The Effect of Fixed Orthodontic Appliances and Fluoride Mouthwash on the Oral Microbiome of Adolescents – A Randomized Controlled Clinical Trial

Abstract

While the aesthetic effect of orthodontic treatment is clear, the knowledge on how it influences the oral microbiota and the consequential effects on oral health are limited. In this randomized controlled clinical trial we investigated the changes introduced in the oral ecosystem, during and after orthodontic treatment with fixed appliances in combination with or without a fluoride mouthwash, of 10–16.8 year old individuals (N = 91). We followed several clinical parameters in time, in combination with microbiome changes using next-generation sequencing of the bacterial 16S rRNA gene. During the course of our study, the oral microbial community displayed remarkable resilience towards the disturbances it was presented with. The effects of the fluoride mouthwash on the microbial composition were trivial. More pronounced microbial changes were related to gingival health status, orthodontic treatment and time. Periodontal pathogens (e.g. Selenomonas and Porphyromonas) were highest in abundance during the orthodontic treatment, while the health associated Streptococcus, Rothia and Haemophilus gained abundance towards the end and after the orthodontic treatment. Only minor compositional changes remained in the oral microbiome after the end of treatment. We conclude that, provided proper oral hygiene is maintained, changes in the oral microbiome composition resulting from orthodontic treatment are minimal and do not negatively affect oral health.

Impact of Mouthwashes on Antibacterial Activity of Subjects with Fixed Orthodontic Appliances: A Randomized Clinical Trial

“…2 Formation of white spot lesions, undesirable esthetic effect, and cavity formation requiring restoration can also occur as a result. 3 The initial step in dental caries is dental plaque formation, and SM is considered as the main culprit in this multispecies dental biofilm. There is fivefold increase in the number of SM during orthodontic treatment as has been observed.…”

Microbiomes in Supragingival Biofilms and Saliva of Adolescent Patients with Induced and Naturally Occurring Gingivitis Relative to Gingival Health

“…Some genera, including Lautropia, Kingella, Neisseria, Actinomyces, Rothia and Megasphaera were extensively more abundant in the control samples. These genera have been associated with gingival health [15,34,67,[80][81][82][83]. Comparison of relative abundances of bacterial species revealed a substantially higher abundance of C. concisus in the two gingivitis groups versus controls (Figure 3).…”

“…The development of gingivitis in patients undergoing orthodontic therapy has been linked to plaque accumulation at the new retention sites, which are di cult to access for oral hygiene [33,34]. The composition of the bacterial communities in induced gingivitis was also reported distinct from the microbiomes in naturally occurring gingivitis [33].…”

“…A signi cant fraction of adolescents and adults may undergo orthodontic treatment to correct crowded, rotated, buried or prominent front teeth [32]. The application of permanent orthodontic appliances (braces) may facilitate plaque accumulation by creating new retention sites, which are di cult to access during teeth cleaning [33,34]. It was also suggested that the surface of orthodontic appliances may favor the build-up of bacterial communities, which differ in composition from the microbiomes of dental plaques causing spontaneous gingivitis [33].…”

Ecological approaches to dental caries prevention: Alteration of biofilms by natural products and casein-phosphopeptide-amorphous calcium phosphate

“…Ideally, the remineralizing agent itself should be able to reverse any dysbiosis and maintain a symbiotic oral microbiome. However, fluoride, regarded as the gold standard among remineralizing agents, has minimal to no effects on microbial composition of dental plaque [Adams et al, 2017;Koopman et al, 2015;Reilly et al, 2016;Reilly et al, 2014]. The milk protein-based remineralizing technology called casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) may hold greater promise in effecting a beneficial shift in the dental plaque microbial ecology.…”