The Relationship between Orthodontic Treatment and Dental Caries

Abstract

Orthodontic treatment is the main treatment procedure to achieve a well-aligned dental arch and an esthetic smile. For this purpose, various types of removable or fixed orthodontic appliances are designed. However, each has their specific disadvantages. The most important one is that orthodontic appliances especially the brackets and the ligation mode create new retention areas in addition to blocking plaque-removing shear forces arising from fluid flow and masticatory loads with a resultant undesired effect of accumulation of dental plaque. Increased amount of dental plaque containing cariogenic bacteria is the main etiologic factor in decalcification of enamel during orthodontic treatment. This demineralization of the tooth surfaces results in appearance of white spots or even caries. However, in the literature, there are conflicting results in the relationship between orthodontic treatment and development of dental caries. Many preventive methods such as topical fluoride application, using bonding materials releasing fluoride, using mouth rinse with sodium fluoride, applying chlorhexidine, and so on were defined. The general comment of the authors is that supplying an adequate oral hygiene has the main role in prevention of demineralization-caries during orthodontic treatment. In the light of the previous studies' results, it can be concluded that professional application like a varnish can be provided for patients who have high caries incidence.

Salivary Streptococcus mutans colony-forming unit count in patients with and without orthodontic appliances

“…Fixed orthodontic appliances are one of the most common ways to treat dental malocclusions. Given their retentive nature, these appliances have been associated to increased dental biofilm in the oral cavity [1][2][3][4] . Dental biofilm is made up of multiple species of acidogenic bacteria related to dental caries progression such as Lactobacillus spp.…”

“…These bacteria produce acids as a byproduct of fermentable carbohydrate metabolism, which in a favorable oral environment can lead to demineralization of the tooth surface 5 . The adherence and colonization of these microorganisms during orthodontic treatment is influenced by various factors such as bracket material, its physical properties, the presence and type of ligatures, and the patient's oral hygiene habits 3 . Microbial interactions between the surface of the brackets and the oral microbiota are due in part to the amount of surface free energy (SFE) in the bracket material, which is a determining factor in the degree of bacterial adhesion and therefore also in the accumulation of dental biofilm 6 .…”

Comparative Study of the Shear Bond Strengths and Bracket Failure Rates of Two Orthodontic Adhesive Systems

“…The technique was an advancement to the previous method of banding. It allows the direct bonding of brackets to the teeth without the use of bands making treatment more acceptable to the patients [2,3].…”

“…However, the acid etch technique also has its limitations. It is technique sensitive and predisposes the teeth to decalcification and forming white spot lesions on the enamel surface [3,4]. Enamel fractures may also occur during debonding of brackets with associated enamel discoloration resulting from retention of resin tags in the enamel [5,6].…”

“…Unfortunately, these orthodontic bracket failures are relatively frequent with attendant consequences [8][9][10]. First, a niche may form between the bracket and enamel surface, which will encourage plaque accumulation resulting in periodontal compromise [3]. Secondly, the tooth from which this detachment has occurred ceases to be influenced by the active component; as such, no further movement of that tooth occurs in the meantime.…”