Abstract
Background:
Fixed orthodontic treatment provides good alignment and improves the maxilla-mandibular and dentoalveolar function. The present study was conducted to evaluate fixed orthodontic patients' periodontal condition with professional oral hygiene measures.
Materials and Methods:
One-hundred and twenty patients undergoing fixed orthodontics were included in the study, divided with 60 patients in the control group (Group I) and the other 60 in the experimental group (Group II). Periodontal indices were compared.
Results:
In Group I, there were 40 females and 20 males, and in Group II, there were 35 females and 25 males. The mean gingival index was 0.62 and 1.14, plaque index was 0.94 and 1.38, and pocket depth was 1.50 and 1.68 at T0 and T1 in Group I, respectively. The mean gingival index was 0.80 and 1.14, plaque index was 1.2 and 0.81, and pocket depth was 1.31 and 1.57 at T0 and T1 in Group II, respectively.
Conclusion:
For patients undertaking orthodontic fixed appliance therapy, professional oral hygiene measures can significantly improve periodontal health.
KEYWORDS: Fixed orthodontic, oral hygiene, periodontal health
INTRODUCTION
The orthodontic treatment guarantees adequate arrangement of the dental tissues and results in improvement of occlusal relationships. This further helps in improved masticatory function, speech function, and facial esthetics. This, in turn, contributes to improved general and orodental health with significant alteration of the quality of life. At the same time, orthodontic treatment is also reported to be associated with certain risks and complications.[1] One of the most frequently encountered adverse events associated with orthodontic therapy is periodontal pathology. With braces and other orthodontic auxiliaries, the patients usually struggle to maintain good oral health and hygiene, resulting in the oral tissues' inflammatory pathologies. Gingivitis and gingival enlargement are among the most common adverse events associated with orthodontic treatment.[2]
Previous studies have reported a significant association between enhanced plaque accumulation and orthodontic treatment because of improper proper brushing techniques.[3] This is evident clinically where orthodontic appliances are positioned in deep gingival tissue. The reactionary gingival enlargement further complicates the removal of plaque, thereby supporting the periodontopathic microorganism's domination.[4,5] Hence, in light of the data mentioned above, the present study was undertaken to assess fixed orthodontic patients' periodontal condition with professional oral hygiene measures.
MATERIALS AND METHODS
The current study was done in the department of orthodontics and dentofacial orthopedics of the dental institution. The ethical committee approved the ethical clearance for the study of the dental institution. All the patients were informed regarding the study, and their consent was obtained. A total of 120 patients undergoing fixed orthodontic appliance therapy were enrolled in the current study. A proforma was made, and complete clinicodemographic details of all the subjects were recorded. Patients with the presence of any congenital bone pathology were excluded from the present study. Mouth mirror, probe, and tweezers were used for carrying out a clinical examination. A dental impression was taken, and primary cast models were made. There were two groups with 60 patients each as follows:
Group I: Fixed orthodontic cases with Class I molar relation and bimaxillary protrusion with all four extractions of the first premolars. Conventional oral hygiene instructions with an oral hygiene kit, including orthodontic toothbrushes, interproximal brushes, toothpaste, and mouthwash, were given to the patients
Group II: Fixed orthodontic cases with Class I molar relation and bimaxillary protrusion with all four extractions of the first premolars. Conventional oral hygiene instructions with an oral hygiene kit, including orthodontic toothbrushes, interproximal brushes, toothpaste, and mouthwash, were given to the patients with every 5th-month professional scaling.
For periodontal health indexing, the selected teeth were 16, 25, 36, 45, and 41. Gingival index, pocket depth, and plaque index were measured. Results were tabulated and statistically analyzed using Statistical package for the social sciences (SPSS) version 21 (IBM Corp., Chicago, Illinois, USA) software. If P < 0.05, it was considered significant.
RESULTS
The present research was conducted in the department of orthodontics and dentofacial orthopedics of the dental institution. A total of 120 patients undergoing fixed orthodontic appliance therapy were enrolled in the current study. Table 1 shows 40 females and 20 males in Group I, and in Group II; there were 35 females and 25 males. Table 2 shows that the mean gingival index was 0.62 and 1.14, the plaque index was 0.94 and 1.38, and pocket depth was 1.50 and 1.68 at T0 and T1 in Group I, respectively [Table 2]. The mean gingival index was 0.80 and 1.14, plaque index was 1.2 and 0.81, and pocket depth was 1.31 and 1.57 at T0 and T1 in Group II, respectively. P < 0.05 was considered significant.
Table 1.
Gender distribution among the groups
| Groups | Group I | Group II |
|---|---|---|
| Methods | Control | Experiment |
| Male:female | 20:40 | 25:35 |
Table 2.
Comparison of periodontal measurements
| Index | Group I | P | Group II | P | ||
|---|---|---|---|---|---|---|
|
|
|
|||||
| T0 | T1 | T0 | T1 | |||
| Gingival index | 0.62 | 1.14 | 0.02 | 0.80 | 0.14 | 0.01 |
| Plaque index | 0.94 | 1.38 | 0.01 | 1.2 | 0.81 | 0.03 |
| Pocket depth | 1.50 | 1.68 | 0.04 | 1.31 | 1.57 | 0.04 |
DISCUSSION
Orthodontic treatment impedes adequate oral hygiene and oral health. At the same time, it also inspires the beginning of gingivitis and periodontitis. The exact underlying mechanism for gingivitis is still unknown, but it is supposed that plaque the universal causative factor.[6] It has also been accepted that definite subjects are more susceptible to its development because of genetic or epigenetic factors. These comprise genetic polymorphisms and altered genetic susceptibility.[7] In such conditions, gingivitis progresses to periodontitis. Of significance in orthodontics is whether orthodontic materials and appliances enhance the accusation of gingivitis into periodontitis. This is because plaque could accumulate between the orthodontic appliances and the gingival margins.[8]
During fixed orthodontic treatment, plaque retention is an important etiological factor for demineralization and gingival and periodontal diseases. The cytotoxicity of metal brackets, bands, and auxiliaries causes a localized inflammation; as metal bands are placed subgingivally, gingivitis is commonly seen with them.[9] Gingival enlargement due to gingivitis further hinders proper removal of plaque, thereby increasing the bacterial dominance of periodontopathic microbes (Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus).[10] Hence, under the light of the data mentioned above, the present study was undertaken for assessing fixed orthodontic patients' periodontal condition with professional oral hygiene measures.
There were 40 females and 20 males in Group I in the present study, and in Group II, there were 35 females and 25 males. Pandey et al.[11] did a questionnaire study on orthodontic patients regarding the practice management in oral health maintenance and calculated the dental neglect scores, and oral hygiene index simplified scores. They found that only 26% of the orthodontic patients brushed twice daily, and only 9% used other interdental oral hygiene aids. They also found a positive correlation between the oral hygiene index simplified score and dental neglect scores.
In the present study, we observed that the mean gingival index was 0.62 and 1.14, plaque index was 0.94 and 1.38, and pocket depth was 1.50 and 1.68 at T0 and T1 in Group I, respectively. The mean gingival index was 0.80 and 1.14, plaque index was 1.2 and 0.81, and pocket depth was 1.31 and 1.57 at T0 and T1 in Group II, respectively. Our results were concordant with the results obtained by Francis et al., who also observed similar findings in their respective study. They analyzed 20 patients who underwent fixed orthodontic treatment. The impact of conventional home oral hygiene therapies only in comparison to oral prophylaxis done by professionals and conventional home oral hygiene on periodontal health was evaluated. Gingival, plaque, and bonded bracket plaque indices and probing depth were evaluated. The results confirmed that for an improved gingival and periodontal health status in orthodontic patients, oral prophylaxis done in the 5th month could be very beneficial.[12]
CONCLUSION
From the above results, the authors concluded that professional oral hygiene measures could significantly improve periodontal health for patients undertaking orthodontic fixed appliance therapy.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Naranjo AA, Triviño ML, Jaramillo A, Betancourth M, Botero JE. Changes in the subgingival microbiota and periodontal parameters before and 3 months after bracket placement. Am J Orthod Dentofacial Orthop. 2006;130:275.e17–22. doi: 10.1016/j.ajodo.2005.10.022. [DOI] [PubMed] [Google Scholar]
- 2.Ristic M, Vlahovic Svabic M, Sasic M, Zelic O. Clinical and microbiological effects of fixed orthodontic appliances on periodontal tissues in adolescents. Orthod Craniofac Res. 2007;10:187–95. doi: 10.1111/j.1601-6343.2007.00396.x. [DOI] [PubMed] [Google Scholar]
- 3.Ristic M, Vlahovic Svabic M, Sasic M, Zelic O. Effects of fixed orthodontic appliances on subgingival microflora. Int J Dent Hyg. 2008;6:129–36. doi: 10.1111/j.1601-5037.2008.00283.x. [DOI] [PubMed] [Google Scholar]
- 4.Huser MC, Baehni PC, Lang R. Effects of orthodontic bands on microbiologic and clinical parameters. Am J Orthod Dentofacial Orthop. 1990;97:213–8. doi: 10.1016/S0889-5406(05)80054-X. [DOI] [PubMed] [Google Scholar]
- 5.Paolantonio M, di Girolamo G, Pedrazzoli V, di Murro C, Picciani C, Catamo G, et al. Occurrence of Actinobacillus actinomycetemcomitans in patients wearing orthodontic appliances. A cross-sectional study. J Clin Periodontol. 1996;23:112–8. doi: 10.1111/j.1600-051x.1996.tb00543.x. [DOI] [PubMed] [Google Scholar]
- 6.Alexander SA. Effects of orthodontic attachments on the gingival health of permanent second molars. Am J Orthod Dentofacial Orthop. 1991;100:337–40. doi: 10.1016/0889-5406(91)70071-4. [DOI] [PubMed] [Google Scholar]
- 7.Hamp SE, Lundström F, Nyman S. Periodontal conditions in adolescents subjected to multiband orthodontic treatment with controlled oral hygiene. Eur J Orthod. 1982;4:77–86. doi: 10.1093/ejo/4.2.77. [DOI] [PubMed] [Google Scholar]
- 8.Boyd RL, Murray P, Robertson PB. Effect of rotary electric toothbrush versus manual toothbrush on periodontal status during orthodontic treatment. Am J Orthod Dentofacial Orthop. 1989;96:342–7. doi: 10.1016/0889-5406(89)90354-5. [DOI] [PubMed] [Google Scholar]
- 9.Sallum EJ, Nouer DF, Klein MI, Gonçalves RB, Machion L, Wilson Sallum A, et al. Clinical and microbiologic changes after removal of orthodontic appliances. Am J Orthod Dentofacial Orthop. 2004;126:363–6. doi: 10.1016/j.ajodo.2004.04.017. [DOI] [PubMed] [Google Scholar]
- 10.Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25:229–35. [PubMed] [Google Scholar]
- 11.Pandey V, Chandra S, Dilip Kumar HP, Gupta A, Bhandari PP, Rathod P. Impact of dental neglect score on oral health among patients receiving fixed orthodontic treatment: A cross-sectional study. J Int Soc Prev Community Dent. 2016;6:120–4. doi: 10.4103/2231-0762.178752. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Francis PG, Parayaruthottam P, Antony V, Ummar F, Shaloob KM, Hassan KJ. A Comparative assessment of the effect of professional oral hygiene measures on the periodontal health of patients undergoing fixed orthodontic appliance therapy. J Indian Orthod Soc. 2019;53:43–8. [Google Scholar]