Plaque Levels Of Patients With fixed Orthodontic Appliances Measured By Digital Plaque Image Analysis

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Plaque levels of patients with fixed orthodontic appliances measured by digital plaque image analysis
Malgorzata Klukowska,a Annike Bader,b Christina Erbe,c Philip Bellamy,d Donald J. White,e Mary Kay Anastasia,f and Heiner Wehrbeing Mason, Ohio, Mainz, Germany, and Egham, United Kingdom

Introduction: A digital plaque image analysis system was developed to objectively assessdental plaque formation and coverage in patients treated with fixed orthodontic appliances. Methods: 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. Results: Plaque levels ranged from 5.1% to 85.3% of the analyzed tooth areas. About 37% of the patients hadplaque levels over 50% of the dentition, but only 10% exhibited plaque levels below 15% of tooth coverage. The mean plaque coverage was 41.9% 6 18.8%. Plaque was mostly present along the gum line and around the orthodontic brackets and wires. Conclusions: The digital plaque image analysis system might provide a convenient quantitative technique to assess oral hygiene in orthodontic patients withmulti-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. (Am J Orthod Dentofacial Orthop 2011;139:e463-e470)O

rthodontic treatment can improve the self-image of patients through the provision of better esthetics and a more attractive smile. In addition, orthodontics can in principle have long-term health advantages for patients, since crooked and crowded teeth are difficult to clean and maintain. Despite the posttherapy health advantages of orthodontics, the treatment regimen itself createsobstacles for patients, because orthodontic brackets create plaque-retentive sites that

a Senior scientist, Procter and Gamble Company, Mason Business Center, Mason, Ohio. b Former postgraduate student, Department of Orthodontics, University Medical Centre, Johannes Gutenberg University, Mainz, Germany. c Assistant professor, Department of Orthodontics, University Medical Centre, Johannes GutenbergUniversity, Mainz, Germany. d Principle researcher, Procter and Gamble Company, Rusham Park Research Center, Egham, United Kingdom. e Research fellow, Victor Mills Society, Procter and Gamble Company, Mason Business Center, Mason, Ohio. f Principle researcher, Procter and Gamble Company, Mason Business Center, Mason, Ohio. g Professor and head, Department of Orthodontics, University Medical Centre,Johannes Gutenberg University, Mainz, Germany. This study was supported by Procter and Gamble. Reprint requests to: Malgorzata Klukowska, Procter and Gamble, Mason Business Center, 8700 Mason-Montgomery Rd, Mason, OH 45040; e-mail, klukowska.m@pg.com. Submitted, January 2010; revised, April 2010; accepted, May 2010. 0889-5406/$36.00 Copyright Ó 2011 by the American Association of Orthodontists.doi:10.1016/j.ajodo.2010.05.019

impede tooth cleaning. Dental plaque is a causative factor for oral disease, and thus its removal and control are important aspects of oral health maintenance.1,2 This plaque can lead to enamel demineralization3-5 and gingivitis.6-8 Previous studies have shown that the rate of decalcification in orthodontic patients is higher than in patients without orthodontictreatment. White spots have been reported in as many as 50% of teeth treated with brackets and in up to 50% of orthodontic patients.3,4 Although various studies have evaluated fluoride treatments for their effects in reducing white spot formation associated with orthodontic treatment,9,10 surprisingly only a few studies have assessed plaque prevention by antimicrobials.11-13 Most of those studies...