Oral Hygiene and Decalcification in Orthodontics Essay

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Oral Hygiene and Decalcification in Orthodontics

Malocclusions are believed to be the third most frequent oral health problem and are connected with a number of problems. Orthodontic therapy can often correct these problems or at least stop them from moving ahead. It also holds some probability for damage to teeth and periodontal tissues. It is thought that oral hygiene is hard to uphold during treatment, which then leads to plaque buildup and gingival irritation. It has been shown that orthodontic treatment encourages changes in the oral setting, with an increase in the bacteria's presence and changes in buffer capability, pH acidity and salivary flow rate. This is however, little known about periodontal irritation that results in occult blood being present in saliva and the acidity of dental plaque. It is imperative to recognize the changes in the oral environment in patients who undergo orthodontic treatment with fixed appliances. In some cases that consist of long treatment length, dentists are dedicated to protecting the patient's oral health (Lara-Carrillo, Montiel-Bastida, Sanchez-Perez and Alanis-Tavira, n.d.).

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Patients who undergo orthodontic treatment with fixed appliances often face a challenging set of oral hygiene circumstances. Orthodontic bands, brackets, and wires are obstructions to brushing and flossing, and thus facilitate the buildup of plaque and put in danger gingival well-being. It has been well documented that orthodontic treatment with fixed appliances brings about an increased danger of caries and gingivitis. A microbiological alteration after the placing of orthodontic appliances has been demonstrated in many studies. Growing numbers of Streptococcu smutans and lactobacilli after bonding of fixed appliances have been found. Other reports have exposed statistically significant increases in alleged periodontal pathogens like spirochetes, motile rods, and other negative organisms (Schatzle, Thomas, Sener and Schmidlin, 2009).

TOPIC: Essay on Oral Hygiene and Decalcification in Orthodontics Assignment

Orthodontic appliances hinder tooth cleaning and can promote the onset of chronic hyperplastic gingivitis (CHG). The precise aetiology of chronic hyperplastic gingivitis is still not known, although plaque has been established to be the main contributory factor. It has also been documented that certain people are more susceptible because of genetic and environmental aspects. CHG leads to periodontitis and the loss of tooth attachment over time. The issue in orthodontics is whether appliances speed up the evolution from gingivitis to periodontitis. This is thought to happen because plaque accumulated between the brackets and bands and the gingival boundaries. Furthermore, plaque maintenance throughout fixed appliance orthodontic treatment has been found to be a significant aetiological feature in the progression of demineralization in addition to chronic hyperplasic gingivitis. It is often thought that the metals in orthodontic brackets and bands are cytotoxic and encourage localized inflammatory alterations in the gingival tissues. This has been clinically apparent when orthodontic bands have been placed sub-gingivally (Gray and McIntyre, 2008).

Effectual oral hygiene is particularly important for those who are undergoing orthodontic treatment. Fixed orthodontic appliances often prevent both successful tooth brushing and the mechanical cleaning act of mastication, which then leads to plaque buildup. Taking into contemplation the extended treatment times, stress must be placed on usual hygiene for the orthodontic patient, as well as professional tooth cleaning and home care directives (Arici, Alkan and Arici, 2007).

When teeth are banded for orthodontic therapy, metal is put completely around the tooth, leaving a metal-enamel connection both occlusally and gingivally. These locations, particularly in the gingival junction, are the major areas of plaque buildup. Following the placement of orthodontic bands and arch wires, there is a considerable increase in the facultative microbial population, comprising the streptococci, lactobacilli, staphylococci, and yeast. Along with a boost in the microbial population, there is an associated increase in both extracellular and intracellular carbohydrate per milligram of plaque. This increase in carbohydrates brings about an in increase in plaque persistence, decreasing the efficient washing of the tooth surface by saliva, and thus reduces salivary neutralization of acids, which then results in more acidogenic plaque. Enhanced techniques in the use of straightforward and indirect bonding of orthodontic brackets to teeth by resin systems have abridged the application of metal bonding. This bonding method allows the dentist to fasten the bracket to one surface of the tooth, thereby reducing the influenced surface area of the tooth. An enhancement in gingival health and reduced occurrence of decalcification has been seen when bonding has been used. Yet, even with the direct bonding methods, the dilemma of demineralization is not totally reduced. The connection between the bonding resin and the enamel is a regular site for plaque buildup and possible enamel demineralization. The resin used to fasten the bracket leaves an uneven margin around the bracket which then allows the oral micro-organisms to have a greater chance to attach and cultivate (Mattingly, Sauer, Yancey, and Arnold, 1983).

Iatrogenic demineralization of enamel all the way through orthodontic treatment takes place in about fifty percent of all patients. These abrasions are unattractive and often lead to premature ending of treatment. This is very exasperating not only for the dentist but for the patient as well. The active equilibrium that exists between enamel demineralization and remineralization is influenced by several things, comprising the regularity of refined carbohydrate consumption, along with the intake of carbonated soft drinks (Mattick, Mitchell, Chadwick and Wright, 2001).

The use of fluoride and antibacterial solutions has been highly recommended in order to decrease these unnecessary results. These measures are, however, reliant on either regular professional oral hygiene or patient conformity. Sealing of the enamel exterior with resin-based bonding materials or even the use of veneers have been suggested in order to guard the enamel in opposition to demineralization. Effectual brushing of the teeth is still the most significant preventive measure that there is. There are many types of toothbrushes have been designed and endorsed for use with orthodontic patients (Schatzle, Thomas, Sener and Schmidlin, 2009).

It is thought that low levels of fluoride can tip the equation in support of remineralization and is also known to slow down the development of plaque, which may then further inhibit decalcification. The accessibility of fluoride during orthodontic treatment is thought to reduce decalcification. It has been found that fluoride mouth washes are very successful. Unfortunately, this relies on patient fulfillment and it has been found that those patients who are most at risk for decalcification are thought to be the least likely to conform with added preventative measures. One answer to this problem may be to the use of elastomeric modules saturated with fluoride that would encourage fluoride uptake around orthodontic brackets. This is predominantly an attractive method of fluoride delivery, since it does not get in the way of routine clinical practice and guarantees fresh release of fluoride with each visit (Mattick, Mitchell, Chadwick and Wright, 2001).

It has been found that in spite of the status of dental caries, banded patients have been found to have significantly greater buccolingual S. mutans plaque populations, and considerably higher percentages of S. mutans in both buccolingual and interproximal plaque. It has also been discovered that carious banded patients have considerably higher S. mutans levels than carious non-banded patients do. Caries-free banded patients have also been found to have significantly more S. mutans-infected sample sites than non-banded patients without caries. Carious non-banded patients and all carious patients have been found to have an appreciably greater number of S. mutans-infected sites than caries-free people. This direct relationship among S. mutans plaque concentrations, the number of S. mutans-infected sample sites, and the occurrence of orthodontic bands and dental caries re-emphasizes the caries risk problem linked with orthodontic interference and thus promotes the need for an established adjunctive caries deterrence management during orthodontic treatment (Corbett, Brown, Keene and Horton, 1981).

The deterrence of enamel decalcification throughout orthodontic therapy is one of the biggest challenges for orthodontists. White spots are an esthetic dilemma and may necessitate restorations in more harsh cases, thus undermining one of the main reasons for orthodontic therapy. Throughout orthodontic treatment, some deterrent measures may be put into place in order to protect tooth structure. Oral hygiene training and supervision, mechanical removal of plaque and on a daily basis mouth rinses with fluoride solutions are a few of methods used by the orthodontist that depend on the collaboration of the patient. Perfect prevention should not depend on patient assistance, and relevance of sealing material, fluoride collagen resources and cements, and fluoride polish about the bracket may attain this objective (Katsue Miura, Yoko Ito, Enoki, Elias, Matsumoto (2007).

The profession of Orthodontics has encountered a number of significant technological advances over the last several years. A wide diversity of new materials, diverse treatment therapies and new diagnostic techniques has been included in the practice of orthodontics, resulting in an extraordinary development of the service excellence provide to the patients. Yet, orthodontists are still confronted by the dilemma of enamel demineralization around orthodontic appliances (Gontijo, Cruz, Roberval de Almeida and Paulo, 2007).


Arici, Selim, Alkan, Arzu and Arici, Nursel. (2007). Comparison of different tooth brushing protocols in poor-tooth brushing orthodontic patients. European Journal of Orthodontics,

29, 488 -- 492. doi:10.1093/ejo/cjm038.

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