decreased to the pretreatment levels afterwards. After removal of the orthodontic appliance, the four periodontopathogens showed no significant difference compared with before removal. Conclusion The levels of subgingival pathogens presented temporary increases after orthodontic appliance placement, and appeared to return to pretreatment levels several months later. This indicates that orthodontic treatment might not permanently induce periodontal disease by affecting the level of subgingival periodontal pathogen levels. Further studies of high methodological quality are required to provide more reliable evidence regarding this issue.
... The duration of orthodontic treatment also poses a concern from a dental point of view; the predisposition towards root resorption [4][5][6], dental caries [7] and gingival recession [8] rising with an augmentation in treatment time. ...
... 7 The use of orthodontic appliances was also shown to modify the oral microbiota. 8,9 Periodontal inflammation, hyperemia, hyperplasia, and demineralization of the teeth have been found as a result of failure to ensure adequate oral hygiene during orthodontic treatment. 10,11 Determining the bracket system that causes a minimal contribution to the plaque accumulation has gained importance recently. ...
... The increased pathogenicity of the dental plaque and the concomitant periodontal changes during orthodontic treatment have been described by several authors. [13][14][15][16] Contrary to our results, these studies reported signs of increased gingival inflammation after the band application used for fixed orthodontic treatment applications. Sallum et al. [17] reported on the microbial and periodontal changes such as PI, BOP, and PPD after bracket removal. ...
Article
Aim: This study aims to evaluate the clinical and microbiological changes accompanying the inflammatory process of periodontal tissues during treatment with space maintainers (SMs). Materials and methods: The children were separated into fixed (Group 1, n = 20) and removable (Group 2, n = 20) appliance groups. A full periodontal examination, including probing pocket depth (PPD), bleeding on probing (BOP), and plaque index (PI), was performed. Anaerobic microorganisms in the crevicular fluid were detected with the culture method. Clinical and microbial evaluations were performed before (T0) applications. as well as at three (T1), and 9 months intervals (T2) after the application of the fixed or removable appliances. Results: The PI, PPD, and BOP scores at the testing sites of both groups increased significantly from before treatment (T0) to the 9 months' time frame (T2) (P < 0.05), The presence of anaerobic bacteria in the subgingival dental plaque increased from T0 (n = 13, 65%) to T1 (n = 16, 80%) in the fixed SM group, but not statistically significant. The same values were obtained in T1 and T2 (n = 16, 80%). Conclusion: Although, the results of this study demonstrate that the application of fixed or removable SM appliances in children induced an increase of clinical periodontal parameters, anaerobic microbiota consisting of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forshia were not observed in any of the samples in short-term. Further long-term and comprehensive investigations are necessary.
... [7] It has been shown that treatment with fixed orthodontic appliances stimulates the growth of a subgingival plaque where some periodontopathogenic bacterial strains are prevalent such as Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, and Treponema denticola. [8][9][10] In contrast, the use of removable orthodontic appliance is able to allow an adequate oral hygiene and reduce the risk for such negative dental and periodontal complication. [11,12] Orthodontic treatment should be able to expose the patients to none or limited side effects. ...
Article
Objective: The aim of this prospective study was to compare the periodontal health and the microbiological changes via real-time polymerase chain reaction (PCR) in patients treated with fixed orthodontic appliances and Invisalign(®) system (Align Technology, Santa Clara, California). Materials and methods: Seventy-seven patients were enrolled in this study and divided into three groups (Invisalign(®) group, fixed orthodontic appliances group and control group). Plaque index, probing depth, bleeding on probing were assessed. Total biofilm mass and periodontal pathogens were analyzed and detected via real-time PCR. All these data were analyzed at the T0 (beginning of the treatment) T1 (1-month) and T2 (3 months); and statistically compared using the Mann-Whitney test for independent groups. Results: After 1-month and after 3 months of treatment there was only one sample with periodontopathic anaerobes found in patient treated using fixed orthodontic appliances. The Invisalign(®) group showed better results in terms of periodontal health and total biofilm mass compared to the fixed orthodontic appliance group. A statistical significant difference (P < 0.05) at the T2 in the total biofilm mass was found between the two groups. Conclusion: Patients undergoing orthodontic treatment with the Invisalign(®) System show a superior periodontal health in the short-term when compared to patients in treatment with fixed orthodontic appliances. Invisalign(®) should be considered as a first treatment option in patients with risk of developing periodontal disease.
... Human oral microflora is highly diverse and may be changed by several endogenous and exogenous factors [6]. Literature shows that presence of fixed or removable orthodontic appliances in the oral cavity provides retentive spaces for accumulation of microbial plaque and initiation of caries, which in turn compromise oral health and result in subsequent periodontal infection [7][8][9][10][11]. Isolation of aerobic and anaerobic bacteria from blood samples of patients with orthodontic appliances highlighted the role of dental biofilm accumulated on these appliances in this respect [12]. ...
Article
Objectives: Long-term use of orthodontic appliances and fixation ligatures creates a favorable environment for the accumulation of oral normal microflora and increases the risk of enamel demineralization and periodontal disease. The aim of this study was to compare the antimicrobial effects of Zataria Multiflora extract and 0.2% chlorhexidine (CHX) mouthwash on experimentally contaminated orthodontic elastomeric ligatures. Materials and Methods: In this lab trial study, Iranian and foreign-made elastomeric li-gatures were experimentally contaminated in Streptococcus mutans, Enterococcus faecalis and Candida albicans suspensions. Ligatures were then decontaminated using 0.2% CHX as the control, 0.5 mg/ml Zataria multiflora extract mouthwashes as the test and phosphate buffered saline (PBS) as the negative control for one hour. Antimicrobial properties of both solutions were evaluated by comparing the mean viable bacterial cell count on both rings after decontamination, using SPSS version 15 software. Results: The mean viable bacterial cell count on Iranian ligatures was greater than that on foreign-made ligatures before disinfection (P=0.001), however this difference for C. albi-cans was not statistically significant (P=0.061). Chlorhexidine mouthwash completely eliminated all tested microorganisms attached to both elastomeric rings, but Zataria extract was only capable of completely eliminating C. albicans from both ligatures. Statistically significant differences were found in viable bacterial counts on both ligatures before and after disinfection with Zataria extract (P=0.0001). Conclusion: Zataria multiflora extract has antimicrobial properties and can be used for disinfection of elastomeric ligatures. In vivo studies are required to evaluate the efficacy of the incorporation of this herbal extract in mouthwashes for orthodontic patients.
Chapter
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The force applied by the orthodontist to facilitate the orderly movement of teeth to their new position may have deleterious effects on the most important structure involved in the procedure—the periodontium. This chapter endeavors to provide an overview of the biological processes that play a role in achieving the patient’s as well as the orthodontist’s objective.
Article
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È ormai comprovato come una scarsa igiene orale sia la causa principale della maggior parte dei danni ai tessuti molli e duri del cavo orale. Negli ultimi anni un maggior impiego di programmi di prevenzione orale ha sicuramente ridotto l’incidenza di carie e parodontopatie. Questi programmi sono costituiti da sedute di igiene orale professionale, istruzioni di igiene orale domiciliare, fluoroprofilassi e sigillature di solchi e fossette. Molti studi concordano nel ritenere che i pazienti sottoposti a trattamento ortodontico siano da considerare a maggior rischio per lo sviluppo sia di processi cariosi che di malattia parodontale; la presenza nel cavo orale di presidi ortodontici fissi e/o mobili può compromettere il controllo di placca. Scopo del presente lavoro è quello di suggerire le possibili tecniche di igiene da attuarsi nei diversi tipi di trattamento ortodontico, con l’obiettivo di permettere un’ulteriore diminuzione dell’incidenza di patologie ai tessuti molli e duri del cavo orale.
Chapter
The positioning of biomaterials in the oral cavity, such as prostheses or orthodontic appliances, can induce alterations to the oral microbiota. Orthodontic appliances have been associated with increased cariogenic risk and exacerbation of pre‐existing periodontal pathologies. This is because different types of brackets, such as conventional, self‐ligating, and lingual brackets, or different bracket materials, such as metallic, ceramic, and plastic, or also removable orthodontic appliances, can often cause colonization of bacteria followed by enamel demineralization and gingival inflammation. Hence, insertion of orthodontic appliances may result in an increase in retentive sites at which the bacterial plaque and potentially pathogenic species, such as periodontal or cariogenic bacteria or fungi, are able to proliferate more easily, damaging oral health and potentially general health. Another significant variable for microbial alterations is the duration the device is used inside the oral cavity; for this reason, it is evident that removable appliances have a significantly lower impact on oral microorganisms than fixed orthodontic appliances. Although changes taking place in the microbial system involve all types of orthodontic appliances, changes occur more rapidly during fixed orthodontic treatment; such alterations can be recorded only a few months after the start of treatment and can lead to deterioration in periodontal health. Furthermore, being able to remove the orthodontic appliance in order to clean both the appliance and the teeth seems to be more important for maintaining oral health than the duration of treatment. Considering the variations in the microbiota which occur with the introduction of biomaterials in the oral cavity, in particular orthodontic appliances, it is appropriate for patients to undergo personalized hygiene protocols so that the oral bacterial load is controlled and the risk of developing carious and periodontal disease is reduced.
Article
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The purpose of the present cross-sectional clinical study was to check the ability of plaque detection and quantification by QLF-D against conventional digital photographs of disclosed plaque in multibracket appliance (MB) patients. 20 patients were included according to the following criteria: (1) upper and lower jaw treated by MB appliance, (2) patients being 16 years of age or older, (3) all central and lateral incisors as well as canines in situ, (4) absence of developmental defects, carious lesions, surface fillings, prosthetic restorations or recessions greater than 1/3 of root length in central/lateral incisors and canines as well as (5) declaration of consent. QLF-D and conventional photographs were analyzed planimetrically regarding plaque coverage on buccal and oral surfaces of central/lateral incisors and canines. The conventional photographs of stained plaque served as gold standard. On average, in QLF-D pictures 20.7% ± 17.4 of the tooth surfaces were covered with plaque, while the conventional photographs of disclosed plaque presented a mean plaque-covered area of 36.2% ± 23.5. The Bland-Altman plot for both imaging modalities showed a very large inconsistent scattering with both negative and positive deviations. The method discrepancy increased with increasing plaque coverage, thus indicating a systematic method error. On average, the deviation of the methods from the optimal line of accordance was −15.5%. In patients wearing MB appliances, there was no clinical significant agreement regarding the plaque-covered tooth surface depicted by QLF-D respectively conventional images of disclosed plaque. Due to the large method discrepancy, QLF-D is currently not reliable for precise plaque quantification in MB patients.
Article
Background: Oral hygiene maintenance is difficult for patients who are receiving fixed orthodontic treatment. Objective: The aim of the study was to find out deterioration of oral hygiene status during treatment of fixed orthodontic appliances in the Department of Orthodontics in BSMMU. Methodology: This cross sectional study was carried out in the Department of Orthodontics at Bang- abandhu Sheikh Mujib Medical University, Dhaka from July 2013 to July 2014. All the patients taking treatment with fixed orthodontic appliances for more than 6 months were included as study population. During treatment in the OPD all the information of the patients’ oral hygiene maintenance like brush- ing, dental floss use, use of mouthwash, and history of sugar consumption, taking sticky food were recorded. The Orthodontic Plaque Index (OPI) was calculated and recorded. In addition to that frequency of brushing, type of tooth brush, technique of brushing and inter dental brush were also considered. Result: A total number of 100 patients were studied. Mean OPI was 81.78 (22.97). Mean value of OPI was 86.35 (13.27) among patients who brushed their teeth once a day but it was decreased gradually as the patients increased frequency of toothbrush use per day and became 85.74 (±26.12) among the patients who brushed their teeth thrice a day. Mean value of OPI was 81.98 (±23.27) who did not use dental floss and 75.00 (±7.00) who used dental floss once a day. Mean value of OPI was 84.65 (±23.10) who used inter dental brush irregularly but 35.00 (±0.00) who used it thrice a day. Mean value of OPI was 85.70 (±22.43) who did not use mouth wash whereas it reduced to 46.00 (±0.00) among them who used mouth wash thrice a day. Conclusion: All the indexes of oral hygiene are increased in patients treated with fixed orthodontic appliances in the Department of Orthodontics in BSMMU. Ban J Orthod & Dentofac Orthop, April 2017; Vol-7 (1-2), P.16-19
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p> Background: Oral hygiene maintenance becomes difficult during fixed orthodontic treatment. Objective : The aim of this study was to assess Gingival Bleeding Index among patients treated with fixed orthodontic appliances in a tertiary level hospital. Metanitil and Methody : This study was conducted on 100 patients treated with fixed orthodontic appliances for more than six months in the OPD of Orthodontics Department at Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2013 to July 2014. All the information related to oral hygiene maintenance like brushing, dental floss use, use of mout hwash during treatment in the OPD were recorded. The Gingival Bleeding Index (GBI) was calculated and recorded. Apart from this, frequency of brushing, type of tooth brush, technique of brushing and inter dental brush were also considered. Result: Over all mean value of GBI was 23.44±17.00. Mean value of GBI was 26.44 ± 15.23 among patients who brushed their teeth once a day but it was decreased gradually as the patients increased frequency of toot hbrush use per day and became 11.55±4.71 among the patients who brushed their teeth thrice a day. Mean value of GBI was 23.46±17.18 who did not use dental floss and 22.85 (12.64) who used dental floss once a day. Mean value of GBI was 25.30±17.73 who used inter dental brush irregularly but 2.75±0.35 who used it thrice a day. Mean value of GBI was25.17±17.69 who did not use mouth wash whereas it reduced to 8.00±0.00 among them who used mouth wash thrice a day. Conclusion: The Gingival Bleeding Index (GBI) is increased in patients treated with fixed orthodontic appliances. KYAMC Journal Vol. 9, No.-3, October 2018, Page 129-132 </p
Chapter
Malocclusions like deep bite, which destroys the palatal gingiva of the maxillary incisors, or an anterior crossbite with occlusal trauma might be harmful to the periodontium. Orthodontic treatment for patients with such malocclusions is often considered advantageous for periodontal health. Many patients undergoing orthodontic treatment develop a generalized form of gingivitis within a short period of time after insertion of the orthodontic appliance. At present, many bracket systems are in clinical use, with different designs and material characteristics. Several studies investigated the influence of different bracket types and archwire ligation techniques on plaque adhesion. More long-term high-quality investigations are necessary to elucidate whether changes in clinical periodontal parameters and oral and periodontal microbiology associated with the placement of orthodontic appliances, return completely to pretreatment levels after debonding.
Article
Objectives: To evaluate the prevalence and estimate counts of Streptococcus mutans and Candida species and to compare the efficacy of manual and electronic brushes on their count reduction. Materials and Method: Thirty patients undergoing orthodontic treatment in the Department of Orthodontics, Santosh Dental College and 30 patients without orthodontic appliances (as control) were selected to determine the counts of S. mutans in plaque samples and counts of Candida species on Sabaroud's Dextrose Agar. All 30 subjects with appliances were then divided into two Groups: Group 1 was assigned Manual brushes and Group 2 were assigned Electronic brushes and both the groups were evaluated for the counts at the end of 1st, 2nd and 3rd month. Results: S. mutans counts were high in 80% (24/30) and Candida species were found to be 16% (5/ 30) in patients with orthodontic appliances as compared to controls. No significant reduction in counts was observed in patients while using manual brushes. However, in patients using electronic brushes their counts were markedly reduced. Conclusion: There occurs a significant increase in S.mutans and Candida counts after appliance insertion, hence the use of manual brushes is insufficient for satisfactory maintenance of oral hygiene in orthodontic patients and reduction in their counts by using electronic brushes should be related to the reduced risk of oral diseases in such patients. © 2014, Indian Journal of Public Health Research and Development. All rights reserved.
Article
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The aim of the present study has been the evaluation of the effectiveness of oral irrigation with or without toothbrushing and dental flossing, in individuals treated with fixed orthodontic appliances, on controlling the development of dental plaque and, hence, of gingivitis. Eight individuals with a good general and oral status have been chosen. Before the experimental period, they received instructions about oral hygiene with toothbrushing and dental flossing and then they have been monitored to verify they were doing well. At the time T0, the upper tooth have been banded, three Periodontal Indexes (Plaque Index according to Silness and Loe, Modified Gingival Index according to Lobene and Gingival Bleeding Index according to Ainamo and Bay) registered and subgingival plaque samples from the premolars' gingival sulcus collected in order to point out the total anaerobes bacterial counts, the rates of motile bacteria, spirochetes, Gram positive and Gram negative cocci and bacteria, by means of optical and dark field microscopy and of cultural methods. For their oral hygiene, the patients had to use, in the right side toothbrush and dental floss (Control 1), in the left side the oral irrigator alone (Test 1). One month later (time T1), the lower teeth have been banded, too. In the right side the patients had to use toothbrush and dental floss (Control 2), while in the left one they used the same devices as Control 2 plus the oral irrigator (Test 2). At the time T1 Periodontal Indexes and Microbiological analyses have been extended to all the four quadrants.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Predominant bacterial flora resident in subgingival plaque was characterized and evaluated in relation to the etiology of periodontal disease. Small groups of clinically and radiographically identified periodontal patients and control subjects were studied. A comprehensive inventory of cultivable flora was made. The most common group of organisms were the Gram-positive rods, the majority of which were Actinomyces. A larger proportion of anaerobic Gram-negative rods were isolated than indicated in the results of previous studies. Considerable variability in floral content was found in different sites in the same patient. However, no statistically significant differences were observed in the flora between clinically normal and pathological sites of the same patients. A significantly greater number of facultative Actinomyces was present in the flora of periodontal patients as compared to control subjects.Sera from the same nine subjects were assayed by indirect immunofluorescence for circulating antibodies to 12 strains of plaque bacteria. No differences in antibody titers were observed between sera from periodontal patients and control subjects.
Article
This article describes our current oral health program. This program will continue to change as we learn more effective ways to communicate and offer instruction. The orthodontist and his staff are in a unique position to help patients become concerned about oral health. The cumulative effect of such patient educations is tremendous since hundreds of patients can be affected. Improving the effectiveness of an oral health program is an excellent opportunity to expand our service as health-care practitioners. A survey of dental home-care programs shows that a relationship exists between dentists' attitudes toward their programs and the degrees of success. Usually an oral health program will not become effective unless the orthodontist is motivated and accepts responsibility for motivating his staff and patients. The extent to which an orthodontist is enthusiastic and involves himself in oral health motivation will be reflected in how enthusiastic his auxiliaries are when instructing patients. If an orthodontist delegates both the motivational and instructional aspects of oral hygiene improvement to auxiliaries, his program will fall short of its potential effectiveness. A comment at each appointment telling the patient about his cleaning effectiveness is especially helpful. This feedback should be offered with kindness, objectivity, and respect for the patient. If an orthodontist feels impatient or frustrated, the patient will perceive this; perception of this negativity will frequently result in patient resistance to instruction and cooperation. When an orthodontist offers guidance in oral hygiene with sincere interest and respect, patients usually respond to his concern and become receptive to improving themselves. The extent to which we recognize a patient's "potential" to achieve excellent oral health, regardless of his present condition, will affect our ability to motivate that person. Our respect for patients will increase when we accept that nearly every patient has the inner capability for achieving excellent oral health. We have an opportunity to help patients recognize this potential. When patients recognize more of their potential, self-respect grows and they gain interest in caring for themselves.
Article
Nowadays, the orthodontic treatment makes necessary to use for a long time fixed-band appliance. This work shows that the presence of funguses, identified from samples taken from the bacterial plaque in patients with banded teeth, do not lead to any pathology. The development of the inflammatory reaction and the increase of the funguses number, are only owing to the quantity of the dental plaque for the reason that hygienics is often wrong. This study prove that hygienics is the only therapeutic, prophylacticly and curative, of any pathogenical aspects due to the being of bands.
Article
This study has been planned to examine the effects of various orthodontic appliances on periodontal tissues and the effect of motivation from the point of oral hygiene during the usage period of these appliances. 45 individuals; 15 of them using removable appliances, 15 of them using fixed-DBS appliances and 15 of the patients treating with fixed-multiband technics, have been used. In the beginning; the pocket depths, gingival and plaque indices of all cases have been reported and then they were motivated for their oral hygiene. The measurements were repeated for each of the motivated cases after 1 month. Statistically significant difference was found only in pocket depth between the 3 groups. There were statistically significant differences in pocket depth, gingival and plaque indices values in each of the groups before and after motivation.
Article
In association studies, micro-organisms can only be recognized as suspects for playing a major rôle in the development of a pathological environment, if their destructive action goes along with a marked proportional increase of their numbers or if their first detection can be related to the clinical onset of the disease. Limitations in the reproducibility of repeated samples have to be taken into account, when changes of the microbial composition of subgingival environments are to be studied, and when local clinical changes are to be related to shifts in the composition of the pertaining microbiological compartment. To study reproducibility, a total of 109 sites was sampled repeatedly with sterile paperpoints at an interval of 7 to 10 days in 24 patients suffering from periodontal disease and 12 edentulous patients wearing successful and failing osseointegrated titanium implants. Using continuous anaerobic techniques, the samples were cultured on nonselective and selective media and were studied by darkfield microscopy. Both the intertest-agreements of frequencies of detection (kappa-statistics) as well as the discrepancies of proportions of bacterial groups and selected bacterial species were determined. The standard deviation of proportional differences between first and second samples ranged between 6.4% (fusiform organisms) and 17.2% (coccoid cells) for darkfield parameters, between 4.3% (B. melaninogenicus on ETSA/Kana.) and 14.0% (B. gingivalis on ETSA/Kana.) for selected bacterial species and between 6.9% (gram-negative anaerobic cocci) and 24.0% (gram-positive facultative cocci) for bacterial groups classified according to gram stain characteristics and atmospheric growth conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
A study was made to determine the extent of bacteremia experienced by patients undergoing orthodontic treatment with fixed appliances during periods of routine oral hygiene--namely, brushing the teeth. Sixteen orthodontic patients made up the population--11 who practiced good oral hygiene and five who demonstrated poor oral hygiene. Blood was drawn aseptically from the median cubital vein of the subjects before and 15 minutes after brushing the teeth. An aliquot of each blood specimen was added to separate blood culture bottles and incubated at 37 degrees C for a period of up to 5 days. Blood was also used to determine the immune status of the subjects. Anaerobic bacteria were recovered from the blood of nine of the 16 patients studied; aerobic bacteria were not recovered. A negative blood culture before brushing and positive blood culture after brushing were expected but did not occur. Some subjects showed bacteremia before brushing and a negative blood culture after brushing. Others showed bacteremia before and after brushing. The unexpected results could be attributed to the patients eating and/or brushing before starting the test. The study showed the capacity of specific anaerobic bacteria to remain in the bloodstream for a 15-minute period. It also demonstrated a presence of bacteria in the bloodstream before the test began.
Article
The effect of professional prophylaxis on the periodontium was studied in 14 adolescent orthodontic patients while under active treatment using a split-mouth experimental design. A full-banded appliance was used on all of the patients. The following variables were examined: plaque registration, gingival index, gingival migration, and width of the attached gingiva. Professional rubber-cup prophylaxis was performed on the test side of all patients together with reinforced oral hygiene instruction on a monthly basis. Measurements for the plaque registration, gingival index, gingival migration, and the width of the attached gingiva were recorded at the initial visit (baseline records), the 6-month evaluation, and the 10-month evaluation. Monthly registrations were completed for the plaque deposits and gingival inflammation at each of the 11 visits. All measurements were taken at the midfacial surface of the selected teeth. Four conclusions can be drawn from the findings of this study: the presence of an orthodontic appliance did not result in an increase of plaque accumulation or gingival inflammation for the full-banded orthodontic patient; monthly oral hygiene instruction was effective in significantly reducing the amount of visible plaque and gingival inflammation; monthly rubber-cup prophylaxis had a significant effect in reducing the gingival enlargement routinely associated with a fixed orthodontic appliance; and the width of attached gingiva showed no significant change throughout the course of the study.
Article
Forty-seven adult orthodontic patients with fixed orthodontic appliances were divided into three study groups: (1) oral irrigation with automatic toothbrush, (n = 16); (2) oral irrigation with manual toothbrushing, (n = 16); (3) control group with continued normal toothbrushing only, (n = 15). Gingival and plaque indices, bleeding after probing, and gingival sulcus depths were assessed at baseline, 1-month, and 2-month periods. Marked and significant gingival and plaque improvements from baseline were measured in all three study groups. After 1 to 2 months use of the automatic toothbrush and/or the oral irrigation device, there was a significant reduction in plaque when compared with the control group who used only the manual toothbrush (p = 0.026). Also, there was a significant reduction in gingival inflammation (p = 0.045) and evidence for reducing bleeding after probing (p = 0.037). No significant differences were found in probe depths among the three study groups, however, use of both devices reduced the pocket depth significantly from baseline by 0.5 mm (p < 0.0002). For this population of orthodontic patients, significant reductions in plaque, gingival inflammation, and a tendency for reduced bleeding after probing occurred in both groups with the power device. These improvements were most attributable to the effect of the oral irrigation device.
Article
The objective of the present study was to investigate the relationship between oral hygiene level, as judged from the number of non-bleeding papillae (NBP), and approximal caries development and progression in 14- to 15-year-old Norwegians. NBP, according to Gjermo, were registered in 165 15-year-old Norwegians. Approximal lesions in the outer half (D1) or in the inner half (D2) of the enamel or in dentin (D3) and the total numbers of carious approximal surfaces (D1 + D2 + D3), filled approximal surfaces, and sound approximal surfaces were recorded from bite-wing radiographs from premolars and molars at the age of 14 and 15 years (values expressed as mean +/- SD). The average number of NBP in the whole group was 4.6 +/- 4.5. One group with good oral hygiene (NBP > or = 5, 8.7 +/- 3.3, n = 76) and one group with bad oral hygiene (NBP < 5, 1.2 +/- 1.5, n = 89) were established. Carious approximal surfaces and filled approximal surfaces were significantly higher in the group with few than in the group with many NBP (6.0 +/- 5.9 vs. 1.7 +/- 2.8 and 2.6 +/- 4.3 vs. 0.9 +/- 1.8, respectively). The number of lesions at the age of 15 and progression of lesions from 14 to 15 years were also significantly higher in the group with few NBP. It is concluded than in populations exposed regularly to fluoride, the oral hygiene level may be an important indicator of a high caries risk.
Article
The percentage of anaerobic micro-organisms in the subgingival microflora represents a simple microbiological index which not only refers to the state but also the risks of periodontal health. The present study aimed to compare two different methods of calculating this index. The study was performed in 45 subjects with moderate gingivitis provoked by the previous application of dental fixtures anchored to both arches. A sample of subgingival microflora was collected from each patient at the level of the vestibular gingival sulcus of the first upper right molar. This was then vortexed, diluted and inoculated in three series of plates. It was chosen to use Walker's culture medium. The total bacterial count was evaluated by incubating the first series of plates in anaerobiosis; the anaerobic bacterial was calculated by subtracting from the total the of facultative aerobic-anaerobic micro-organisms, which in turn was obtained using two methods: the first (method AE) consisted of incubating another series of plates in aerobiosis; the second (method M) involved incubating the last series of plates in anaerobiosis, and adding metronidazole to the culture medium in a solution of 2.5 mg/l. The plates were then kept at 37 degrees C for seven days. The mean percentage of anaerobic microorganisms, given by the percentage ratio between anaerobic and total, relating to the 45 cases studied, was as follows: using method AE: 57.8 +/- 26.3%, and using method M: 40.2 +/- 27.2%. Both figures come close to that proposed and calculated using a much more sophisticated method by Slots, namely 41.5 +/- 19.2% in the event of gingivitis.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
It has been shown that patients with localized juvenile periodontitis (LJP) often harbor Actinobacillus actinomycetemcomitans in the subgingival area. However, little is known of the oral microflora in non-LJP juvenile periodontitis patients with less extensive disease. The purpose of this study was to describe the microflora and clinical parameters of young adults with minor to moderate periodontitis during treatment for a period of 1 year. Eleven patients 15 to 16 years of age were studied. All of them had 4 to 8 mm loss of attachment at minimally one site, but the typical clinical description of localized juvenile periodontitis was an exclusion criterion in this study. Microbiological examination of the deepest periodontal pocket and of the tongue revealed that 6 patients harbored Actinobacillus actinomycetemcomitans and 5 harbored Porphyromonas gingivalis. Almost all subjects showed relatively high proportions of Prevotella intermedia, Campylobacter rectus, motile organisms, and spirochetes. On the basis of clinical and microbiological parameters the 11 patients could be assigned to 1 of 2 groups. Six cases had moderate periodontal breakdown with loss of attachment at 7 to 44 sites. All harbored A. actinomycetemcomitans and 5 of them P. gingivalis. These 6 cases responded relatively well to initial treatment despite the continued presence of A. actinomycetemcomitans. The other group consisted of 5 cases with relatively minor periodontal breakdown; i.e, 1 or 2 sites with 4 to 6 mm loss of attachment. Neither A. actinomycetemcomitans nor P. gingivalis was detected in the deepest pocket of these patients. All 5 responded well to initial treatment.(ABSTRACT TRUNCATED AT 250 WORDS)