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JADA Specialty Scan - Orthodontics
Orthodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Dental hygienists' role in reducing plaque retention

Do dental hygienists make a difference in patients’ oral hygiene?

Italian scientists publishing in the June 2015 issue of The European Journal of Orthodontics evaluated the literature to learn whether prophylactic procedures performed by dental hygienists are effective in reducing the risk of demineralization in orthodontic patients fitted with multibracket appliances. They also wanted to know if it is clinically possible to avoid plaque increase and prevent white spot lesions and caries.

The authors noted previous research showing the association between fixed orthodontic appliances and the accumulation of bacterial plaque around the brackets. Brackets tend to hinder the patient’s ability to remove plaque with normal home care hygiene procedures. “Flossing is particularly difficult, thereby making the onset of periodontal tissue inflammation all the more likely,” authors said. They called out research documenting that in addition to an increase in subgingival bacterial flora during fixed orthodontic treatment, there is a change in its composition, specifically a shift from aerobic to anaerobic — the major culprits in gum disease and periodontal problems.

“Fixed appliances also increase the likelihood of enamel demineralization, as evidenced by the appearance of WSLs [white spot lesions] and caries, and orthodontic treatment with multi-bracket fixed appliances is therefore considered a risk factor for both soft and hard tissue damage,” the authors said.

To gather the evidence on the efficacy of dental hygienist intervention on plaque increase in patients with fixed appliance orthodontics, the scientists conducted a targeted electronic search of the literature prior to June 2013 using relevant headings. They qualified 10 of 630 articles for this review. Eight of the studies were randomized clinical trials, one was a controlled clinical trial and one was a before/after study.

They grouped findings of the systematic review and included evidence on plaque index, gingival index, oral hygienist intervention, communication techniques, caries, white spot lesions and prophylaxis regime. Through their analysis, the scientists concluded that the data indicate that dental hygiene appointments for orthodontic patients are efficient in reducing plaque, even if a specific well-defined approach does not emerge in the literature.

“The synergic teamwork between the orthodontist and dental hygienist should lead to a decrease of oral health risks due to the orthodontic treatment,” authors said among conclusions. “The dental hygienist intervention involves not only the traditional scaling and polish but also thorough and comprehensive instruction and motivation of the patients in terms of patient home oral hygiene routine.” The findings support the need for regular dental hygiene appointments during active fixed appliance orthodontic treatment, underscoring the importance of a team approach to dental care.

In addition, scientists found the literature on optimal oral health maintenance during orthodontic treatment lacking and called for more high quality studies, such as randomized clinical trials.

Read the original article.


Consulting Editor: Lee W. Graber, DDS, MS, PhD
Diplomate, American Board of Orthodontics

Texts to patients encourage oral hygiene compliance

If you’re looking for an effective way to encourage oral hygiene compliance you may want to communicate the way your patients do: by text.

Some 75 percent of 12- to 17-year-olds in the U.S. own cell phones and three quarters of them send text messages, according to the Pew Research Center’s 2010 Internet and American Life Project. Previous research in medicine and dentistry show that text messaging is an effective tool for behavioral change and disease prevention. Positive changes previously reported include smoking cessation, diabetes self-management and anti-obesity.

Considering such results and recognizing that oral hygiene compliance can be challenging to achieve with the orthodontic treatment population, a team of scientists at Seton Hill University Center in Pennsylvania set out to learn if there is a difference in oral hygiene between patients who receive direct text oral hygiene motivational messages and those who do not. They published their research in the July 2015 issue of the Angle Orthodontist.

They conducted a randomized, controlled clinical trial on a sample of 50 consecutively treated patients between June 2013 and June 2014. Patients between the ages of 10 and 18 with access to a cell phone, orthodontic treatment with fixed appliances and at least six months of remaining orthodontic treatment were eligible. Scientists divided subjects into two groups: those who received text messages and those who did not.  All subjects were unaware of their group status or that text messages were part of the study.

After examining for plaque at the first appointment, scientists took photographs of four maxillary and four mandibular teeth in both groups. They used planimetry-based scales for measurement of plaque accumulations, which implement digital analysis software.

Both groups of subjects watched an audiovisual presentation on how to properly brush. The treatment group received automated text messages two to three times per week for four weeks (totaling 12 texts) reminding and encouraging them to practice good oral hygiene. The control group received no text messages. After the four-week period, scientists reevaluated both groups and took intraoral photos to evaluate plaque. The text group received a text once a week for eight weeks thereafter. Scientists again reevaluated subjects in both groups after the eight weeks. Plaque coverage measurements for subjects at weeks four and 12 were compared with those from the initial appointment.

Researchers found that the group that received text messages had a statistically significant reduction in plaque when compared with the control group at both evaluations.

“The results of this study suggest that a text message reminder improves the amount of plaque removed at a particular time point,” authors said. They added that since this study looked at only a short time span, any long-lasting effect from text messaging requires further investigation.

“The power of the spoken word, or in this instance the written word, appears invaluable when it comes to serving as a means of communicating with young orthodontic patients,” authors said.

They noted research that texting is not just for teens (reports state that 43 percent of those in Generation Y are texting daily, while 31 percent of Generation X has adopted texting). The number of individuals owning a cell phone is greater than the number of individuals owning a computer.

“One might expect that the number of individuals using text messaging as a primary means of correspondence will only grow,” authors said. The bottom line of this study was that by using readily available and popular communication technology to enforce home care recommendations, clinicians in this study were able to improve plaque scores.

Read the original article.


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With CS Solutions for Orthodontics, users have the option to create digital impressions with the CS 3500 intraoral scanner for use with new CS Model software. The CS 3500 intraoral scanner acquires true color, 2D and 3D images without the need for a heater, powder or trolley system.

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Malocclusion and quality of life in children and adolescents

Seeking to gain knowledge about the influence of malocclusions on oral health-related quality of life (OHRQoL) in children and adolescents, Swedish scientists conducted a systematic review of quantitative studies and published their findings in the June 2015 issue of The European Journal of Orthodontics.

The researchers found strong evidence that severe malocclusions in the esthetic zone have negative effects on OHRQoL in children and adolescents, predominately in the areas of emotional and social well-being. They described “a high level of underlying scientific evidence for the negative effects.”

They believe the findings are new and describe the relationship between malocclusions and OHRQoL in greater detail compared with previous research.

The study focused on the question: “Do malocclusions have an impact on OHRQoL in children and adolescents?” To find out, the scientists searched five electronic databases filtering for children six to 12 and adolescents 13 to 18 years of age.

Scientists deemed six cross-sectional studies eligible for analysis, with four having been produced within the past two years, “indicating that high quality studies that are carefully planned and performed in accordance with the research question are now emerging within the field." Four studies were ranked as high quality, meeting the following criteria: sufficient material; relevant subgrouping; drop-out rate not greater than 30 percent; and control of important confounders such as caries, socioeconomic factors, age and gender. If one of the criteria was lacking the study was downgraded to moderate. Thus, two included studies were evaluated as moderate in quality. All four studies evaluated as having a high level of quality had good control of differences between study and control groups regarding selection, performance, attrition and detection bias.  These are important considerations when discussing cross-sectional studies and high-value evidence, according to the scientists.

Among results, four studies reported that severe malocclusions, predominantly anterior crowding, spaced dentition or increased overjet had a negative impact. Two studies stated that increased orthodontic treatment need had a negative impact on OHRQoL. Two studies revealed that malocclusions predominantly affected emotional well-being and social well-being.

Calling for qualitative studies to measure OHRQoL on the individual level, scientists said, “Perhaps a suitable combination for future research would be quantitative measure via instruments and qualitative measure via interviews, giving even more nuanced information on how malocclusions may affect OHRQoL.”

Read the original article.


Adult orthodontic patients and oral health quality of life

Clinicians may want to advise their adult patients pursuing fixed orthodontic therapy that although an initial dip in oral health-related quality of life (OHRQoL) during the earliest stages of their treatment is possible, it’s likely temporary. 

The findings, by scientists publishing in the June 2015 issue of The European Journal of Orthodontics determined oral health-related quality of life generally returns to pre-treatment levels by the completion of their orthodontic treatment. Self-esteem, though, did improve when compared to pre-treatment scores.

“It is important to take into account what patients will experience during orthodontic treatment to provide insight in the true benefits and health gains associated with orthodontic therapy,” authors said. Finding little evidence to evaluate the impact of fixed orthodontic treatments in adults despite their increasing numbers, the scientists aimed to assess its impact on OHRQoL and self-esteem in adult orthodontic patients.

To investigate, the scientists conducted a prospective study of 61 adult patients from four orthodontic practices across Southeast England. The mean age of subjects was 41.2 and 78 percent were female. All of the patients had a borderline or definite treatment need. Patients completed the Rosenberg Self-Esteem Scale, which consists of 10 questions — five positive and five negative, and the OHIP-14, which measures seven domains: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. Patients completed questionnaires prior to treatment, at one, three and six months into treatment and again post treatment.

Results showed patients’ OHRQoL deteriorated significantly through the third month of treatment and returned to pre-treatment scores at the end of treatment. “This information could be useful to further inform patients of the likely impact of orthodontic treatment to their lives and in particular during the first three months and thus helping to not only manage their expectations but also adaptation,” scientists said in discussion.  

Self-esteem ranked high among the group overall, leading scientists to believe its impact on malocclusion was unlikely to be detected. The study’s results showed no statistically significant difference in self-esteem scores during orthodontic treatment. However, scientists saw a significant difference between the start and end of treatment. In discussion, they reported that although self-esteem is influenced by many factors and therefore the interaction with orthodontic treatment may be variable, the findings of the present study suggest that the increase in self-esteem was a result of treatment and that orthodontic treatment might impart psychological benefits to adult patients.

Read the original article.

Capture high-resolution images with the CS 3500 intraoral scanner

With CS Solutions for Orthodontics, users have the option to create digital impressions with the CS 3500 intraoral scanner for use with new CS Model software.

The CS 3500 intraoral scanner acquires true color, 2D and 3D images without the need for a heater, powder or trolley system. The scanner features high-angulation scanning of up to 45 degrees and to a depth from -2 to +13 millimeters. It also includes an autoclavable tip available in two sizes, a smaller tip for children or adults with small mouths and a larger tip for adults, to ensure users adhere to the best practices for infection control.    
With the scanner, practitioners can capture high-resolution images digitally rather than using the putty associated with traditional impressions — eliminating the need for using impression material, pouring molds or waiting for stone models to set.

Once digital impressions are created, CS Model software takes basic distance measurements — including overjet, overbite, pressure map, arch length, tooth size, crowding measurement and more — to further improve clinicians’ diagnostic capabilities. CS Model enables orthodontists to quickly create digital models; review and store them electronically; and produce orthodontic appliances through preferred labs.

Creating digital models is an environmentally friendly solution that ensures that patients’ models are not damaged, lost or mixed up over time. Plus, CS Model gives practices access to all cases 24/7, without the need to access third-party storage via the Internet.

Digital models not only save time and money, but also serve as a powerful tool to engage patients in treatment planning and increase case acceptance.

For more information, click here.

Winter meeting in California

“Collaborative Management of Complex Dentofacial Conditions” is the title of the American Association of Orthodontists’ 2016 Winter Conference, which is being co-sponsored by the American Association of Oral and Maxillofacial Surgeons. The conference will be held Jan. 22-24, 2016, at the Hyatt Regency Indian Wells Resort & Spa in Indian Wells, Calif., near Palm Springs. 

The meeting will focus on orthodontic and surgical perspectives of state-of-the-art care of patients with complex dentofacial conditions. Registration will open on Aug. 14. Twelve continuing education credit hours are available at this meeting. For more information and to register visit the AAO website.

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CS Solutions for Orthodontics
With CS Solutions for Orthodontics, users have the option to create digital impressions with the CS 3500 intraoral scanner for use with new CS Model software. The CS 3500 intraoral scanner acquires true color, 2D and 3D images without the need for a heater, powder or trolley system.

For more information, click here.


What is Specialty Scan?

This is one in a series of quarterly newsletters updating dentists on selected specialties in dentistry. Information presented is aggregated and summarized from previously published materials, each item attributed to its publication of origin. This issue of JADA Specialty Scan focuses on orthodontics, the third in the series on this topic for 2015. Other Specialty Scan issues are devoted to endodontics, oral and maxillofacial radiology, oral pathology, pediatric dentistry, periodontics and prosthodontics. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. We welcome feedback on this and all Specialty Scan issues.

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