The importance of effective oral hygiene during orthodontic treatment

The main aims of orthodontic treatment

For many patients, aesthetics are the main concern when embarking on a course of orthodontics.[ii] It is important to take into account the expectations of each patient, and put together a treatment plan with a high chance of meeting and managing them, while working with the individual to ensure they understand the role they play in a successful outcome. This should include making an assessment of their periodontal health prior to treatment, ensuring they are able to carry out excellent oral hygiene, and would be able to maintain this with an orthodontic appliance.[iii]

For some patients, malocclusion can have an impact on their quality of life. Patients may be dissatisfied with the appearance of their teeth, which for some can lead to low self-esteem and negative body image, therefore choosing to seek orthodontic treatment to correct.[iv] With the rising popularity of clear aligners, some patients may feel that orthodontic treatment is more accessible to them, convincing them to seek the advice of a dentist. Whether the patient requires a removable appliance, or fixed, it is vital that they understand the challenges associated with each when it comes to oral hygiene maintenance.

Maintaining oral health with a fixed appliance

During orthodontic treatment, tooth brushing and interdental cleaning abilities can become hindered. Because fixed appliances can cover and obstruct a large area of the tooth, making it harder to properly clean the teeth, the ideal conditions are created for bacterial plaque to grow if not removed.[v] When plaque is allowed to grow, it produces acid, causing demineralisation and caries.[vi]

Because of this, between 50% and 70% of patients with fixed orthodontic appliances can expect to experience enamel demineralisation and gingivitis.[vii] If significant amounts of plaque are allowed to develop due to insufficient oral hygiene, treatment outcomes may be put at risk, as well as the health of the teeth and soft tissues. In fact, in 5% to 10% of cases, patients were unable to complete their treatment because of problems maintaining oral hygiene.[viii]

Support your patients to achieve oral health

This being said, research suggests that, if plaque control is maintained sufficiently during the course of treatment, minimal levels of disease will occur in both soft and hard tissues.[ix] It is important to support patients of all ages, encouraging the continuous maintenance of oral hygiene, and reinforcing its importance for a successful outcome. By implementing techniques which motivate patients to perform adequate plaque removal, you can expect lower levels of periodontal disease, bone loss, and caries, as well as more successful orthodontic treatment.[x]

Some research recommends demonstrating effective plaque removal using dye, helping patients to physically see any areas of plaque build-up, and where they should focus their attention when cleaning.[xi] Studies have also demonstrated the ways technology can be useful in motivating patients to comply with oral hygiene routines. Sending automated reminder texts when patients are due for an appointment, or at regular intervals reminding them to carry out effective oral hygiene, for example, can be effective at creating behavioural changes.[xii]

Above all, the patient’s ability to carry out oral hygiene to high levels is essential for removing plaque and maintaining healthy teeth and gums. Consider recommending the FLEXI interdental tool and PREVENT GEL from TANDEX to help protect the teeth from development of oral diseases. Recommend that your orthodontic patients supplement their oral hygiene routines with PREVENT GEL, which can be easily applied to the FLEXI interdental brush for an antibacterial effect and enamel strengthening properties. PREVENT GEL contains chlorhexidine, the gold standard for oral disinfection, to help prevent oral diseases like gingivitis, as well as fluoride to strengthen the teeth against caries. Help your patients choose between the 11 different sizes of interdental brush, and teach them how to remove plaque effectively.

Maintaining oral hygiene during orthodontic treatment is essential for achieving successful outcomes. It is important that your patients understand their role in maintaining their oral health, as failure to do so may mean treatment is disrupted. Be sure to support your patients during treatment, to ensure they are able to carry out effective oral hygiene.

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Author Kimberley Lloyd- Rees on behalf of Tandex
Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.

[i] Gorbunkova, Angelina, et al. “Impact of orthodontic treatment on periodontal tissues: a narrative review of multidisciplinary literature.” International journal of dentistry 2016 (2016). https://www.hindawi.com/journals/ijd/2016/4723589/

[ii] Saccomanno, S., et al. “Motivation, Perception, and Behavior of the Adult Orthodontic Patient: A Survey Analysis.” BioMed Research International 2022 (2022). https://www.hindawi.com/journals/bmri/2022/2754051/

[iii] Gorbunkova, Angelina, et al. “Impact of orthodontic treatment on periodontal tissues: a narrative review of multidisciplinary literature.” International journal of dentistry 2016 (2016). https://www.hindawi.com/journals/ijd/2016/4723589/

[iv] Samsonyanová, Lusine, and Zdenek Broukal. “A systematic review of individual motivational factors in orthodontic treatment: facial attractiveness as the main motivational factor in orthodontic treatment.” International journal of dentistry 2014 (2014). https://www.hindawi.com/journals/ijd/2014/938274/

[v] Huang, Jing, et al. “Effects of motivational methods on oral hygiene of orthodontic patients: A systematic review and meta-analysis.” Medicine 97.47 (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392669/

[vi] Acharya, Shivesh, et al. “Effect of three different motivational techniques on oral hygiene and gingival health of patients undergoing multibracketed orthodontics.” The Angle Orthodontist 81.5 (2011): 884-888. https://meridian.allenpress.com/angle-orthodontist/article/81/5/884/59209/Effect-of-three-different-motivational-techniques

[vii] Huang, Jing, et al. “Effects of motivational methods on oral hygiene of orthodontic patients: A systematic review and meta-analysis.” Medicine 97.47 (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392669/

[viii] Huang, Jing, et al. “Effects of motivational methods on oral hygiene of orthodontic patients: A systematic review and meta-analysis.” Medicine 97.47 (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392669/

[ix] Acharya, Shivesh, et al. “Effect of three different motivational techniques on oral hygiene and gingival health of patients undergoing multibracketed orthodontics.” The Angle Orthodontist 81.5 (2011): 884-888. https://meridian.allenpress.com/angle-orthodontist/article/81/5/884/59209/Effect-of-three-different-motivational-techniques

[x] Acharya, Shivesh, et al. “Effect of three different motivational techniques on oral hygiene and gingival health of patients undergoing multibracketed orthodontics.” The Angle Orthodontist 81.5 (2011): 884-888. https://meridian.allenpress.com/angle-orthodontist/article/81/5/884/59209/Effect-of-three-different-motivational-techniques

[xi] Acharya, Shivesh, et al. “Effect of three different motivational techniques on oral hygiene and gingival health of patients undergoing multibracketed orthodontics.” The Angle Orthodontist 81.5 (2011): 884-888. https://meridian.allenpress.com/angle-orthodontist/article/81/5/884/59209/Effect-of-three-different-motivational-techniques

[xii] Huang, Jing, et al. “Effects of motivational methods on oral hygiene of orthodontic patients: A systematic review and meta-analysis.” Medicine 97.47 (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392669/