Long-term beneJits of orthodontic treatment on oral hygiene

Dr. Feliu

Jose Leon Feliu, M.D., D.D.S. Mudrid, Spain

The purpose of this project was to determine whether orthodontic patients have better oral hygiene than dental patients who have not received orthodontic treatment. A random sample of 158 boys and girls ranging from 11 to 15 years of age were selected for this project. Seventy-four had been treated orthodontically and seventy-four had not had orthodontic treatment. Gingivitis and plaque indices were used to measure the patients’ oral hygiene. The patients who had received orthodontic treatment displayed superior oral hygiene to those dental patients who had not received orthodontic treatment.

Key words: Health education, behavior modification, orthodontic treatment, plaque control, gingivitis

0 ne of the problems encountered during Since the maintenance of good oral hygiene is orthodontic treatment is the maintenance of adequate stressed throughout orthodontic treatment, I wanted to oral hygiene by the patient. The placement of orth- conduct a study to see if, in a random sample, dental odontic bands and brackets increases the risk of plaque patients who have completed orthodontic treatment dis- accumulation, caries, decalcifications, etc. Conse- played better oral hygiene than dental patients who had quently, orthodontic patients must practice strict plaque not had orthodontic treatment. control to prevent the development of dental pathosis. *M

If the efforts of the dentist and the hygienist are not combined, it is obvious that decalcifications, caries, and injury of the soft tissues may occur.1F14

METHODS AND MATERIALS

One hundred fifty-eight boys and girls, ranging in age from 11 to 15 years, were selected for this study

Fig. 1. Chart used for recording gingival inflammation and plaque accumulation on each tooth.

ooo2-p416/82/120473+05$00.50/0 0 1982 The C. V. Mosby Co. 473

Table I. Results _-_--- _~__

Putienrs treated orihodonricul!, Patients NOT treured orthodoniicul!\ --__-

Plaque index Gingivifis index Plaque index Gingiviris rndex (percent) (percent) (percent) (percenr)

I. 0 0 4 II

2. I 0 II 0

3 2 0 14 3 4. 3 0 15 4 5. 3 0 15 6 6. 3 0 I9 6 7. 4 0 19 7 8. 4 0 29 8 9. 5 0 30 8

IO. 5 0 33 8 Il. 5 0 38 9 12. 6 0 39 9 13. 6 0 40 9 14. 7 0 40 9 15. 7 0 40 IO 16. 7 0 40 IO 17. 7 0 41 10 18. 7 0 41 II 19. 8 0 42 I2 20. 8 0 43 I4 21. 8 0 43 1.5 22. 8 I 43 I5 23. 8 I 45 I7 24. 8 I 45 17 25. 8 I 47 I9 26. 9 I 47 I9 27. 9 I 48 I9 28. 9 I 49 20 29. 9 I 51 20 30. 9 I 51 20 31. 9 I 53 21 32. 10 2 53 21 33. II 2 54 21 34. II 2 54 22 35. II 2 55 23 36. II 2 55 23 37. II 2 55 23 38. II 2 56 23 39. 12 2 58 24 40. I3 2 58 25 41. 13 2 59 25 42. I3 2 59 25

43. I4 3 60 26 44. I4 3 60 28

45. I4 3 61 28 46. I4 3 61 29

47. I4 3 62 29

48. I4 3 64 30

49. 14 3 64 30 50. I5 3 66 31

51. 15 4 66 31

52. I6 4 68 32 53. 17 4 68 32 54. I7 4 69 33

55. I8 5 69 33 56. 18 5 71 33

57. I8 5 71 36

58. 20 5 73 36

Volume 82 Number 6

Long-term benejits of orthodontic treatment on oral hygiene 475

Table I (Cont’d)

59.

60.

61. 62. 63.

64. 65. 66.

61. 68.

69. 70.

71. 12. 73.

74.

75. 76.

77. 78.

79.

Patients treated orthodontically Patients NOT treated orthodontically

Plaque index Gingivitis index Plaque index Gingivitis index (percent) (percent) (percent) (percent)

20 5 15 38 21 6 15 40

21 6 75 41 22 I 15 42 22 7 77 42

22 I 17 43 23 8 78 44 24 8 19 45

24 8 79 45 28 8 79 48 28 9 80 48 28 9 80 49

29 9 84 49 29 10 84 51 31 10 85 54 32 12 86 59 38 12 88 61 40 12 88 65

41 13 88 65 45 13 89 68 41 18 91 76

79 m15.01 79128913.65 79m56.91 79/2,170/27&i

90

a5

60

7.5

70

65

60

55

Plaque 5c

scores 4c in% ”

4C

35

3t

Z!

21

l!

II

,

0 2

Plaque scores for orthodontically treated

90

patients N =79 a5

Mea” x = 15% Standard deviation = 10.42 80 Standard error of mea” = 1.16 Maximum = 47 75 Minimum 0 Median = 24 70 Mode = Not unique Flange = 47

65

6C

55

50

45

4

35

x

. l 5

.*: .:

0

12345676910

0 3

No. of ~ccu~ences

: . . . .

. . l

. . .

Plaque scores for nonorthccfontically

treated patients N = 79

Mea” ic = 56.76 Standard deviatlo” = 20.65 Standard error of the mea” = 2.36 Maximum = 91 Minimum = 4 Median = 56 Mode=40 Range = 67

12 3 4 5 6 7 8 910

No. of ocwrrences

Figs. 2 and 3. Scattergrams of plaque scores.

476 Fe/i/,

50 i l : 45 .

: 40 :’

. 35 l

.

30 i

.

Figs. 4 and 5. Scattergrams of gingivitis scores.

from the Orthodontic Department of San Rafael Hospi- tal in Madrid, Spain.

Seventy-nine patients had been treated orthodon- tically with fixed appliances and their treatment had been completed at least 1 year earlier; these constituted the experimental group. The remaining seventy-nine patients had not been treated orthodontically, and they made up the control group.

The plaque control index developed by Lee’;’ was used to assess accumulations of plaque in the two groups. The gingival inflammation was measured with the gingival index developed by Milleman.‘fi Record- ings of gingival inflammation and plaque accumulation were made on the mesial, distal, facial, lingual, and occlusal surfaces of each tooth (Fig. 1). All of the examinations were carried out by the same investigator. All 158 patients were from a similar socioeconomic level.

Table I provides, in ascending order, the scores recorded for each patient in the two groups. The scat- tergrams (Figs. 2 to 5) reveal even more dramatically the difference in plaque and gingivitis scores of the two groups.

The measurements accumulated were used to assess the probability that there was a statistical difference in the two groups.

The statistical method for comparing the plaque and gingivitis scores was the t test. This test is based upon the hypothesis that the mean score for the control group

is not significantly different from that of the test group. The t test for significance may be employed by

usine the formulas: ”

t plaque = sSt - X,/qS.E: + S.Ez t gingivitis = XI - &/vS.Et + S.E:

where X, = The mean of the test group X, = The mean of the control group S.Et = The standard error of the test group S.E,. = The standard error of the control group

The t test is significant at the 0.005 level if the t value exceeds the table value of 2.576 for 154 degrees of freedom.

The t value for the plaque test group was 15.93, and the t value for the gingivitis test group was 6.75. Both of these values are much greater than the probability level of 0.995, so we may assume that chance alone could be expected to account for the differences in these two groups in fewer than 5 patients out of 1,000.

These scores are highly significant statistically and permit the experimenter to state unequivocally that most patients who have been treated orthodonticaIly should be expected to have better plaque control and lower gingivitis scores than those patients who have not undergone orthodontic treatment.

MNXJSSK)N

Although this is a small sample, the results indicate that, on the average, one can expect a patient who has completed orthodontic treatment to display better oral

Volume 82 Number 6

Long-term benejts of orthodontic treatment on oral hygiene 477

hygiene than dental patients who have not had orth- odontic treatment.

3.

The implication of this study is that orthodontic treatment provides a lasting improvement in the hygiene of orthodontic patients.

4.

Runyon, H.: Patient motivation: Some implications from behav- ioral sciences, Quintessence J. 9: 61-65, 1978. Schrems, H. T.: Patient motivation for oral hygiene from the dentist’s viewpoint, Dtsch. Zahnarztl. 2. 34: 445448, 1979. Dreyling, U.: Motivating the patient in mouth hygiene, Quintes- sence J. 8: 33-36, 1978.

This is possibly due to the emphasis that the orth- odontist places on good oral hygiene during treatment. Orthodontic patients make frequent visits to their orth- odontists over a period of several months, so there is ample opportunity for them to learn techniques that promote good oral hygiene. These frequent visits en- able orthodontic patients to receive immediate feedback about their oral hygiene practice. This feedback permits patients to correct defects in their technique before they become intractable habits. The frequent office visits also permit the doctor and the staff to give patients encouragement that keeps them motivated toward good oral hygiene.

5.

6.

7.

Hoffman, A.: The importance of prophylaxis in orthodontic treatment, Zahnarzt 22: 441-426, 1978. Miiller-Fahlbusch, H.: The patient’s motivation for oral hygiene: A psychological consideration, Dtsch. Zahnarztl. Z. 34: 291- 296, 1979.

8.

9.

10.

Schwaninger, B.: Developing an effective oral hygiene program for the orthodontic patient: Review, rationale, and recommen- dations, AM. J. ORTHOD. 75: 447-452, 1979. Hollender, L.: Proximal caries progression in connection with orthodontic treatment, Swed. Dent. J. 2: 153-160, 1978. Zarichsson, B. U.: Oral hygiene for orthodontic patients: Cur- rent concepts and practical advice, AM. J. ORTHOD. 66: 487- 497, 1974.

11.

If this study is valid, orthodontic treatment im- proves the oral hygiene of patients, and this improve- ment can be expected to last beyond the period of orth- odontic treatment.

Albino, J. E.: Effects of an instructioned-motivational program on plaque and gingivitis in adolescents, J. Public Health Dent. 37: 281-289, 1977.

12.

13.

14.

REFERENCES 1. Lundstrom, Frederik, and Sven-Erik, Hamp.: Effect of oral

hygiene education on children with and without subsequent orthodontic treatment, Stand. J. Dent. Res. 88: 53-59, 1980.

2. White, L. W.: Behavioristic technique for oral hygiene: An up- date, AM. J. ORTHOD. 77: 568-570, 1980.

15.

16.

Tenti, F. V.: Orthodontics and prevention, Rev. Stomatol. 3: 41-44, 1977. Zachrisson, B. U.: Caries incidence and oral hygiene during orthodontic treatment, Stand. J. Dent. Res. 79: 394401, 1971. Craighead, W. E., Kazdin, A. E., and Mahoney, M. J.: Behav- ior modifications: Principles, issues and application, Boston, 1976, Houghton Mifflin Company, pp. 140-141.

Loe, H.: A review of the prevention and control of plaque. In McHugh, N. D. (editor): Dental Plaque, Dundee, 1970, The University of Dundee, pp. 259-270. Millernan, J.: W.H.O. Oral Health Surveys: Basic methods, Geneva, 1977, World Health Organization.