Adherence to Dietary Advice and Oral Hygiene Practices Among Orthodontic Patients

A cross-sectional study to correlate oral hygiene habit among orthodontic patients with their clinical findings and periodontal treatment need

BACKGROUND

Orthodontic treatment requires good oral hygiene for successful completion of treatment. As protocol, patients are usually given instructions for oral hygiene and diet at the start of treatment, however, they are not fully followed. Different methods are employed in order to increase patient compliance including digital means, however, these are not possible in teaching hospitals with high burden of patient care and limited resources. The present study aims to correlate the patient reported behavior with their clinical findings and treatment need. This will enable us to identify potential sources of motivation which will be incorporated in daily practice and enable us to improve methods to enhance patient's behavior.

METHOD

A cross-sectional study was conducted in the orthodontic department of a semi-government teaching hospital from August to October 2023 using a modified questionnaire. The clinical examination was done using a Community Periodontal Index for Treatment Need-C (CPITN-C) probe. The diagnosis of presenting clinical conditions and treatment need was done using Community Periodontal Index for Treatment Need (CPITN) and Gingival Bleeding Index (BI). Data collected was analyzed for frequencies and correlation was done using Spearman Correlation Coefficient. P- value ≤ 0.05 was taken as statistically significant.

RESULT

The sample size consisted of 110 patients of which 60% were entitled to receive treatment. The predominant age group was 15-20 years (39.1%). Approximately 70% patients were in code 1 for CPITN and GI and in need of oral hygiene instructions. Overall patients' showed good level of awareness, however, they were not compliant in behavior.

CONCLUSION

Although patients showed a good level of awareness towards oral hygiene practices, there was a lack of compliance in following them. Patients were more concerned for being affected by dental caries due to poor oral hygiene than its effect on overall treatment outcome.

Assessment of Motivations, Treatment Risks, and Oral Health in Adults with Fixed Orthodontic Care: A Cross-Sectional Study

Aim: This cross-sectional study aims to investigate the reasons why adults seek orthodontic treatment, their perceived treatment risks, oral hygiene habits, and awareness of oral health. Materials and Methods: This study, which involved 246 adults, used a self-report questionnaire to collect sociodemographic data and examine the participants' understanding of oral health, self-assessment of oral health status, adherence to oral hygiene routines, and use of oral hygiene products. In addition, the reasons for opting for orthodontic treatment, negative associations, and expected outcomes were examined. The collected data were subjected to statistical analysis, including descriptive and regression methods. Results: The results showed that factors such as previous oral health education and regular use of specialized toothbrushes, including rotary toothbrushes, were significantly associated with higher knowledge levels (p < 0.05). However, daily oral hygiene practices were suboptimal, with the low utilization of aids: only 58.9% reported using interdental brushes, and 36.6% used dental floss regularly. Commonly reported dental problems included food debris between teeth (46.3%), tartar (35.4%), and tooth sensitivity to cold (26.4%). The primary motivations for orthodontic treatment were aesthetic improvement (63.8%), enhancements in oral function (49.6%), and addressing psychosocial concerns (42.7%). In contrast, the most frequently mentioned negative aspects associated with fixed orthodontic treatment were aesthetic concerns (30.9%), treatment duration (27.6%), and mouth ulcers (24.0%). Conclusions: Based on the research findings, regular oral hygiene education is recommended for adult patients considering fixed orthodontic therapy, including the use of additional tools such as interdental brushes and floss to improve oral health and reduce the risk of complications during treatment. The importance of chemical compounds in dentifrices and mouthwashes cannot be overstated, as they play a crucial role in addressing various dental issues. In addition, it is crucial to carefully weigh the pros and cons of therapy and to visit a dentist regularly to maintain oral health and monitor progress during treatment.

White Spot Lesions in Fixed Orthodontics: A Literature Review on Etiology, Prevention, and Treatment

White spot lesions (WSLs) are a common complication after treatment using fixed orthodontic appliances. Decalcification of enamel surrounding fixed orthodontic appliances, known as WSLs, poses a significant aesthetic difficulty during and after treatment, as the purpose of fixed orthodontic therapy is to improve facial and dental appearance. Modern dentistry utilizes remineralization therapies to non-invasively treat WSLs to prevent the progression of disease and enhance the strength, appearance, and functionality of the affected tooth. This review aims to identify and assess the etiology, formation, and risk factors, as well as current treatment approaches used in achieving WSLs remineralization, induced by fixed orthodontic appliances. An electronic search on the PubMed and ScienceDirect databases was performed using a selected keyword. A total of 172 studies (from 2013 to 2023) were retrieved. Their references were also checked to find other relevant studies. Duplicate copies were excluded. After the abstract and full-text screening, only 39 studies were included. Even though numerous studies address the different treatment modalities for managing post-orthodontic WSLs, such as antiseptics; fluorides such as dentifrices, mouthwash, and varnish, and remineralizing agents such as casein phosphopeptides amorphous calcium phosphate, biomimetic self-assembling peptides, lasers, bleaching, microabrasion, and resin infiltration. There is a lack of evidence-based studies that examine the long-term effects of WSL treatment. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

Successful Management of a Tooth With an Endodontic-Periodontal Lesion Using a Bone Graft

As periodontal and endodontic tissues have a close association, they come into close touch and have a lot of possible places for communication. In a clinical setting, this correlation promotes infection spread and results in the typical endo-perio lesion appearance. Because the two tissues are in close touch with one another, managing such lesions can be difficult. The success of treatment depends on a thorough examination and careful planning, with the sole focus on repair and regeneration. In these situations, bone graft materials with such characteristics have demonstrated encouraging outcomes. The treatment outcome along with a follow-up for a case of an endo-perio lesion with furcation involvement is shown in the accompanying case report. In treating such instances, a multidisciplinary approach is necessary, emphasizing regeneration.

Impact of Orthodontic Treatment on the Incidence of Dental Caries in Adolescents: A Prospective Cohort Study

BACKGROUND

Orthodontic treatment is a widely embraced intervention aimed at enhancing dental aesthetics and correcting malocclusions among adolescents. However, concerns persist regarding its potential impact on oral health, particularly on the development of dental caries. This study aimed to systematically investigate the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents.

METHODS

A prospective cohort design involving adolescents aged 12-18 years was employed. A total of 82 patients met the inclusion criteria. In addition, an age-matched control group of 82 participants who did not undergo orthodontic treatment was included. The study included both a treatment group undergoing orthodontic treatment (braces or aligners) and an age-matched control group that did not undergo any orthodontic intervention. Demographic characteristics, orthodontic treatment details, and oral hygiene practices were documented at baseline and throughout the study period. Dental examinations at six-month intervals post-treatment were conducted to track the incidence and progression of carious lesions.

RESULTS

The demographic characteristics, baseline oral health status, orthodontic treatment details, and oral hygiene practices were comparable between the treatment and control groups. Post-orthodontic treatment assessment revealed a slightly higher incidence of new carious lesions in the treatment group (14.6%) than in the control group (9.8%), although this difference was not statistically significant (p = 0.15). Dental examinations at six-month intervals demonstrated a gradual increase in caries incidence over time in both groups, with no substantial disparities observed.

CONCLUSIONS

This study provides a comprehensive examination of the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents. While a trend towards higher caries incidence in the treatment group was observed, the difference was not statistically significant. These findings contribute to the existing body of knowledge and emphasize the need for ongoing research to guide clinical practice.

Orthodontic Pain and Dietary Impact Considering Age Groups: A Comparative Study

(1) Background: orthodontic treatment can frequently be associated with discomfort and pain, a significant factor contributing to treatment discontinuation. (2) Methods: This study, conducted on 160 orthodontic patients across different age groups, aimed to explore the influence of age on patients' responses to treatment, particularly regarding changes in dietary patterns and weight loss. The patients were categorized into three age groups and assessed through a questionnaire about pain perception, pain latency, dietary changes, and weight loss associated with orthodontic appliances. (3) Results: Younger patients (6-12 years) reported lower pain levels, shorter pain latency and fewer alterations in dietary habits compared to adults (over 18 years). Females over 18 represented a significant portion of the sample, suggesting a self-driven inclination towards orthodontic treatment for aesthetic reasons. Fixed orthodontic appliances induced more significant pain than removable ones. Adults experienced more changes in dietary habits and weight loss than younger individuals. (4) Conclusions: the results provide valuable insights for orthodontic practitioners aiming to mitigate adverse effects and improve overall patient experience during treatment.

Oral hygiene awareness and practice in orthodontic patients in Makkah city: A cross sectional study

OBJECTIVES

To evaluate the level of oral hygiene awareness and practice among orthodontic patients that have fixed appliances and investigate the differences in awareness as per age, gender, and education qualification.

MATERIALS AND METHODS

A cross-sectional study with 250 patients was included. A questionnaire was used to collect information regarding the patient's oral hygiene.

RESULTS

The level of awareness and oral hygiene practice was significantly higher among females, with a consistent stepwise increase toward older ages. Also, increased with higher education level, longer duration since getting the appliance, and receiving instructions from the orthodontist.

CONCLUSIONS

Oral hygiene instructions received by the orthodontist play an important role in the patient's awareness level. Also, many predictors have a significant effect on the patient's cooperation in practicing oral hygiene measures.

Significance of Non-Statistically Significant Results in the Prediction of Oral Health-Related Quality of Life in Orthodontic Patients: A Survey Using Two Linking Questionnaires

Patients with a fixed orthodontic appliance may have difficulties in maintaining good oral health-related quality of life (OHRQoL), and evaluating self-perceived OHRQoL in orthodontic patients could be challenging for their orthodontists. Therefore, this research was conducted to investigate whether orthodontic postgraduates would accurately evaluate the OHRQoL of their patients. Two self-administered questionnaires were designed for patients to rate their OHRQoL and for their orthodontic postgraduates to evaluate them on OHRQoL. All pairs of patients and their orthodontic postgraduates were requested to independently complete the questionnaires. Pearson's correlation and multiple linear regression were performed to determine the relationships of the variables and to identify significant predictors on OHRQoL, respectively. There were 132 pairs of orthodontic patients and their residents who completed the questionnaires. There were no significant correlations between OHRQoL perceived by patients and evaluated by their orthodontic postgraduates in all aspects of treatment needs and dietary difficulties (p > 0.05). In addition, the regression model demonstrated no significant predictors for the self-perceived treatment needs and dietary difficulties of orthodontic patients. There seemed to be challenges for orthodontic postgraduates to evaluate their patients' oral health-related quality of life. Therefore, the OHRQoL measures should be increasingly implemented in orthodontic education and practice in order to enhance the concept of patient-centered care.

Influence of resin modified glass ionomer cement incorporating protein-repellent and antimicrobial agents on supragingival microbiome around brackets: an in-vivo split-mouth 3-month study

Objective

To explore the influence of resin modified glass ionomer cement (RMGIC) adhesives containing protein-repellent and quaternary ammonium salt agents on supragingival microbiome, enamel and gingival health around brackets.

Materials and Methods

Ten patients (21.4 ± 3.5 years) about to receive fixed orthodontics were enrolled in this study. Unilateral upper teeth bonded with RMGIC incorporating 2-Methacryloyloxyethyl phosphorylcholine (MPC) and Dimethylaminohexadecyl methacrylate (DMAHDM) were regarded as experimental group (RMD), while contralateral upper teeth bonded with RMGIC were control group (RMGIC), using a split-mouth design. Supragingival plaque was collected from both groups before treatment (T0), and at 1 month (T1) and 3 months (T2) of treatment. High-throughput sequencing was performed targeting v3-v4 of 16S rRNA gene. Streptococcus mutans and Fusobacterium nucleatum quantification was done by qPCR analysis. Bracket failures, enamel decalcification index (EDI), DIAGNODent scores (Dd), plaque index (PI) and gingival index (GI) were monitored at indicated time points.

Results

Within 3 months, alpha and beta diversity of supragingival plaque had no difference between RMGIC and RMD groups. From T0 to T2, the relative abundance of Streptococcus depleted in RMD but remained steady in RMGIC group. Streptococcus, Prevotella, and Fusobacterium became depleted in RMD, Haemophilus and Capnocytophaga became depleted in RMGIC group but Prevotella enriched. Quantification of Fusbacterium nucleatum and Streptococcus mutans showed significant difference between RMGIC and RMD groups at T2. Teeth bonded with RMD had significant lower plaque index (PI) and DIAGNODent (Dd) score at T2, compared with teeth bonded with RMGIC (p < 0.05). No difference in bracket failure rate was examined between both groups (p > 0.05).

Conclusion

By incorporating MPC and DMAHDM into RMGIC, the material could affect the supragingival microbial composition, inhibit the progress of plaque accumulation as well as the key pathogens S. mutans and F. nucleatum in the early stage of orthodontic treatment.

The Effect of Nano Calcium Carbonate and/or Recombinant Bone Morphogenetic Protein as a Biological Orthodontic Retainer on the Body Weight of Experimental Rat

BACKGROUND

Retention after orthodontic tooth movement (OTM) is essential to prevent relapse. This study examined the effects of a fixed orthodontic device and Nano Calcium Carbonate (CaCO₃) nanoparticles with or without recombinant human bone morphogenetic protein (rhBMP) on rat body weight.

MATERIALS AND METHODS

OTM was administered for 21 days to 80 Wistar Albino rats. First molar mesialization was active then forming two 40-rat groups which were subdivided into four subgroups of 10 rats each. These subgroups received 5 µg/kg rhBMP, 75 µg/kg CaCO₃, 80 µg/kg rhBMP-loaded CaCO₃ and one control. The relapse rate was examined weekly over the second 21 days when the second group exhibited mechanical retention and the first did not. Group 1 rats were murdered after 21 days (day 42), whereas group 2 rats entered a third 21-day post-retention period and then murdered (day 63). BW and OTM were measured on days 1, 21, 28, 35, 42, and 63.

RESULTS

Within each group, the animal body weight was reduced significantly after the intervention and continued over time with a higher average reduction in the 9-week group than the 6-week group. However, there were no significant (P-value ˃0.05) differences in the BW between the groups of the two (6-week and 9-week) sets and the subgroups of the 6-week set across each time point. In contrast, there was a significant (P-value ˂0.05) difference between the BW of the conjugate subgroup and the other three subgroups in the 9-week set, particularly on 63^rd day.

CONCLUSION

CaCO₃ nanoparticles and/or BMP with orthodontic treatment collectively or individually cause a reduction of body weight in rats.

Motivation, Perception, and Behavior of the Adult Orthodontic Patient: A Survey Analysis

Purpose

The article is aimed at improving the understanding of the sociocultural profile of adult orthodontic patients and their expectations. In particular, it addresses three main aspects: the motivation and needs that underpin the decision to start orthodontic treatment, how it influences the patients' daily life, and the different oral hygiene demands.

Materials and Methods

An online survey was completed by 276 patients undergoing orthodontic treatment with different techniques. The questions asked concerned gender, age, type of appliance, any previous orthodontic treatments, type of any previous retainers, reasons for therapy, satisfaction, pain, problems in eating, daily number of teeth brushings and flossings before and during the treatment, perception of cost, sensation of visibility of the appliance, and if they would recommend orthodontic treatment.

Results

A significant role within our sample is played by gender; 87.94% consisted of female patients out of which 72.57% wanted to improve their aesthetics, while only 54.84% of male patients cited the same reason. Invisible aligners were preferred by 67.70% of the patients due to them being considered the least painful, causing the fewest problems with eating, and the least visible. Metal braces were perceived as the less expensive treatment. Over a third of the patients (33.85%) had previously undergone orthodontic treatment, among them 54.05% wore a mobile retainer, 31.08% a fixed one, and 14.86% both. Daily tooth brushing and flossing increased during therapy with clear aligners by 48.94% and 126.39%, respectively.

Conclusions

The greatest demand for orthodontic treatments comes from women, as they pay more attention to aesthetics, which makes the clear aligners the most common choice. The relapse after orthodontic treatment seems to cause a higher demand for retreatment, and oral hygiene habits significantly improve during orthodontic treatment, especially with the clear aligners.

Oral Hygiene Practices and Knowledge among Adolescents Aged between 15 and 17 Years Old during Fixed Orthodontic Treatment: Multicentre Study Conducted in France

The aims of this study were to assess oral health knowledge, attitudes, and practices among orthodontic patients between the ages of 15 and 17 years old compared to adolescents without orthodontic treatment. This cross-sectional study included 392 adolescents drawn from various French teaching hospitals. A closed-ended questionnaire was used to collect data. Adolescents undergoing orthodontic treatment had a higher knowledge of oral health than adolescents without orthodontic treatment. The majority of adolescents for both groups (69%) claimed to brush their teeth twice a day. Regarding complimentary dental material, 81.9% of adolescents without orthodontic treatment never used an interdental brush and 78.8% never used dental floss. For those undergoing orthodontic treatment, 48.5% never used an interdental brush. Only 4% of adolescents without and 3% of adolescents with orthodontic treatment never consumed fizzy drinks, 4.9% and 3% never consumed sweets, and 4% and 8.4% never ate fast-food. Adolescents without treatment consumed more sodas (p = 0.048) and more fast food (p = 0.029). Adolescents had insufficient knowledge of oral health. Health education programmes should be implemented to improve adolescents’ knowledge and individual oral prophylaxis with interdental brushes.