Abstract
Fixed vestibular appliances decrease the “self-cleansing” action of saliva and promote aggregation of dental plaque by disturbing the salivary flow field on tooth surfaces, leading to a higher prevalence of enamel demineralization and periodontal diseases. In the current study, we investigated the salivary dynamic characteristics of plaque retention and periodontal status around appliances during orthodontic treatment. By reconstructing lower central incisors and orthodontic appliances, we simulated saliva flow on the tooth surface and then characterized and quantified the salivary flow pattern surrounding the bracket and archwire. In parallel, we tested the total peri-bracket bacterial counts and periodontal status to assess interrelations. Our results demonstrate that orthodontic appliances disturb the salivary flow field on tooth surfaces and can lead to a decrease in salivary velocity and an increase in bacterial numbers. Local vortexes forming in the areas gingival to the bracket, together with the narrow space limitation, contributed to the periodontal inflammatory response. This study confirms that changes in salivary flow are an obvious predisposing factor for bacterial accumulation, and advances the ability to replicate, in vitro, the salivary characteristics of plaque retention and periodontal status around appliances during orthodontic treatment.
Highlights
Fixed vestibular appliances often increase the risk of both, enamel demineralization [1] and periodontal diseases [2], by promoting aggregation of dental plaque [3] locally as well as ectopically to less common sites on the labial surface of the teeth
Before and after the application of appliances, the bacteria collected from the tooth surfaces were cultured in blood agar with the colony appearance of 2–3 mm yellowish round shapes
The surface irregularities protect colonized bacteria from natural removal forces such as salivary flow and muscle action, which may be why rough surfaces are directly associated with increased bacterial accumulation and higher incidences of gingival inflammation
Summary
Fixed vestibular appliances often increase the risk of both, enamel demineralization [1] and periodontal diseases [2], by promoting aggregation of dental plaque [3] locally as well as ectopically to less common sites on the labial surface of the teeth. A protective and nourishing community of periodontopathogenic bacteria [4], dental plaque is formed due to the dynamic interactions among diet, salivary flow, microorganisms and biochemical factors [5]. Bacterial adhesion to solid surfaces appears to be influenced by many factors such as ‘‘selfcleansing’’ mechanisms [6], movement of the oral musculature as well as saliva. The increasing number of oral bacteria may account for rapid plaque growth and decrease in pH value [9], leading to continued structural damage to the teeth and their supporting tissue [10]
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