Hygiene In Orthodontic Patients Research Articles

A short-term evaluation of oral hygiene education methods in fixed orthodontics patients: a randomized clinical trial comparing assistant training, software, and social media

ObjectiveTo compare the effectiveness of different oral hygiene education strategies on periodontal health in fixed orthodontic patients in a one-month period: assistant-led instruction, social media-based education, and custom-made software.MethodsSixty orthodontic patients from Mashhad University of Medical Sciences’ Dentistry School were randomly assigned into three groups. Each group received oral health education differently: via assistant instruction, educational videos on social media, or a researcher-designed software for Android smartphones. After a month, participants’ oral health was evaluated using the plaque index (PI) and the gingival index (GI).ResultsAssistant-led education group demonstrated the highest PI (1.26 ± 0.70) and GI (0.92 ± 0.67), while the software group reported the lowest indices (PI = 0.68, GI = 0.46 ± 0.46). The social media group’s measurements fell between these extremes (PI = 0.89 ± 0.75, GI = 0.60 ± 0.52). Significant group differences were found for both PI and GI (P = 0.028 and P = 0.047, respectively). Pairwise comparison revealed significantly lower PI and GI in the software group compared to the assistant group. No significant differences were found between the social media and other groups.ConclusionOur results suggest that the use of specially designed software could be the most effective strategy for improving oral hygiene in orthodontic patients. Meanwhile, traditional assistant-led education showed the least effectiveness. The study supports the potential benefit of utilizing digital tools, such as bespoke software and social media, in oral health education for orthodontic patients.Trial registrationThe study was registered in the Iranian Registry of Clinical Trials (IRCT) database with the identification code IRCT20200609047705N2 in 13.07.2021.

The effectiveness of water jet flossing and interdental flossing for oral hygiene in orthodontic patients with fixed appliances: a randomized clinical trial

BackgroundOrthodontic treatment presents challenges with plaque accumulation around brackets, archwires, and elastics, leading to retained plaque and gingival inflammation. Conventional toothbrushing may not be enough, requiring additional oral hygiene aids like interproximal brushes, dental flosses, and water flossers. Limited research exists on comparing water flossing and interdental flossing in orthodontic patients. Therefore, this study aims to assess their effectiveness in maintaining oral hygiene during active orthodontic treatment.MethodsA single-blind, randomized, parallel clinical study recruited orthodontic patients with full-mouth brackets and archwires. Thirty participants were randomly assigned to either water jet flossing or interdental flossing groups. All participants were instructed to brush twice daily with a provided toothbrush and toothpaste and use the assigned intervention once daily at night. Clinical measures, including the Gingival Bleeding Index (BI), Plaque Index (PI), and Gingival Index (GI), were recorded at baseline and day 14. Descriptive statistics and statistical tests were performed using SPSS software.ResultsThe water jet flossing group demonstrated a slightly higher, albeit non-significant, benefit in plaque removal (median difference of 6.79%%, P = 0.279) and bleeding reduction (median difference of 5.21%%, P = 0.172) compared to the interdental flossing group after two weeks. Both groups showed significant reductions in gingival bleeding index and plaque index from baseline to the 2-week follow-up. The interdental flossing group had median mean percentage differences of 16.13%% (plaque index) and 23.57% (gingival bleeding index), while the water jet flossing group had median percentage differences of 21.87% (plaque index) and 32.29% (gingival bleeding index). No significant changes in gingival index grades were observed in either group.ConclusionBoth water jet flossing and interdental flossing were effective in reducing plaque accumulation and gingival bleeding among orthodontic patients. While no significant differences were found between the two methods, water jet flossing showed a potential advantage. Further research is needed to validate its effectiveness, assess long-term impact, and understand its benefits for orthodontic patients.

The effectiveness of dental water jet in reducing dental plaque and gingival bleeding in orthodontic patients: A systematic review and meta-analysis of randomized clinical trials.

This systematic review and meta-analysis tests the effectiveness of dental water jet (DWJ) with manual toothbrushes (MTB) compared to MTB alone in oral health maintenance in orthodontic patients. Four databases were systematically searched: PubMed, Scopus, Web of Science (WoS) and Cochrane Library until 6 January 2022 using a combination of medical subject heading (MeSH) terms and keywords. Randomized clinical trials (RCTs) were only included and critically appraised using the Cochrane Risk of Bias (ROB) tool. The mean difference (MD) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to compare both study groups (p-value < 0.05). After reviewing 5881 studies from a systematic search, six were selected for inclusion, with four involved in the quantitative analysis. The risk of bias was low in two studies, moderate in two studies and high in the remaining two studies. The meta-analysis showed a significant improvement in plaque index and bleeding scores in DWJ + MTB group compared MTB alone group in orthodontic patients with generalized gingivitis (MD = -0.75, 95% CI [-1.29, -0.22], p = 0.006) and (MD = -0.17, 95% CI [-0.27, -0.08], p = 0.0003), respectively. However, no significant improvement was detected between both groups in the gingival index. The use of DWJ as an adjunctive device in addition to MTB can be an effective strategy for maintaining oral hygiene in orthodontic patients with gingivitis. However, more high-quality RCTs are needed to confirm the findings.

Effectiveness of a New App in Improving Oral Hygiene in Orthodontic Patients: A Pilot Study

ObjectivesThe aim of this randomised clinical trial was to evaluate the effects of a mobile application (app) on the oral hygiene (OH) of adolescents undergoing fixed orthodontic treatment. MethodsEight volunteers (14–19 years old) were randomly allocated to the experimental or control groups. Volunteers in the control group received standard OH (SOH) instructions, whilst volunteers in the experimental group received SHO + OH guidance and motivation through an app tailor-made for this study. Clinical assessments were made using the visible plaque index (VPI) and gingival bleeding index (GBI) at 5 different time points: before orthodontic device installation (T0); at baseline (T1); and 30 (T2), 60 (T3), and 90 (T4) days after randomisation. Significant differences were evaluated using Student t test and multilevel logistic regression analysis. ResultsAlthough no significant difference could be observed, VPI at T1 and T2 were lower for volunteers in the experimental group (33.20 ± 19.29; 32.10 ± 7.72) than for the volunteers in the control group (42.11 ± 8.56; 43.59 ± 34.71). The same was observed for GBI, in which volunteers in the experimental group presented lower GBI at T1 and T2 (12.70 ± 8.10; 13.72 ± 7.39) than volunteers in the control group (27.53 ± 17.89; 20.38 ± 9.95). Good acceptance for using the app was shown by volunteers. ConclusionsThis study shows the potential utility of the mobile app for improving the OH of adolescents.

Randomized study to evaluate and compare the corrosion for five different orthodontic wires surface because of prophylactic fluoride exposure and GC tooth mousse with distilled water using scanning electron microscope (SEM)

Maintaining proper oral hygiene and caries management is one of the most crucial aspects of effective orthodontic treatment. Enamel demineralization occurs around Orthodontic brackets as a result of direct bonding and de-bonding treatments. Many sites have been observed to be vulnerable to plaque buildup. Due to the numerous locations available for plaque collection and the difficulty in cleaning them, maintaining excellent oral hygiene is challenging. Chlorhexidine mouth rinses, Fluoride mouth rinses, and the newly available GC Tooth mousse are all common methods of maintaining oral hygiene in Orthodontic patients. Orthodontic wires have been found to corrode and discolour due to fluoride ions generated by fluoride prophylactic agents. The coefficient of friction is increased when the surface properties of the arch wires are altered by pitting and corrosion, which has clinical importance during the gap closure stage. Using a Scanning Electron Microscope (SEM), the following article attempts to examine and compare the corrosion of five distinct Orthodontic wire surfaces as a result of prophylactic fluoride exposure and GC Tooth mousse with Distilled water.

Effect of Removeable Orthodontic Appliance on Oral PH, Candida Albicans, Candida Dubliniensis, and Streptococcus Mutans Count

Removable orthodontic appliances (ROAs) are popular devices to move or retain teeth during or after orthodontic treatments providing a good environment for adhesion and colonization of pathogenic and non-pathogenic organisms. The aim of the present study was to explore the presence and variability of oral PH, levels of Candida Albicans, Candida Dubliniensis, and Streptococcus (S.Mutans) in children before and during the treatment with ROAs. In this clinical trial study, a total of 160 patients aged 8–12 years old in both genders were enrolled from a larger sample of patients who were clinically confirmed to obtain ROAs. They were randomly divided into three groups; 1- PH Group (n=51), 2- Candida Group (n=51), and 3- S.Mutans Group (n=58). Patients were assessed prior (T0) and again one month later (T1) following appliance insertion. The oral cavity was sampled for PH level, Candida species and bacterial species by culture. Paired t-Test and ANOVA were applied for statistical analysis. The level of significance was assumed to be P ≤ 0.05 for all tests. In Group 1, PH values decreased from 6.89±0.5 in T0 to 6.55±0.7 in T1 (0.5% decrease) with statistically significant difference (P=0.002). In group 2, total Candida count at dorsal tongue was more than hard palate. Also, the difference (5.1±6 increase) was significant between the mean Candida count in T0 and T1 (P=0.001). Although the C.Albicans count was more than C.Dubliniensis, the difference was not significant. In group 3, S.mutans showed a significant difference between the two subgroups of case and control (P&lt;0.005). ROAs change the balance to decrease the values as well as increase the proliferation/colonization of Candida specimen and S.mutans. This implicated the importance of paying special attention to oral hygiene in orthodontic patients to prevent oral disease and the aggravation of systemic disease in immunocompromised conditions.

Effects of remote digital monitoring on oral hygiene of orthodontic patients: a prospective study

BackgroundRemote digital monitoring during orthodontic treatment can help patients in improving their oral hygiene performance and reducing the number of appointments due to emergency reasons, especially in time of COVID-19 pandemic where non-urgent appointments might be discouraged.MethodsThirty patients scheduled to start an orthodontic treatment were divided into two groups of fifteen. Compared to controls, study group patients were provided with scan box and cheek retractor (Dental Monitoring®) and were instructed to take monthly intra-oral scans. Plaque Index (PI), Gingival Index (GI), and White Spot Lesions (WSL) were recorded for both groups at baseline (t0), every month for the first 3 months (t1, t2, t3), and at 6 months (t4). Carious Lesions Onset (CLO) and Emergency Appointments (EA) were also recorded during the observation period. Inter-group differences were assessed with Student's t test and Chi-square test, intra-group differences were assessed with Cochran’s Q-test (significance α = 0.05).ResultsStudy group patients showed a significant improvement in plaque control at t3 (p = 0.010) and t4 (p = 0.039), compared to control group. No significant difference was observed in the number of WSL between the two groups. No cavities were detected in the study group, while five CLO were diagnosed in the control group (p = 0.049). A decreased number of EA was observed in the study group, but the difference was not significant.ConclusionsIntegration of a remote monitoring system during orthodontic treatment was effective in improving plaque control and reducing carious lesions onset. The present findings encourage orthodontists to consider this technology to help maintaining optimal oral health of patients, especially in times of health emergency crisis.

Surface characterization and frictional force between stainless steel brackets and archwires in orthodontic patients using chlorhexidine- and Persica-containing mouthrinses: A randomized controlled trial

The aim of this study was to compare the effect of chlorhexidine- and Persica-containing mouthrinses on the surface characterization of orthodontic appliance and friction between the orthodontic stainless steel wires and brackets. In this randomized controlled trial, 75 orthodontic patients (aged 13-30) were allocated (n = 25) into two experimental groups (prescribed by Persica- or chlorhexidine-containing mouthrinse) and one control group (no prescription). The ovoid stainless steel archwires were placed, and the maxillary first premolar stainless steel edgewise brackets were ligated to wires by elastomeric rings. The patients were recalled after 2 weeks, and then, the archwires were removed and replaced. The surface analysis of archwires and brackets was evaluated using scanning electron microscopy and atomic force microscopy. The frictional forces between the archwires and brackets were measured using a universal testing machine. The data for surface roughness were analyzed by the nonparametric Kruskal-Wallis and Mann-Whitney tests. The frictional forces data were analyzed using a two-way analysis of variance and Tukey's post hoc test using SPSS software. The level of significance was P < 0.05. The retrieved brackets showed minor changes in their surface topography. The surface roughness of archwires after the intervention was significantly greater for the chlorhexidine than that of Persica (P < 0.05). The friction force between the archwires and brackets was also significantly higher for the chlorhexidine than that of Persica (P < 0.05). The Persica-containing mouthrinse from the biomechanical and biochemical standpoints may be a better option for oral hygiene in orthodontic patients compared with the chlorhexidine.

TO DETERMINE THE EFFECTIVENESS OF REMINDING PATIENTS IN MAINTAINING GOOD ORAL HYGIENE VIA WHATSAPP MESSAGES COMPARED WITH THE CONVENTIONAL TEXT MESSAGING

To determine the effectiveness of reminding patients in maintaining good oral hygiene via Whatsapp messages compared with the conventional text messaging. In this randomized, controlled clinical trial, thirty four orthodontic patients were assigned to two groups of Whatsapp and text message. Patients in both the groups were reminded twice each week for 5 weeks and one reminder message for 8 weeks thereafter. Oral hygiene compliance was measured using bleeding index (BI), modified gingival index (MGI), and plaque index (PI) at the start (T0), at 5 weeks after baseline (T1), and at 8 weeks after the start (T2). The Whatsapp group had highly significant lower BI, MGI, and PI scores than the text message group at T2. The use of Whatsapp messaging over the text message reminders, sent by the orthodontist, was more effective for maintaining oral hygiene in orthodontic patients.

Dental water jet efficacy in the plaque control of orthodontic patients wearing fixed appliance: A randomized controlled trial.

BackgroundDifferent studies assess the role of fixed orthodontic appliances in supragingival plaque accumulation. In patients wearing fixed orthodontic appliances a good management of oral hygiene is required in order to prevent complication like as decay, enamel demineralization, gingivitis, gingival hyperplasia and periodontitis. The aim of this Randomized Controlled Trial (RCT) is to evaluate the efficacy of the use of a DWJ in patients under orthodontic treatment with fixed multibracket appliance.Material and MethodsThe study design was single-blinded RCT with a split mouth protocol. Each patient followed a personal cleaning protocol using a DWJ in addition to traditional brushing only on one side while just brushing on the control side. The side on which was decided to use the DWJ was chosen randomly and the dental hygienist who took the measurements was blind. Plaque and gingival indexes were evaluated at baseline and at one, three and six-months follow-up.ResultsIt did not emerge any difference in the plaque and gingival indexes trend between the two groups. Patients initially reported an worsening of the indexes at one month evaluation, then they set at baseline levels at three and six months.ConclusionsThe dental water jet does not improve significantly the efficacy of home oral hygiene in orthodontic patients wearing a multi-bracket fixed appliance. Patients did not show the traditional worsening during the whole orthodontic therapy. Key words:Dental water jet, fixed orthodontics, plaque index, gingival index.

To Assess the Knowledge, Attitude and Practice of Oral Hygiene Protocols Among Patients Having Orthodontic Treatment

INTRODUCTION: Orthodontic treatment is widely acknowledged and accepted in everyday dental practice due to the positive effects it has on the dentofacial complex. Importance of oral hygiene in orthodontic patients is also important to prevent any further oral diseases.AIM: The aim of this study was to assess the knowledge, attitude, and practice of oral hygiene protocols among patients having orthodontic treatment.MATERIALS AND METHODS: The sample consisted of 90 patients who had permanent dentition from the Department of Orthodontics and Dentofacial Orthopedics and various questions were asked regarding the knowledge, attitude and practice on oral hygiene during the time of orthodontic treatment. All the responses were analysed statistically.RESULTS: The results of the study showed that nearly 40% of the patients were unaware about gingival health, 65% did not follow the oral hygiene instruction. Despite being given instructions, most of them were reluctant in practicing them strictly.CONCLUSION: The knowledge, attitude, practice of oral hygiene among orthodontic patients were poor and showed the need of better education and motivation. Many factors may be responsible for the non-maintenance of gingival health practices. There is a need to incorporate and evaluate more intense oral hygiene programs in the future.

Effectiveness of motivational interviewing to improve oral hygiene in orthodontic patients: A randomized controlled trial

Maintaining good oral hygiene in patients wearing fixed appliances is a challenge for orthodontics. Conventional education has been demonstrated to be insufficient for the promotion of good oral habits, while motivational interviewing has the potential to facilitate health behavior change. The present randomized controlled trial with 130 patients aimed to evaluate the effectiveness of a single session of motivational interviewing in enhancing oral hygiene in orthodontic patients compared with conventional education alone. Results revealed an immediate improvement in oral hygiene which remained stable throughout the 6-month follow-up.

Oral Hygiene Awareness and Effect of Orthodontic Treatment on Periodontal Health among Medical Students

Abstract Background: Orthodontic treatment helps in improving aesthetics, oral hygiene as well as functional occlusion. Also, importance of oral hygiene in orthodontic patients is always intensified to prevent any further periodontal disease. Regular oral hygiene maintenance is important for the maintenance of gingival health during and after orthodontic therapy as it helps in preservation of the health of gingiva as well as overall oral health. Objective: To assess the extent of oral hygiene awareness and impact of orthodontic treatment on of periodontal health, among medical students. Method: A cross sectional survey containing 19 questions was answered by 150 medical students who had undergone fixed Orthodontic treatment from various colleges in Mangalore, Karnataka. Results and Conclusion: The results of this survey showed that medical students have adequate knowledge of oral hygiene practices. Majority of medical students who had undergone orthodontic treatment showed increased bleeding from gums, increased sensitivity and difficulty in brushing and flossing indicating that orthodontic treatment does have impact on maintenance of oral hygiene. Thus, a thorough assessment of the periodontal health is recommended prior to orthodontic treatment. Equal emphasis should also be laid on the necessity of good oral hygiene and regular periodontal maintenance for the best outcome.

The Influence of Text Message Reminders on Oral Hygiene Compliance in Orthodontic Patients

Objective: To determine if text message reminders regarding oral hygiene have an effect on maintaining good oral hygiene in orthodontic patients. Materials and Methods: In this randomized, controlled clinical trial, 34 orthodontic patients were assigned to a text message or control group. Patients in the text message group received 2 reminder text messages each week for 4 weeks and one reminder text message for 8 weeks thereafter. Oral hygiene compliance was measured using bleeding index (BI), modified gingival index (MGI), and plaque index (PI) at baseline (T0), at 4 weeks after baseline (T1), and at 8 weeks after baseline (T2). Results: Text message group had highly significant lower BI, MGI, and PI scores than control group at T2. Conclusion: The use of text message reminders sent by the orthodontist was effective for improving oral hygiene compliance in orthodontic patients.

Effect of Orthodontic Appliances on the Oral Carriage of Streptococcus Mutans and Candida Species

Objectives : To evaluate the prevalence and estimate counts of Streptococcus mutans and Candida species and to compare the efficacy of manual and electronic brushes on their count reduction. Materials and Method : Thirty patients undergoing orthodontic treatment in the Department of Orthodontics, Santosh Dental College and 30 patients without orthodontic appliances (as control) were selected to determine the counts of S.mutans in plaque samples and counts of Candida species on Sabaroud's Dextrose Agar. All 30 subjects with appliances were then divided into two Groups: Group 1 was assigned Manual brushes and Group 2 were assigned Electronic brushes and both the groups were evaluated for the counts at the end of 1st, 2nd and 3rd month. Results : S. mutans counts were high in 80% (24/30) and Candida species were found to be 16% (5/ 30) in patients with orthodontic appliances as compared to controls. No significant reduction in counts was observed in patients while using manual brushes. However, in patients using electronic brushes their counts were markedly reduced. Conclusion : There occurs a significant increase in S.mutans and Candida counts after appliance insertion, hence the use of manual brushes is insufficient for satisfactory maintenance of oral hygiene in orthodontic patients and reduction in their counts by using electronic brushes should be related to the reduced risk of oral diseases in such patients.

WITHDRAWN: Interspace/interdental brushes for oral hygiene in orthodontic patients with fixed appliances.

This review has been withdrawn from publication because it is out of date. It is being updated and replaced by a new expanded Cochrane review entitled 'Interdental cleaning in patiens wih fixed orthodontic appliances' by HH Goh and B Doubleday. It will remain withdrawn when the new review is published.

Effectiveness of Herbal and Non-Herbal Toothpastes in Reducing Dental Plaque Accumulation

Maintaining good oral hygiene in orthodontic patients is important and as the community interest in herbal ingredients increases, herbal toothpaste was developed. Its effectiveness against dental plaque accumulation is still under debate. Herbal toothpaste has not been tested in fixed orthodontic patients. Objective: To study the effectivenes differences between herbal toothpaste and non-herbal toothpaste. Methods: This randomized, double blind clinical trial was participated by 16 subjects aged range 15-35 years who were planned for fixed orthodontic. The subjects were divided into two groups based on the type of toothpaste used. Plaque accumulations were measured according to Loe and Sillness plaque index on Ramfjord teeth before and two weeks after bonding. Results: Wilcoxon test result showed there was no significant reduction of plaque index on herbal toothpaste usage nor significant increase on non-herbal toothpaste usage. Mann-Whitney test showed no significant differences between herbal and non-herbal toothpaste. Conclusion: There was no significant differences in plaque acummulation between usage of herbal toothpaste nor usage of non-herbal toothpaste. There was no significant effectiveness differences between those toothpastes in fixed orthodontic patients, although herbal toothpaste usage showed a reduction of plaque index, whereas non-herbal toothpaste usage showed an increase of plaque index. DOI: 10.14693/jdi.v19i3.143

Evaluación de la eficacia de dos prescripciones de cepillos dentales en la remoción de placa bacteriana en pacientes ortodóncicos

Orthodontic fixed appliances include elements that allow the accumulation of bacterial plaque, making tooth brushing more difficult and increasing the risk of developing caries, white spot lesions, and periodontal disease. Several toothbrushes designs have been developed to facilitate oral hygiene in orthodontic patients; however, it has been observed that most patients do not take enough time to brush using adequately both commonly prescribed toothbrushes (Oral-B End-Tufted® and Oral-B Orthodontic® brushes). Oral B Cross Action Pro-Health® has been presented as an alternative, easier to use and to transport. To assess the effectiveness of Cross Action Pro-Health® versus commonly prescribed toothbrushes, two randomly assigned groups of 23 orthodontic patients each, were evaluated. One group of patients used commonly prescribed toothbrushes and the second group used Cross Action Pro-Health®. O‘Leary, modified gingival and Bracket plaque index were measured before and 45 days after the daily use of the two mentioned toothbrushes prescriptions. T-test was used to detect statistically significant differences among the brushes for each index. The results demonstrated a significant reduction of the three indexes with the daily use of Cross Action Pro-Health® and no differences were found versus commonly used prescription. Orthodontic patients may benefit from the use of a single brush prescription (Cross Action Pro-Health®), because effective plaque removal can be achieved easier and faster.

The staining effect of chlorhexidine mouthwash on nonmetallic brackets (An in vitro comparative study)

Background: Since it is needed to have means other than mechanical plaque control to achieve good oral hygiene in orthodontic patients, and since an eliminating the metallic appearance of orthodontic appliance is always desired to achieve a maximum esthetic appliance, so this study was done to investigate and compare the staining effects of chlorhexidine mouthwash 0.2% on the un bonded ceramic brackets, ceramic brackets bonded with no mix adhesive, ceramic brackets bonded with light cured adhesive, un bonded composite brackets, composite brackets bonded with no mix adhesive and composite brackets bonded with light cured adhesive. Materials and Methods: The effect of the chlorhexidine was studied through immersion the brackets and bonded brackets in the mouth wash for three different time intervals: 1, 2 and 3 hours, which represent the accumulated daily use of the mouthwash for 1, 2, and 3 months respectively and compared them with corresponding control groups which not immersed in chlorhexidine 0.2%. The sample consisted of two hundred eighty eight brackets. AShimadzu, UV 160A UV-Visible spectrophotometer was used to perform a light absorption test for each subgroup with twelve brackets each. Results: ANOVA and LSD post Hoc tests were used to identify the significant effects of the mouthwash at a significance level P ≤ 0.05, A significant effects identified with ceramic brackets bonded with no mix adhesive, ceramic brackets bonded with light cured adhesive, un bonded composite brackets, composite brackets bonded with no mix adhesive and composite brackets bonded with light cured adhesive, while non significant effect of un bonded ceramic brackets. Conclusions: It can be concluded that the chlorhexidine mouthwash do not have a staining effect on the un bonded ceramic brackets while significant changes in staining effect when ceramic and composite brackets bonded to no mix adhesives and that effect decrease when bonded to light cured adhesives. The mouthwash has a staining effect on the un bonded composite brackets also.

Plaque levels of patients with fixed orthodontic appliances measured by digital plaque image analysis

A digital plaque image analysis system was developed to objectively assess dental plaque formation and coverage in patients treated with fixed orthodontic appliances. The technique was used to assess plaque levels of 52 patients undergoing treatment with fixed appliances in the Department of Orthodontics at Johannes Gutenberg University in Mainz, Germany. Plaque levels ranged from 5.1% to 85.3% of the analyzed tooth areas. About 37% of the patients had plaque levels over 50% of the dentition, but only 10% exhibited plaque levels below 15% of tooth coverage. The mean plaque coverage was 41.9% ± 18.8%. Plaque was mostly present along the gum line and around the orthodontic brackets and wires. The digital plaque image analysis system might provide a convenient quantitative technique to assess oral hygiene in orthodontic patients with multi-bracket appliances. Plaque coverage in orthodontic patients is extremely high and is 2 to 3 times higher than levels observed in high plaque-forming adults without appliances participating in clinical studies of the digital plaque image analysis system. Improved hygiene, chemotherapeutic regimens, and compliance are necessary in these patients.