Effects of Fixed and Removable Space Maintainers on Plaque Accumulation, Periodontal Health, Candidal and <b><i>Enterococcus Faecalis</i></b> Carriage

Abstract

Objective: To evaluate the effects of space maintainers on plaque accumulation, periodontal health and oral microflora. Subjects and Methods: The study participants comprised 38 patients aged 4-10 years requiring either fixed or removable space maintainers. Plaque index, gingival index, bleeding on probing index, candidal colonization and Enterococcus faecalis were recorded just before the application of space maintainers (T0) and during treatment at the 1st (T1), 3rd (T2) and 6th (T3) month. Results: The gingival and bleeding on probing index scores increased significantly (gingival index from 0.20 ± 0254 to 0.54 ± 0417 and bleeding on probing index from 7.18 ± 9.946 to 18.07 ± 14.074) in the regions with fixed space maintainers at T3 (p < 0.01). The mean Candida counts also increased (for removable appliances from 1.90 ± 3.638 to 1.98 ± 3.318, p < 0.05, and for fixed appliances from 4.25 ± 4.587 to 4.52 ± 4.431, p < 0.001). The salivary E. faecalis counts at T3 also increased significantly with the use of fixed and removable appliances (for removable appliances from 5.93 ± 2.65 to 85.53 ± 34.1 and for fixed appliances from 4.95 ± 2.94 to 123.59 ± 29.51, p < 0.001). A positive correlation was found between the plaque (r = 0.67), gingival (r = 0.76) and bleeding on probing index scores (r = 0.76) and the candidal colonization for the fixed space maintainers (p < 0.01, p < 0.001). Conclusions: In this study, both fixed and removable space maintainers led to an increase in the number of microorganisms in the oral cavity as well as to increases in the periodontal index scores. Patients should be informed that space maintainers may serve as a source of infection and that special attention must be given to their oral hygiene.

Changes in oral microbiota due to orthodontic appliances: a systematic review

“…Six studies analyzed removable devices [11,17,18,31,49,52]. One study analyzed different interceptive removable appliances [49], demonstrating an increase in both S. mutans and Lactobacillus spp.…”

“…In one study [11], the use of space maintainers defined an increase in BOP in the number of bacteria and in Candida . Furthermore, D’Ercole et al [17] pointed out that the use of sports mouthguards produced an increase in BOP and PI (Table 8).…”

Influencia de la aparatología ortodóntica sobre la ocurrencia de Candida spp. en la cavidad oral

“…El presente trabajo, presenta evidencias significativas que la instalación de aparatología ortodóntica puede predisponer a la colonización por especies de Candida, probablemente, debido a la interferencia que tienen en un adecuado cepillado y limpieza de la cavidad oral, como previamente se ha reportado 15,32,33 . La inadecuada limpieza bucal favorece la acumulación de placa dento-bacteriana debido a la presencia de microorganismos orales que influyen en cambios en la microbiota oral 8,15,34 . La teoría microecológica oral sostiene que existe un balance ecológico entre los microorganismos de la cavidad oral y el propio individuo, y éste se ve alterado cuando las condiciones del hospedero cambian.…”

Space maintainers application, indication and complications

“…Researchers reported that both removable and fixed dental space maintainers are associated with a significantly high risk of oral cavity microorganism growth and increased periodontal index scores. 31 Candida was found to be commonly encountered in patients with removable dental appliances whereas salivary Enterococcus faecalis was isolated from fixed appliances. 31 Appliances with direct contact to the mucosa and soft tissue, such as loops, bands, and lingual arches, are potentially complicated with soft tissue impingement, ulceration, bleeding, and pain.…”

“…31 Candida was found to be commonly encountered in patients with removable dental appliances whereas salivary Enterococcus faecalis was isolated from fixed appliances. 31 Appliances with direct contact to the mucosa and soft tissue, such as loops, bands, and lingual arches, are potentially complicated with soft tissue impingement, ulceration, bleeding, and pain. Gingival hyperplasia and mucosal overgrowth are also commonly encountered.…”