May, 2007
The Importance of Oral Hygiene in Orthodontic Treatment
Dr. Mohamad Azhar Ibrahim Kharsa, DDS, PhD Orth
Abstract
In this article, the author discusses the importance of Oral Hygiene in orthodontic treatment, the aftermath of negligence of oral hygiene maintenance and the recommendations that must be kept in mind to avoid the sequellae of bad oral hygiene on orthodontic patients. In addition, the article is going to discuss the side effects of dental caries, gingival recession, periodontitis and patients non-compliance on the outcomes of orthodontic treatments. Finally, the author presents some examples, recommendations and solutions to such dilemmas.
Discussion
Orthodontics is an art and science that requires complete cooperation between orthodontist, hygienist, patient and other specialists related to skeletal and facial correction. One of the dilemmas that may accompany orthodontic treatment is the patients negligence in oral hygiene jeopardizing the treatment or even worsening the previously compromised dental situation.
The pertinent compromising oral hygiene factors are:
- Dental Caries.
- Periodontitis and gingival recession.
- Pigmentation and Stains.
- Compromised aesthetic appearance.
Dental Caries & Orthodontic Treatment
Dental decay in orthodontic treatment is one of the factors that imperils and complicates therapy, especially when it occurs as a consequence of compromised oral hygiene. Figure 1.
Figure 1. Widespread dental caries in a non-compliant patient, who has failed his appointments for more than six months, and presents with wide-ranging dental caries especially on the maxillary dental. A result of very poor oral hygiene.
Wires, brackets and bands may becomedental caries hubs if patient fails in oral hygiene maintenance. This complication hinders the completion of orthodontic treatment, as it is necessary to put the active orthodontic treatment “on hold” until restorative treatment can be completed. Figure 2.
Figure 2. The active orthodontic treatment has been suspended, the patient has transferred for restorative treatment and case will need to be reevaluated after restorative treatment has been completed.
Periodontitis and gingival recession
Periodontitis and gingival recession complicate orthodontic treatment, especially when it hinders oral hygiene. Hygiene becomes so compromised that it adversely affects successful therapy Figure 3.
Figure 3. Gingival recession on 31, 41 (US #24 and #25). Patient is under periodontal treatment, to repair the gingiva before continuing his orthodontic treatment. In this case the brackets and passive archwire become a “splint” to help the periodontist with stablization during the graft, and relevant periodontal treatments.
Figure 4. A case of compromised periodontal situation, tongue thrust, gingival recession and dental movement (especially on 32, 31) (US #23 and #24) of 2nd degree.
It is recommended that periodontal treatment be performed before active orthodontic treatment, nonetheless, orthodontists sometime help in the preparation of splints with brackets and passive archwire to function as a fixed splint, Figure 3. or by lingual splints. Figure 5.
Figure 5. A lingual splint, that helps in preparation for periodontal treatment preceding active orthodontic treatment.
Figure 6. The active periodontal treatment that precedes the orthodontic treatment.
In spite of the importance of active orthodontic treatment, it is crucial that the periodontist and orthodontist cooperate to form a Team for treatment coordination. Figure 6.
Pigmentation and Stains
Compromised oral hygiene is related to the formation of stains and pigments. Figure 7. Figure 8. Plaque and calculus accumulation what may promote yellow or brown stains and pigments.
Figure 7. Yellow stains because of poor oral hygiene.
Figure 8. Stains (on the maxillary arch) and gingivitis (on the mandibular arch) because of poor and compromised oral hygiene.
Compromised aesthetic appearance
Compromised oral hygiene impacts a patient’s aesthetic appearance. This in turn may influence the patients psychological attitude creating a vicious cycle of patient oral hygiene negligence, patient depression and despair leading to further negligence and carelessness in hygiene Figure 9.
Figure 9. Compromised aesthetic appearance as a result of inattention to oral hygiene and patient noncompliance to instructions pertinent to orthodontic diet and oral hygiene maintenance, lack of tooth brushing, and coarse food.
Conclusion
Oral hygiene is a paramount factor in successful orthodontic treatment. Any negligence in maintaining oral hygiene may have a negative impact on orthodontic treatment results, aesthetic appearance, and lead to decayed teeth, gingivitis, periodontitis and other sequellae.
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Contributed by:
Dr. Mohamad Azhar Ibrahim Kharsa, DDS, PhD Orth
Consultant Orthodontist, King Fahad Hospital. MADINA. Saudi Arabia. Scientist Fellow of American Society for Laser Medicine and Surgery, WFO Fellow AOS Fellow, Member of Saudi Orthodontic Society and Saudi Ortho Club.
