Editorial

Oral hygiene affected by the use of orthodontic appliances

0000-0003-1885-0938Yadira Yanes Ruiz^{1  *}  , 0000-0002-8101-9234Orlando Martín Cárdenas¹ 

¹Clínica Estomatológica Provincial de Sancti Spíritus, Sancti Spíritus, Cuba.

Dentomaxillofacial anomalies are considered the third most frequent oral health problem in many countries, which has led to an increase in orthodontic treatment in recent years. ¹

Orthodontics is the specialty that studies the prevention and correction of anomalies of the dental arches and jaws. For its treatment it mainly includes three types of appliances: functional, removable or fixed; ² they are essential tools for the patients’ management.

The use of appliances, mainly those fixed, is associated with gingival inflammation, bleeding, gingival hyperplasia and white spot lesions, since it creates retention areas that predispose to greater accumulation of supragingival plaque; this way the normal conditions of the oral environment are altered, changing the composition of the bacterial flora. ⁽³ also it has even been associated with changes in the buffering capacity of saliva.

Among the main causes related is the interference for an adequate brushing and cleaning of the oral cavity. Oral hygiene is more complicated to perform especially close to the gingival margin, in the interproximal area and around brackets and bands, places where greatest decalcification of the enamel and inflammation occur. ¹

The oral microecological theory refers that exists an ecological balance between the microorganisms in the mouth and the individual, that is altered when the host conditions change. ¹

One of the most frequent changes is due to the increase of dental plaque, a heterogeneous accumulation of bacteria, viruses, fungi and sugars like a colorless film that adheres to the teeth; this can become resilient and form some tartar, which requires more complex treatments; moreover, if the patient has local or systemic factors it makes him susceptible to its accumulation. ⁴

This organic film of salivary origin is present in healthy and sick people, it forms a deposit on the surface of the hydroxyapatite of the dental enamel and although it protects this one from the incorporation of acids, it is destructive when collaborating with the colonization of bacteria through calcium bridges. ⁵ Under normal conditions the plaque formation occurs a few minutes after cleaning the surface of the teeth; its development is ruled by a constant dynamic according to the good or bad hygiene of the patient. ³

Plaque is constantly generated on the teeth and if it is not correctly removed daily, it accumulates on the tooth and in the gingival sulcus (located between the tooth and the gum). After a few days, gingivitis (gum inflammation) may appear, characterized by reddish gum color, swollen texture and bleeding when brushing. ² This complication may slow down the course of tooth movement, even forcing its suspension. ^6,7

The other two most frequent oral diseases are dental caries and periodontal diseases, for which bacterial plaque is a triggering factor. White spot lesions around the teeth occur in 13-50 % of patients, due to changes in the oral environment, such as decreased pH and salivary flow. ⁸

The increase of retentive surfaces rises the bacterial levels of Streptococcus mutans and Lactobacillus, and the demineralization of the enamel, as there is a 10-micron space between the resin which the brackets are cemented and the periphery of the demineralized enamel, then generates microfiltration and early colonization of bacteria. ⁹

At present, the main method of controlling supragingival dental plaque is mechanical action by toothbrushing, interproximal brushing and flossing. Chemical agents such as mouth rinses and toothpastes are also used, but these mouth rinses improve hygiene when they are an adjunct to toothbrushing. ³

Antimicrobial agents used to inhibit bacterial plaque formation and therefore to prevent or eliminate gingivitis only affect supragingival plaque and can be divided into bis-biguanide antiseptics, quaternary ammonium, phenolics or essential oils, metal ions and natural products. ³

In order to achieve good results in orthodontic treatment, it is important to maintain optimal oral hygiene by brushing the teeth and orthodontic appliances properly. ²

Despite the advances in recent years in terms of techniques and materials used in orthodontics, the development of demineralization and dental caries around the appliances continues to be a problem; therefore, it is necessary to consider the actions that should be prioritized in oral hygiene through education, specific and individual training also application of preventive measures. ⁴

In order to promote healthy behaviors, it should be taken into account that people need information on what to do and how to do it; this information allows fostering the emergence of new beliefs that can be included in the cultural traditions of human groups. ⁹

One of the aspects to be emphasized in health promotion is self-care, a set of actions and decisions that a person takes to maintain and improve their state of health, as well as to prevent, diagnose and attenuate the negative impact of the disease. ¹⁰ The actions of health promotion and disease prevention constitute an indispensable tool to provide a solution to dentomaxillofacial anomalies as a health problem. ²

Health education as a strategy in health promotion has become a form of teaching, which aims to lead the person and the community to a process of change of attitude and behavior, starting from the detection of their needs and trying to result in the improvement of the health conditions of the individual and their community. ¹⁰

The essence is always the same: to achieve changes in the thinking and acting of people, based on a preventive rather than curative conception of Stomatology. ¹⁰

Learning opportunities should be facilitated, as far as possible, so it is necessary to promote experiences aimed at the exercise of those skills that are intended to develop by children, where creativity and motivation should be an impulse targeted to satisfying and strengthening the achievement of good habits that stimulate their independence. ¹¹

It is necessary to train, instruct, document or conduct talks with parents to make them aware of the importance of hygiene, not only for the health of children, of great importance, but also at the affective and social level, making a commitment to exercise what they have learned in their homes also all members of the family do it. ¹²

Health education for children has additional advantages, since in addition to developing favorable attitudes and practices for the maintenance of their health from early age, it constitutes a good way for family education. ¹⁰

It is necessary to develop preventive programs that reinforce the treatment quality so to reduce the economic and biological costs for the patient and can also fulfill the aesthetic objectives wanted. Patients should be provided with periodic advice and instructions on oral cavity hygiene and appliances, that will result in a preventive effect. ¹

Comprehensive orthodontic practice should include an oral hygiene program that includes a detailed explanation on the relationship between bacterial plaque and inflammation, dietary advice, patient training about some techniques and products available for plaque removal, and finally, monitoring of their efficiency when used by the patient. ³

Oral hygiene programs should be implemented prior to the start of orthodontic treatment in order to prevent detrimental effects and be maintained throughout all the time the patient receives orthodontic treatment, which may decrease the risk of infectious oral diseases. ¹³

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Received: March 08, 2022; Accepted: April 24, 2022

^*Autor para la correspondencia. Correo electrónico: [e-mail]

Los autores declaran que no existen conflictos de intereses.