Optimising oral hygiene for orthodontics

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  Posted by: Dental Design      27th March 2024

Malocclusion can have a significant impact on a patient’s quality of life. Oral function may be seriously impaired, causing issues with mastication, swallowing and speech. It can also make oral hygiene more difficult, increasing the risk of gingivitis and caries. In addition, there are implications for a person’s social status and psychological wellbeing when their malocclusion is bad enough to influence interactions with others and dampen self-confidence.[i] In many situations, orthodontics provides a solution by aligning the teeth, enhancing function, hygiene and aesthetics.

Despite the many advantages of orthodontic therapy, it is widely acknowledged that oral hygiene tends to suffer during treatment. Studies[ii] have demonstrated that both the number of decayed, missing and filled permanent teeth, and plaque index scores increase during orthodontic therapy among adolescents. Research[iii] has confirmed that the oral microbiota changes when any orthodontic appliance is fitted, resulting in a significantly increased bacterial count. These alterations can be detected one month after treatment commences. There is also evidence that the type of appliance impacts the risk of oral health concerns.

A recent systematic review and meta-analysis[iv] compared levels of oral hygiene between patients with fixed and removable appliances. Though it found only relatively low-quality evidence, it did suggest that fixed solutions lead to higher plaque scores, as well as higher incidence of S.mutans and lactobacilli bacteria in the first 6-12 months after treatment begins.

Why is this important for the general dental practitioner to be aware of and confident in supporting patients through? Because demand for adult orthodontics is on the up. Approximately 76% of UK orthodontists reported a rise in demand for treatment among adults in the three years preceding August 2023.[v] A large proportion of this increase has been attributed to more time spent on video calls, in addition to the greater sway of influencers and celebrities. With no sign that this will change again any time soon, we can safely assume a continued need for orthodontic solutions.

The importance of oral hygiene during treatment must be highlighted to patients in order to optimise outcomes. For example, orthodontic treatment in periodontally-compromised patients can lead to axillary anterior teeth proclination, absence or loss of interdental spacing, tooth rotation, super-eruption, pathological tooth migration and tooth loss.[vi]

While many people understand the importance of oral health, there is still a disconnect between their perceptions and how effective their dental hygiene actually is. For instance, one survey[vii] found that almost 80% of orthodontic patients believed their oral hygiene to be good, even though 51% reported bleeding gums. As such, continued and intensive education is essential throughout orthodontic treatment,[viii] teaching patients how to reduce bacterial counts while navigating orthodontic brackets or other considerations.

It has also been found that reinforcing oral hygiene by communicating key messages post-treatment is advantageous in enhancing patient compliance.[ix] Reminding patients either by text or phone call has been shown to significantly improve motivation and lead to lower plaque index scores in patients after tooth alignment is achieved. Other research has highlighted the positive role that dietary advice can have on post-treatment oral health as well.[x]

Of course, all of this requires excellent communication from practitioner to patient, delivering information on the potential risks faced during orthodontic therapy in a way that they really understand and can relate to. This is the cornerstone of effective patient education in relation to any type of dental treatment, including orthodontics.

Importantly, this communication and education should continue beyond treatment completion. Finding innovative yet efficient and convenient ways to remind patients about their commitment to oral hygiene even once alignment is achieved, is crucial.

Use of cutting-edge technologies can help substantially, facilitating communication as frequently as necessary with just the click of a button. Sharing useful information in a digital format also enables patients to review the oral hygiene advice and recommendations at a time that best suits them, retaining access for as long as they need it. This is just one of the functionalities that Chairsyde provides. A state-of-the-art patient consultation platform, Chairsyde features a stunning library of animations that clearly explains a vast range of dental conditions and related treatment procedures – including different orthodontic solutions – along with all their benefits and risks. Once shown to patients during an appointment, these animations are automatically recorded in patient notes and can be easily emailed to patients for review at home. Chairsyde is also fully integrated with Dentally and Software of Excellence practice management software for convenience. This technology could be the game-changer you need to help your patients optimise their oral hygiene during and after orthodontic treatment!

However you support your patient education and communication, ensuring they have the right information and are motivated to follow it, is crucial for the best possible results. Orthodontic appliances may increase the risk of oral bacteria, but effective dental hygiene will ensure treatment outcomes are never jeopardised. 

For more information, or to book a Chairsyde demo, please visit

www.chairsyde.com or call 020 3951 8360

[i] Elyaskhil, M., Shafai, N.A.A. & Mokhtar, N. Effect of malocclusion severity on oral health related quality of life in Malay adolescents. Health Qual Life Outcomes 19, 71 (2021). https://doi.org/10.1186/s12955-021-01710-2

[ii] Cantekin K, Celikoglu M, Karadas M, Yildirim H, Erdem A. Effects of orthodontic treatment with fixed appliances on oral health status: A comprehensive study. Journal of Dental Sciences. 2011: 6 (4): 235-238. ISSN 1991-7902. https://doi.org/10.1016/j.jds.2011.09.010.

[iii] Lucchese A, Bondemark L, Marcolina M, Manuelli M. Changes in oral microbiota due to orthodontic appliances: a systematic review. J Oral Microbiol. 2018 Jul 3;10(1):1476645. doi: 10.1080/20002297.2018.1476645. PMID: 29988826; PMCID: PMC6032020.

[iv] Oikonomou E, Foros P, Tagkli A, Rahiotis C, Eliades T, Koletsi D. Impact of Aligners and Fixed Appliances on Oral Health during Orthodontic Treatment: A Systematic Review and Meta-Analysis. Oral Health Prev Dent. 2021 Jan 7;19(1):659-672. doi: 10.3290/j.ohpd.b2403661. PMID: 34874143.

[v] British Orthodontic Society. New stats from The British Orthodontic Society reveal online working triggers a rise in adults seeking tooth straightening treatment. August 2023. https://bos.org.uk/news/new-stats-from-the-british-orthodontic-society-reveal-online-working-triggers-a-rise-in-adults-seeking-tooth-straightening-treatment/ [Accessed January 2024]

[vi] Alsulaimani L, Alqarni H, Akel M, Khalifa F. The Orthodontics-Periodontics Challenges in Integrated Treatment: A Comprehensive Review. Cureus. 2023 May 14;15(5):e38994. doi: 10.7759/cureus.38994. PMID: 37323308; PMCID: PMC10262598.

[vii] Guo J, Li L, Guan G, Bennani F, Mei L. Oral health knowledge and practice among orthodontic clients in China and New Zealand. Can J Dent Hyg. 2020 Oct 1;54(3):124-132. PMID: 33240372; PMCID: PMC7668273.

[viii] Yadav J, Shinh AS, Natt AS, Maheshwari K, Aulakh S. Oral hygiene status: The critical parameter in orthodontic patient. J Clin Adv Dent. 2023; 7: 007-012.

[ix] Cozzani M, Ragazzini G, Delucchi A, Mutinelli S, Barreca C, Rinchuse DJ, Servetto R, Piras V. Oral hygiene compliance in orthodontic patients: a randomized controlled study on the effects of a post-treatment communication. Prog Orthod. 2016 Dec;17(1):41. doi: 10.1186/s40510-016-0154-9. Epub 2016 Dec 19. PMID: 27891568; PMCID: PMC5165014.

[x] Aljohani SR, Alsaggaf DH. Adherence to Dietary Advice and Oral Hygiene Practices Among Orthodontic Patients. Patient Prefer Adherence. 2020 Oct 20;14:1991-2000. doi: 10.2147/PPA.S277034. PMID: 33116442; PMCID: PMC7586054.

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