Assessment of Oral Health Status of Patients Undergoing Fixed Orthodontics: A Clinical Study.

BACKGROUND: The incidence of dental caries and gingival disease is at higher level in orthodontic patients. The present study demonstrated oral health status of patients undergoing fixed orthodontics.
METHODOLOGY: A total of 168 patients age ranged 12-17 years who were undergoing orthodontic treatment for 2 years of both genders were recruited. The assessment of dental caries as Decayed, Missing, and Filled Teeth (DMFT) score and plaque index was determined at first, second, and last visits.
RESULTS: Age 12 years had 22 males and 28 females, 13 years had 14 males and 22 females, 14 years had 8 males and 18 females, 15 years had 7 males and 15 females, 16 years had 6 males and 14 females, and 17 years had 9 males and 5 females. The mean DMFT score in age group 12 years was 1.74 and 2.24 at first and third visits, respectively, at 13 years was 1.60 and 2.04 at first and third visits, respectively, at 14 years was 2.38 and 2.72 at first and third visits, respectively, at 15 years was 1.74 and 2.08, at 16 years was 3.32 and 3.56 and at 17 years was 3.40, and 3.64 at first and third visits, respectively.
CONCLUSION: There was significant higher dental caries and plaque index in age group 12 years. Copyright:

INTRODUCTION

With the increase in awareness regarding facial esthetics, there have been marked rise in patients seeking orthodontic treatment. The concern regarding malocclusion is usually seen in teenagers.[1] Various types of malocclusion such as Class I, Class II, and Class III with further subcategories are quite common. Few cases are managed with removable appliances, fixed, or myofunctional appliances.[2]

Fixed orthodontics with orthodontic brackets and wires are placed over teeth and mostly the treatment run a long course over 1 year.[3] It is observed that the oral hygiene of these patients is poor owing to difficulty in brushing due to the presence of fixed appliances. Studied mentioned that retention of plaque at various sites increases the risk of dental caries in patients.[4] Dental caries is a chronic disease affecting organic as well as inorganic portion of teeth resulting in demineralization and destruction.[5]

It is further demonstrated in numerous researches that there is significant increase in caries causing bacteria such as lactobacilli in such patients.[6] Thus, the incidence of dental caries and gingival disease are at higher level in orthodontic patients.[7] Patients usually complain of incipient to carious lesions after the completion of fixed orthodontic treatment. The maintenance of strict oral hygiene protocol is essential to overcome the limitations of fixed orthodontics.[8] Inter aid brushes, dental floss, etc., may be useful in removing plaque from retention sites such as below or around the brackets.[910] Therefore, the present study demonstrated oral health status of patients undergoing fixed orthodontics.

METHODOLOGY

This prospective study comprised 168 patients age ranged 12–17 years who underwent orthodontic treatment in the past 2 years of both genders. The consent of the study was obtained from all enrolled patients.

All relevant information such as name, age, and gender was recorded. Patients were recalled for oral examination which was carried by single orthodontist. Oral examination was done under illuminated light using probe, mirror, and tweezed. Dental caries was assessed after drying the teeth with compressed air following the World Health Organization criteria and Decayed, Missing, and Filled Teeth (DMFT) score was recorded. Digital intraoral periapical radiographs using digital sensor (Shick) was used to assess type of caries.

Periodontal status was determined following Silness and Loe index and modified plaque index was recorded at first appointment, after 1 month and at the end of orthodontic treatment. Three values were recalled at each interval and average was considered as final value. All patients were instructed to maintain proper oral hygiene and modified bass method of brushing was prescribed using fluoridated tooth paste to be performed twice daily in the morning and at night time after meals and mouth wash to be used once daily. They were instructed to minimize sugar intake. Results thus obtained were clubbed and subjected to statistical analysis. P < 0.05 was considered significant.

RESULTS

Table 1 shows that out of 168 patients, males were 66 and females were 102. Age 12 years had 22 males and 28 females, 13 years had 14 males and 22 females, 14 years had 8 males and 18 females, 15 years had 7 males and 15 females, 16 years had 6 males and 14 females, and 17 years had 9 males and 5 females.

Table 1

Age distribution of patients

Age group (years)	Males	Females	Total
12	22	28	50
13	14	22	36
14	8	18	26
15	7	15	22
16	6	14	20
17	9	5	14
Total	66	102

Table 2 and Graph 1 shows that mean DMFT score in age group 12 years was 1.74 and 2.24 at first and third visits, respectively, at 13 years was 1.60 and 2.04 at first and third visits, respectively, at 14 years was 2.38 and 2.72 at first and third visits, respectively, at 15 years was 1.74 and 2.08, at 16 years was 3.32 and 3.56, and at 17 years was 3.40 and 3.64 at first and third visits, respectively. Maximum increase in mean DMFT score was seen in age group 12 (0.50) followed by 13 years (0.44), 14 years (0.34), 15 years (0.34), 16 years (0.24), and 17 years (0.22).

Table 2

Assessment of mean decayed missing filled teeth score before and after treatment

Age group (years)	First visit	Third visit	Difference
12	1.74	2.24	0.50
13	1.60	2.04	0.44
14	2.38	2.72	0.34
15	1.74	2.08	0.34
16	3.32	3.56	0.24
17	3.40	3.62	0.22

Graph 1

Assessment of mean Decayed, Missing, and Filled Teeth score before and after treatment

Table 3 and Graph 2 shows that mean difference of DMFT score of 0.40 in males and 0.32 in females with significant difference between first and third visits in each gender (P < 0.05).

Table 3

Changes in decayed missing filled teeth values in both genders during orthodontic treatment

Gender	First visit	Third visit	Mean difference	P
Males	2.10±2.32	2.50±2.58	0.40	0.01
Female	2.00±2.28	2.32±2.46	0.32	0.02
Total	2.05±2.30	2.41±2.52	0.36

Graph 2

Changes in Decayed, Missing, and Filled Teeth values in both genders during orthodontic treatment

Table 4 shows mean plaque index of 1.06 at first visit, 1.00 at second visit, and 1.40 at third visit.

Table 4

Assessment of plaque index during treatment

Time interval	Mean±SD
First visit	1.06±0.40
Second visit	1.00±0.37
Third visit	1.40±0.32

SD: Standard deviation

DISCUSSION

Orthodontic treatment of different types of malocclusion is on rise.[11] The rapid increase in fixed appliances is because of the favorable results as compared to previous years.[12] With the advancement in the field of orthodontics, newer techniques and appliances have resulted in higher success rate with minimum failure rates.[13] The maintenance of oral hygiene in patients undergoing orthodontic treatment is the topic of debate since years. There has been controversy whether there is rise in poor oral status and dental caries. Different authors have found conflicting results.[14] A study by Wisth and Nord[15] on 52 subjects of both genders who underwent orthodontic treatment reported with fewer dental caries as compared to those who did not undergo orthodontic treatment in 111 healthy controls. The reason for this was adoption of strict oral hygiene protocol in orthodontic treatment group under repeated recall visit assessment.[16] The present study demonstrated oral health status of patients undergoing fixed orthodontics.

In the present study, there were 66 males and 102 females. Maximum patients were seen in age 12 years (50, 22 males, 28 females) followed by 13 years (36, 14 males, 22 females), 14 years (26, 8 males, 18 females), 15 years (22, 7 males, 15 females), 16 years (20, 6 males, 14 females), and 17 years (14, 9 males, 5 females). Cantekin et al.[17] determined changes in the oral health status in patients undergoing orthodontic treatment in 659 patients with 258 males and 401 females. Results showed significant difference in total DMFT counts at the time of debonding which found to be higher than at prebonding (P < 0.05) with no gender difference. The PI showed minimum values at the beginning of orthodontic therapy and maximum values at the end of therapy.

We found that maximum increase in mean DMFT score was seen in age group 12 (0.50) followed by 13 years (0.44), 14 years (0.34), 15 years (0.34), 16 years (0.24), and 17 years (0.22). We found that mean difference of DMFT score of 0.40 in males and 0.32 in females with significant difference between first and third visit in each gender. Demirci et al.[18] in their study involved 2383 tooth surfaces (maxillary- 1488, mandibular- 895) found significant higher dental caries in maxillary teeth as compared to the mandibular teeth. Proximal surfaces of all teeth revealed the highest caries rates, ranging from 58.5% to 77.5%. First and second molars showed higher dental caries on occlusal fissures ranging from 52.7% to 66.3%. 59.1% of females and 40.9% of males showed dental caries. Highest dental caries were observed in patients age ranged 17–25 years. Our results also showed that maximum caries was seen in younger age group (12 years) in mandibular premolars and molars and maxillary central incisors. Age group 17 years had lowest caries incidence.

We observed mean plaque index of 1.06 at first visit, 1.00 at second visit, and 1.40 at third visit. Levin et al.[19] observed highest periodontal indices in patients undergoing orthodontic treatment as compared to healthy one. The mean probing depth was 1.90 mm and gingival recession was 0.06 mm. Results showed bleeding on probing in 20.8% of sites. Treated group showed 0.13 mm of labial gingival recession which found to be significantly more than 0.05 mm in nontreated patients. Localized lingual gingival recession was significantly greater in teeth with fixed retainers in comparison to teeth with no fixed retainers. Ristic et al.[20] in their study on 32 subjects (females- 19, males- 13) reported higher dental plaque accumulation, gingival inflammation and pocket probing in subjects undergoing orthodontic therapy with maximum values were observed at 3 months of starting of treatment.

The shortcoming of the study is small sample size and short follow-up.

CONCLUSION

Authors found that there was significant higher dental caries and plaque index in age group 12 years. Thus, there is need to educate the patients undergoing fixed orthodontic treatment regarding the maintenance of good oral hygiene.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.