Relationship between orthodontic treatment and dental caries: results from a national survey

White spot lesion in self-ligating versus conventional ligating bracket systems: A systematic review

BackgroundWhite spot lesion formation around orthodontic brackets is a major complication associated with fixed orthodontic treatment.ObjectiveThis review aimed to evaluate the current evidence regarding the differences in white spot lesion formation between self-ligating and conventional ligating brackets.MethodsEleven bibliographic databases were searched until January 2025. This review covered parallel-group and split-mouth randomized controlled trials, controlled clinical trials, and cross-sectional studies that investigated the differences in white spot lesion formation between self-ligating and conventional ligating brackets.ResultsThree randomized controlled trials, one controlled clinical trial, and one cross-sectional study were included in this systematic review. Among these, three studies were classified as having a low risk of bias. Four of the five included studies showed no statistically significant difference in white spot lesion formation between the two types of bracket systems (p < 0.05).ConclusionThere are no potential differences in white spot lesion formation between self-ligating and conventional ligating bracket systems. However, orthodontists must be aware of the other factors affecting white spot lesion formation, with oral hygiene being the most critical factor.Registration: The protocol was registered in the PROSPERO database (CRD42022353478) on 25 August 2022.

Perception of Dental Caries Risk and Preventive Strategies Among Orthodontic Patients: A Cross-Sectional Survey

INTRODUCTION

Orthodontic treatment significantly improves dental aesthetics, occlusal function, and overall oral health. However, maintaining optimal oral hygiene during treatment is challenging because of plaque accumulation around brackets, wires, and bands, which increases the risk of dental caries. Patient perceptions of caries risk and preventive strategies influence their adherence to oral hygiene measures. This study aimed to assess orthodontic patients' perceptions of dental caries risk, adherence to preventive measures, and effectiveness of oral hygiene instructions provided by orthodontists.

MATERIALS AND METHODS

A cross-sectional survey was conducted at the Department of Orthodontics, India, for over 10 months (January 2024-October 2024). This study included 168 patients who had completed fixed orthodontic treatment and underwent bracket debonding. A structured, self-administered questionnaire was used to collect data on demographic details, perception of caries risk, adherence to oral hygiene measures, preventive strategies, and effectiveness of orthodontist-provided instructions. Chi-square tests were used for associations (p < 0.05, considered significant).

RESULTS

One hundred twenty-eight (76.19%) participants reported difficulty in maintaining oral hygiene, and 132 (78.57%) experienced white spot lesions or early caries. Only 90 (52.38%) were aware of the role of fluoride in caries prevention, whereas 104 (62.50%) believed that orthodontists provided adequate oral hygiene instructions. After treatment, 144 (86.31%) felt confident in maintaining oral hygiene, but many emphasized the need for better patient education. Statistical analysis revealed a significant association (p = 0.001) between caries experience and fluoride awareness, oral hygiene adherence, and dietary modification.

CONCLUSION

Orthodontic patients face significant challenges in maintaining oral hygiene, with gaps in fluoride awareness and dietary adherence. Enhanced patient education, including fluoride use, dietary counseling, and behavioral reinforcement strategies, is essential. Structured oral hygiene guidance during orthodontic treatment is crucial to reduce caries risk and improve long-term oral health outcomes.

Knowledge, attitude, and practice toward oral health management among orthodontic patients: a cross-sectional study

BACKGROUND

This study aimed to investigate the knowledge, attitude, and practice (KAP) toward oral health management among orthodontic patients.

METHODS

A cross-sectional study on orthodontic patients was conducted at Suzhou Dushu Lake Hospital from December 20, 2023, to March 19, 2024. Demographic data and KAP scores were collected using self-designed questionnaires. The cutoff for adequate KAP dimension scores was 70%.

RESULTS

The study included 418 orthodontic patients, of whom 274 (65.55%) were female, and 144 (34.45%) were male. The average age was 32.70 ± 8.47 years (33.72 ± 8.46 in females and 32.17 ± 8.44 in males). The mean knowledge, attitude, and practice scores were 11.80 ± 4.06 (possible range: 0-16), 27.00 ± 3.18 (possible range: 6-30), and 31.13 ± 6.01 (possible range: 8-40), respectively. The proportions of participants who scored above a cutoff of 70% were 247 (59.09%) for knowledge, 403 (96.41%) for attitude, and 290 (69.38%) for practice. Multivariate logistic regression showed that knowledge score (OR = 1.243, 95% CI: [1.152-1.342], P < 0.001), attitude score (OR = 1.255, 95% CI: [1.140-1.381], P < 0.001), and wearing an appliance for 3 to 6 months (OR = 4.309, 95% CI: [1.565-11.861], P = 0.005) were independently linked to proactive practice. Structural equation modeling demonstrated that knowledge directly influenced attitude (β = 0.684, P < 0.001) and practice (β = 0.527, P < 0.001), while attitude had a direct impact on practice (β = 0.587, P < 0.001).

CONCLUSIONS

The majority of orthodontic patients demonstrated adequate knowledge, positive attitudes, and proactive practices toward oral health management. Nonetheless, continuous education is still essential for certain groups, such as recently fitted orthodontic patients, to ensure sustained improvement in oral health outcomes.

Quantitative Determination of Salivary Cariogenic Bacteria in Patients With Fixed Orthodontic Appliances

BACKGROUND AND OBJECTIVES

Fixed orthodontic treatment can alter the oral environment, potentially increasing cariogenic bacteria levels. This study aimed to utilize real-time polymerase chain reaction (qPCR) to quantify salivary levels of cariogenic bacteria in patients undergoing orthodontic treatment with fixed appliances.

METHODS

This case-control study was conducted in Erbil, Iraq, from April 2024 to August 2024. One hundred participants were included in the study by random sampling method and equally divided into two groups: case group or orthodontic group and control group. The orthodontic group included participants with fixed orthodontic brackets, while the control group included participants without current or past orthodontic treatment with matching age and sex as the orthodontic group. Data were collected via questionnaires, clinical examinations, and saliva sampling. Salivary samples were analyzed using real-time PCR to detect Streptococcus mutans (SM) and Lactobacillus (LB) spp. levels.

RESULTS

The age ranged from 18 to 30 years, and the mean age of participants was 23.96 ± 3.64 years. No significant differences were observed between the two groups across most parameters, except in the use of fluoride therapy, where the control group demonstrated better usage (p≤0.003). Real-time PCR results indicated a significant difference in the levels of LB and SM between patients with fixed orthodontics and the control group (p≤0.001). However, no significant differences were found in decay indices such as decayed, missing, and filled teeth; decayed, missing, and filled surfaces; and plaque index in this study.

CONCLUSIONS

The quantity and levels of LB and SM were higher in the orthodontic group compared to the control group. Despite the elevated bacterial levels in the orthodontic group, there was no significant difference in decay and plaque indices between the two groups.

Impact of Orthodontic Treatment on the Incidence of Dental Caries in Adolescents: A Prospective Cohort Study

BACKGROUND

Orthodontic treatment is a widely embraced intervention aimed at enhancing dental aesthetics and correcting malocclusions among adolescents. However, concerns persist regarding its potential impact on oral health, particularly on the development of dental caries. This study aimed to systematically investigate the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents.

METHODS

A prospective cohort design involving adolescents aged 12-18 years was employed. A total of 82 patients met the inclusion criteria. In addition, an age-matched control group of 82 participants who did not undergo orthodontic treatment was included. The study included both a treatment group undergoing orthodontic treatment (braces or aligners) and an age-matched control group that did not undergo any orthodontic intervention. Demographic characteristics, orthodontic treatment details, and oral hygiene practices were documented at baseline and throughout the study period. Dental examinations at six-month intervals post-treatment were conducted to track the incidence and progression of carious lesions.

RESULTS

The demographic characteristics, baseline oral health status, orthodontic treatment details, and oral hygiene practices were comparable between the treatment and control groups. Post-orthodontic treatment assessment revealed a slightly higher incidence of new carious lesions in the treatment group (14.6%) than in the control group (9.8%), although this difference was not statistically significant (p = 0.15). Dental examinations at six-month intervals demonstrated a gradual increase in caries incidence over time in both groups, with no substantial disparities observed.

CONCLUSIONS

This study provides a comprehensive examination of the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents. While a trend towards higher caries incidence in the treatment group was observed, the difference was not statistically significant. These findings contribute to the existing body of knowledge and emphasize the need for ongoing research to guide clinical practice.

Morphological Characteristics and Prevention of Tooth Enamel Demineralization during Orthodontic Treatment with Non-Removable Appliances

Despite the large number of studies on the effect of braces on teeth, there is no information on the dynamics of the state of the ultrastructure of the hard tissues of teeth during orthodontic treatment. The purpose of this study is to examine the state of the hard tissues of the teeth and carry out preventive measures to reduce the risk of complications in the process of orthodontic treatment using a non-removable device. Methods: For the in vitro study, 68 teeth were randomly divided into group A-no prophylactic treatment, and group B-treated with the fluorine varnish Tiefenfluorid. After 35 days, all the teeth were prepared for microscopic examination. The clinical study included 59 patients aged 12-17 years with orthodontic brackets. The split-mouth technique was used. The areas around the bracket of one-half of the oral cavity were treated with Tiefenfluorid every 6 months during the entire treatment period. The teeth of the second half of the oral cavity served as the control group. The data were processed in the SPSS19 package. Results: In vitro and clinical study results showed a statistically significant difference between the prophylactic and control groups of teeth in favor of the prophylactic group, where the statistical significance was p ≤ 0.01.

The Influence of Coordinative Skills on the Oral Health of Children and Adolescents in Permanent Dentition

Removing dental plaque by using a toothbrush is the most important measure for oral hygiene. The aim of the present study was to estimate the impact of the coordination skills of children and adolescents on their oral health (plaque level, DMF/T: decayed, missing, filled teeth). Within a prospective cohort study, 996 children (10 to 18 years) were examined. The results of three coordination tests from the Motorik Modul (MoMo) were included to evaluate the coordination skills. Other parameters taken into account were age, sex, orthodontic treatment and socioeconomic status (SES). Univariate and various multivariate analyses were performed to evaluate relationships. Better results in precision coordination tests were significantly related to a better oral hygiene (backward balancing: logistic regression OR 0.86, 95%CI: 0.73−0.99, p = 0.051, proportional odds model OR 0.86, 95%CI: 0.75−0.99, p = 0.037; one-leg-stand: logistic regression OR 0.78, 95%CI: 0.63−0.96, p = 0.018, proportional odds model OR 0.77, 95%CI: 0.64−0.92, p = 0.003). Higher scores on one-leg-stand were significantly related to a lower caries prevalence (logistic regression OR 0.81, 95%CI: 0.66−0.99, p = 0.037; Poisson regression exp(ß) 0.82, 95%CI: 0.74−0.91, p < 0.001). Coordination test under a time constraint (jumping side-to-side) showed no significant relation. Oral hygiene was poorer in younger children, boys and low SES. Caries prevalence increased with low SES and increasing age. The present results suggest that oral health is influenced by coordinative skills.

Orthodontic Treatment as a Protective Factor for Dental Caries Experience and Severity: A Population-Based Study

Objective

The aim of this study was to assess the effects of orthodontic treatment on the experience, prevalence, and severity of dental caries later in life in a representative sample of U.S. adults.

Methods

Using a population-based study design, data from 9,486 participants in the third National Health and Nutrition Survey (NHANES), including self-reported information on the history of orthodontic treatment and its timing, were obtained. Caries experience and prevalence was assessed using the decayed (DT) and filled (FT) teeth indices (i.e., DT > 0, FT > 0, and their aggregate DFT > 0). Severe dental caries experience and prevalence was defined as DT > 2, FT > 11, and DFT > 12. Unadjusted and adjusted logistic regression models that accounted for the complex sampling design were used to assess the association between orthodontic treatment and dental caries experience, prevalence, and severity. Statistical significance was set at a P value of less than 0.05.

Results

The history of orthodontic treatment was reported in 19.62% of the adults. Around 94% of participants had at least one decayed or filled tooth (DFT > 0), and 21.09% met the aggregate DFT criterion for severe caries (DFT > 12). After controlling for confounding variables, a reported history of orthodontic treatment was found to significantly decrease the odds of DT > 0, DT > 2, FT > 11, and DFT > 12 (odds ratios (OR) = 0.41, 0.36, 0.74, and 0.60, respectively).

Conclusion

A history of orthodontic treatment was a protective factor for untreated dental caries, in assessments of the severity and prevalence of dental caries experience.

Assessing Safety and Clinical Effectiveness of New Approaches to Planning and Integrated Implementation of Full-Mouth Reconstruction

Objectives  Planning, adequate preparation, and further prosthodontic management are the most important steps in the treatment of this population of patients with dental and mandibular anomalies. The purpose of the article is the improvement of safety and clinical effectiveness of prosthodontic rehabilitation of patients after full-mouth reconstruction.

Materials and Methods  A single-center open prospective nonrandomized study, examination, and treatment of 198 patients with partial or total absence of teeth were performed. Higher safety and clinical effectiveness of the treatment were found in the patients of the main group who showed a significant reduction in the rate of complications relative to the comparison group. In the main group, the number of aesthetic defects and cases of repeated prosthetics decreased in comparison with the corresponding occurrence rate of such cases in patient groups.

Results  It showed statistically significantly reduction in the rates of occurrence of the complications when using the proposed algorithm: the rate of inflammation of the marginal periodontium and peri-implant tissues in the main group was 2.9 times less frequent and loosening of the supporting implants was 3.9 times less frequent. The rate of polymer chipping or abrasion in the area of the incisal edge or masticatory surface was two times lower in the main group of patients, short crowns were found 1.9 times less often, sores in the area of the dental pontic in the main group were 1.8 times less frequent than in the comparison group, and no fractures of bridgework were found in the main group. The frequency of neuralgic facial pain in the patients of the main group was 5.2 times less than in the comparison group, complaints about pain in the temporomandibular joint area were 8.4 times less frequent, increased abrasion of antagonist teeth was 3.9 times less frequent, and phonetics disorders were 8.4 times less frequent.

The effectiveness of the algorithm developed by us is also confirmed by the fact that the number of aesthetic defects and cases of the need for repeated prosthetic treatment was reduced in comparison with the corresponding frequency of such cases in groups of patients where standard approaches to prosthetics were applied. In particular, aesthetic defects found in the main group of patients were 2.5 times less frequent than in the comparison group, and repeated prosthetics was performed 2.7 times less frequently.

Conclusion  Application of the developed comprehensive approach to planning of prosthodontic rehabilitation provides for significant reduction in the frequency of complications and aesthetic defects, as well as cases of repeated need for prosthetics.

Dental anxiety and caries experience from late childhood through adolescence to early adulthood

OBJECTIVE

To assess the association between dental anxiety and caries experience from late childhood through adolescence and into early adulthood (12, 15 and 18 years old, respectively).

METHODS

A prospective cohort study was conducted among a population-representative sample of Chinese in Hong Kong. A baseline survey was conducted at age 12 and follow-up assessments were completed at ages 15 and 18. Caries experience was assessed as the number of decayed, missing and filled teeth (DMFT). Dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS). Participants' socio-economic status and oral health-related behaviours were ascertained using a self-complete questionnaire. Negative binomial regression was used to explore the association between dental anxiety and subsequent caries status, controlling for other factors.

RESULTS

At baseline, 668 children participated; 279 (41.8%, comprising 57.0% females) completed all three phases of data collection. MDAS scores at age 18 were lower than at age 12. Caries experience increased as participants aged. At age 15 and 18, females had higher MDAS and DMFT scores than males. Reported frequency of snacking between meals was associated with MDAS scores at age 18. In regression analyses, dental anxiety at age 12 was not significantly associated with dental caries experience at age 15, controlling for socio-demographic and oral-health behaviour factors at age 12. Likewise, dental anxiety at age 15 was not significantly associated with dental caries experience at age 18, controlling for the same factors at age 15.

CONCLUSION

Dental anxiety assessed by MDAS in late childhood and adolescence appears not to predict dental caries experience later in life in this population.