Changes in the oral environment during four stages of orthodontic treatment

Abstract

Objective: To identify clinical, salivary, and bacterial changes during orthodontic treatment with follow-up to 24 months. Methods: In 30 patients, clinical (decayed, missing, and filled surfaces [DMFS], O'Leary's plaque index, and plaque pH), salivary (unstimulated and stimulated saliva, buffer capacity, pH, and occult blood), and bacterial (Streptococcus mutans and Lactobacillus) markers were evaluated. A questionnaire was employed to evaluate their hygienic-dietary habits. Data were analyzed by ANOVA, logistic regression and Spearman's correlation. Results: DMFS increased significantly, whereas the plaque index diminished, plaque pH was more acidic (p = 0.23), and unstimulated salivary flow showed significant differences during the treatment (p = 0.013). Stimulated saliva flow increased in females after the placement of appliances; buffer capacity was diminished in males during the therapy; salivary pH remained at basal values. Bacterial levels and occult blood increased to high-risk levels and were not statistically significant different between genders (p ＞ 0.05). Two major relationships were confirmed: initial plaque with use of dental aids (r = 0.429; p = 0.018) and final DMFS with unstimulated salivary flow (r = −0.372; p = 0.043). Conclusions:The increase in retentive surfaces increased the bacterial levels, plaque pH became acidified, and gingival damage was greater. Buffer capacity was altered but maintained a healthy salivary pH during the treatment.

Effects of the initial stage of active fixed orthodontic treatment and sex on dental plaque accumulation: A preliminary prospective cohort study

“…27 Future studies should assess this issue, as the current literature consists of few studies. 15,18 This pilot study was limited by some factors. A larger sample could favor the reliability and generalizability.…”

“…27 In our study, gender did not have a significant effect on the plaque accumulation, in contrast to some studies in which plaque was more accumulated in males. 15,18 There might exist different factors affecting the role of gender, such as the larger salivary glands in men and the female hormonal pattern that might reduce saliva and increase plaque accumulation in women. 27 Future studies should assess this issue, as the current literature consists of few studies.…”

“…The result was multiplied by 100 for the percentage of PI in each individual. 15,18,19 The first record of PI (control) was taken before the fixed appliances were placed, and the second record (treatment) was taken after successfully finishing the initial phase of orthodontic therapy (leveling) which lasted between 3 and 6 months from the treatment initiation (on a case by case basis). In the beginning and during the treatment, the patients were notified regarding the changes in the oral plaque due to bracket placement, and their need to improve their oral hygiene to avoid white spots, etc.…”

“…12,14 Although some studies agree that plaque aggregation increases by fixed orthodontic treatment, 2 some studies have not found increases. 10,15 This controversy might be attributed to the study durations and educations given to patients.…”

“…Furthermore, it is not known if the problem of plaque accumulation is more serious in males or females, although few studies have suggested that males might have poorer oral hygiene. 15,18 Hence, assessing the role of sex is helpful in better understanding the topic.…”