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ORAL HYGIENE IN ORTHODONTICS

News

28 Sep 2018

Enamel demineralisation, caries, gingivitis and ulcers are some of the problems that orthodontic patients present with if they do not keep adequate oral hygiene. 

Orthodontic treatments, and especially traditional ones with braces, represent an important personal challenge, since they involve a period during which oral hygiene can be significantly affected. 

Orthodontic appliances cause the retention of a great amount of biofilm, or dental plaque, and food and, therefore, oral hygiene must be stricter (1). This greater accumulation of biofilm can have a serious impact on the oral health of people who wear orthodontics. 

ENAMEL DEMINERALISATION 

The accumulation of biofilm around braces or bands in many cases causes the onset of enamel demineralisation, opaque white spots that are usually observed when the appliance is removed (2). To prevent these lesions to the extent possible, great emphasis must be placed on hygiene around the braces and bands, either with manual brushes with V-shaped filaments to hold and clean the braces on all sides, or with electric brushes offering sonic technology that allow for cleaning beyond the reach of the filaments. 

Also, the conical interproximal brushes can clean the braces on the sides, always directed towards the occlusal part. Fluoride pastes and rinses are also recommended to help prevent and remineralise these lesions to the maximum. Recently, pastes and rinses with hydroxyapatite nanoparticles that also help to improve the remineralisation of the lesions, have been released on the market. 

CARIES 

In some very specific cases, these lesions can lead to caries. In addition to the accumulation of biofilm, it has been observed that there may be an increase in cariogenic species including Streptococcus mutans and a decrease in salivary pH, which favour the onset of this pathology (3). If caries is detected, these should be treated as soon as possible, and special emphasis should be placed on improving oral hygiene, as well as limiting the consumption of sugars. Similarly, hygiene can be reinforced with pastes and mouthwashes containing fluoride. 

GINGIVITIS 

Furthermore, the accumulation of biofilm, especially at the level of the gingival margin, can cause inflammation of the gums, aka, gingivitis (4). This can be particularly evident in the interproximal spaces between premolars and molars when interproximal hygiene is deficient. 

Patients should be instructed in the use of dental floss or tape with the help of a threader, which allows it to pass under the arch wire, as well as in the use of interproximal brushes. 

Oral irrigators can also be used to clean the spaces between teeth. Gingivitis in these cases is usually localised and rarely progresses to periodontitis. 

PERIODONTITIS 

In the case of adults who have been treated for periodontitis in the past, special care should be taken, since poor oral hygiene during orthodontic treatment could cause the recurrence of periodontitis. Regular periodontal maintenance should be performed every two or three months to carefully monitor these patients. It is also important to evaluate the level of attached gingiva at all times to prevent the appearance of mucogingival defects, in the form of recessions in general, which can worsen the prognosis of a tooth in the medium and long term. 

In all patients and especially those with periodontal problems, it is important to reinforce mechanical hygiene and to use pastes and mouthwashes formulated with specific antiseptics for controlling periodontal disease. 

SORES AND ULCERS 

Finally, it should not be forgotten that during orthodontic treatment, ulcers or sores may develop from rubbing of the appliances, which may be very bothersome. In this case, placing orthodontic wax on the components causing the problem can help to mitigate the pain and allow for a speedier recovery. 

VITIS® ORTHODONTIC: THE BEST SOLUTION FOR ORAL HYGIENE IN ORTHODONTIC PATIENTS 

The VITIS® orthodontic range is designed to meet the needs of orthodontic patients: 

VITIS® orthodontic toothbrushes (available with normal or access heads) have filaments with a V-shaped brushing surface that allow you to clean appliances, teeth and gums at the same time. 

VITIS® orthodontic toothpaste and mouthwash are specially formulated to prevent possible complications during orthodontic treatment, in addition to reducing the accumulation of the oral biofilm and gingival inflammation. The fluid texture of VITIS® orthodontic toothpaste facilitates access to orthodontic spaces. 

VITIS® orthodontic cleansing tablets clean appliances safely and effectively. 

VITIS® Orthodontic wax can be applied to the different orthodontic appliances that protrude from the teeth (brackets, arches or metal bands) and works by forming a thin protective layer that prevents lesions from developing. 

Bibliography

  1. Klukowska M, Bader A, Erbe C, Bellamy P, White DJ, Anastasia MK, Wehrbein H. Plaque levels of patients with fixed orthodontic appliances measured by digital plaque image analysis. Am J Orthod Dentofacial Orthop 2011; 139: 463-470. 
  2. Chang HS, Walsh LJ, Freer TJ. Enamel demineralisation during orthodontic treatment. Aetiology and prevention. Aus Dent J 1997; 42: 322-327. 
  3. Vizitiu TC. Ionescu E. Microbiological changes in orthodontically treated patients. Therapeutics, Pharmacology and Clinical Toxicology 2010; 14: 283-286. 
  4. Van Gastel J, Quirynen M, Tenghles W, Carels C. The relationships between malocclusion, fixed orthodontic appliances and periodontal disease. A review of the literature. Aust Orthod J 2007; 23: 121-129.

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