Periodontal health and orthodontic treatment
Featured Products Promotional FeaturesPosted by: Dental Design 24th October 2024
As an increasing number of adults seek orthodontic treatment for aesthetic reasons as well as to restore function, it’s important to be reminded of the relationship between orthodontic treatment and periodontal health, which is both significant and complex.[i]
Understanding the connection is crucial for clinicians and patients, as it can impact the overall success of orthodontic procedures as well as the long-term gingival health and the supporting structures of the teeth. Poor periodontal health can lead to tooth mobility, loss of attachment, and even tooth loss.[ii]
Orthodontic treatment as a benefit to periodontal health
While there are challenges associated with orthodontic treatment and periodontal health, there are also many potential benefits.[iii] Straightening teeth can lead to a less traumatic occlusion, reducing the acceleration of bone loss in those patients suffering with periodontal disease. Addressing malocclusion has also been found to result in a reduction of periodontal pocket depths in some patients.[iv]
Once orthodontic treatment is complete, and teeth are aligned, patients can often find it easier to maintain proper oral hygiene due to improved tooth alignment, which can contribute to better long-term periodontal health. iii
Careful remodelling
The primary goal of orthodontic treatment is to reposition teeth. As teeth move, a complex series of changes occur around the surrounding periodontal tissues and alveolar bone. Whilst remodelling tissue and bone is an essential part of orthodontic treatment, the process can temporarily affect the health of these tissues, and has to be managed and monitored carefully to prevent complications.
Healthy periodontal structures include a root cementum, periodontal ligament (PDL), and alveolar bone, and constitute a functional unit or organ. The PDL forms a vitally important and complex connection between teeth and the alveolar bone.[v] Fibroblasts from the PDL maintain and repair the alveolar bone as well as the cementum of the teeth. Orthodontic treatment can result in traumatic widening of the PDL, which can cause it to thicken, affecting its function. This widening is implicated in the processes resulting in the thinning of alveolar bone as well as gingival recession, and is considered to be a warning sign of periodontal disease. [vi]
Before commencing any orthodontic treatment, a thorough periodontal assessment is essential. Clinicians should evaluate the health of the gums and supporting structures to identify any pre-existing conditions. Treating periodontal issues, and evaluating patient motivation prior to orthodontic intervention is vital to ensure better outcomes and minimise risks during treatment.i
Regular monitoring of periodontal health throughout orthodontic treatment is also crucial. The dental team should work collaboratively to ensure that patients maintain good oral hygiene and that any signs of periodontal disease are addressed promptly.
Oral hygiene challenges during treatment
Patients with fixed appliances may find it challenging to maintain adequate oral hygiene around brackets and wires to prevent the spread of harmful bacteria. The intricate surfaces of braces can create additional opportunities for food particles to accumulate, leading to the formation of biofilm, increasing the risk to periodontal health.i
The antibacterial and flushing effects of saliva, as well as contact with the lips and tongue that help keep teeth and gingiva clean can be hampered during clear aligner treatment, and tight, form-fitting plastic of aligners or retainers create new surfaces for biofilm to adhere to.[vii] Keeping aligners clean is vital to protect oral health, and to prevent demineralisation, fluoride toothpaste, rinses and gels are recommended.[viii]
Support for patients
Regular oral health examinations with both orthodontists and dental hygienists are important for professional cleanings and monitoring periodontal health during treatment. Maintaining excellent oral hygiene is paramount to prevent periodontal complications. Patient education is essential to ensure they brush their teeth at least twice a day.
Patients with fixed appliances should also be shown how to perform interdental cleaning during treatment, and how to clean around brackets and wires effectively. Incorporating antimicrobial mouth rinses and gels can help reduce the build-up of biofilm, protecting teeth and gingiva throughout their treatment. Enhanced oral hygiene routines are important post-treatment too, as subgingival bacteria can remain higher than average for orthodontically treated patients for up to 6 months after the removal of their fixed appliance.[ix]
Oral hygiene products like the FLEXI range of interdental brushes from TANDEX are perfect for use with orthodontic appliances. FLEXI comes in 11 different brush sizes to suit every interdental space, and is perfect for cleaning difficult-to-reach areas around brackets and wires. Extra protection can be easily achieved by adding a small amount of PREVENT Gel to FLEXI brushes. With 0.12% chlorhexidine and 900 ppm fluoride, the gel is perfect for everyday oral hygiene routines.
Due to the strong links between periodontal health and orthodontic treatment, clinicians continually prioritise periodontal assessment and monitoring throughout the treatment process to ensure optimal outcomes. By understanding the interplay between orthodontics and periodontal health, both practitioners and patients can work together to achieve not only a straighter smile but also excellent overall oral health.
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[i] 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.
[ii] Overview: Gingivitis and periodontitis NUH.nlm.com, August 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279593/ Accessed August 2024
[iii] Alfuriji S, Alhazmi N, Alhamlan N, Al-Ehaideb A, Alruwaithi M, Alkatheeri N, Geevarghese A. The effect of orthodontic therapy on periodontal health: a review of the literature. Int J Dent. 2014;2014:585048. doi: 10.1155/2014/585048. Epub 2014 May 29. PMID: 24991214; PMCID: PMC4060421.
[iv] Javali MA, Betsy J, Al Thobaiti RSS, Alshahrani RA, AlQahtani HAH. Relationship between Malocclusion and Periodontal Disease in Patients Seeking Orthodontic Treatment in Southwestern Saudi Arabia. Saudi J Med Med Sci. 2020 May-Aug;8(2):133-139. doi: 10.4103/sjmms.sjmms_135_19. Epub 2020 Apr 17. PMID: 32587495; PMCID: PMC7305683.
[v] Jan A. De Boever, AnneMarie De Boever, in Functional Occlusion in Restorative Dentistry and Prosthodontics, 2016
[vi] Rizk, M., Niederau, C., Florea, A. et al. Periodontal ligament and alveolar bone remodeling during long orthodontic tooth movement analyzed by a novel user-independent 3D-methodology. Sci Rep 13, 19919 (2023). https://doi.org/10.1038/s41598-023-47386-0
[vii] Celestino Nobrega, Gabriel Pereira Nunes, Yvonne de Paiva Buischi, Natália de Campos Kajimoto, Alberto Carlos Botazzo Delbem, In vitro assessment of dental erosion caused by clear aligners, Journal of the Mechanical Behavior of Biomedical Materials, Volume 152, 2024, https://doi.org/10.1016/j.jmbbm.2024.106390.
[viii] Moshiri M, Eckhart J, McShane P, German DS. Consequences of Poor oral hygiene During Clear aligner Therapy. August 2023. https://smilesaintlouis.com/wp-content/uploads/2021/09/consequences-poor-hygiene.pdf
[ix] Papageorgiou SN, Xavier GM, Cobourne MT, Eliades T. Effect of orthodontic treatment on the subgingival microbiota: A systematic review and meta-analysis. Orthod Craniofac Res. 2018 Nov;21(4):175-185. doi: 10.1111/ocr.12237. Epub 2018 Jul 20. PMID: 30028077.
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