Optimization of oral hygiene in children with malocclusion during orthodontic treatment with fixed appliances

Background

The prevalence of malocclusion in the mixed dentition is increasing and requires not only a personalized approach to treatment selection, but also oral hygiene management during orthodontic treatment.

Aim

To investigate the possibilities of optimizing oral hygiene during orthodontic treatment of malocclusion in children aged 7–12 years.

Methods

The study was conducted from July 2022 to August 2024 in two stages. Stage 1 (experimental) evaluated the adhesion activity of the microflora against samples of dental materials, used in the manufacture of bases for fixed orthodontic appliances. A total of 128 samples representing eight different types of polymerizations (four hot and four cold, 16 samples per type) were studied. Stage 2 (clinical) involved the examination of 46 children of both sexes aged 7–12 years with malocclusion and fixed dental appliances. Two groups were formed: Group 1 (n=23) included patients who performed standard dental care, while Group 2 (n=23) included patients who additionally used the probiotic DentoBLIS® (Medico Domus d.o.o., Serbia). The effectiveness of the used hygiene methods was evaluated based on the values of Oral Hygiene Index-Simplified (OHI-S), and the study of biological samples (n=230) of the buccal epithelium with subsequent calculation of the buccal epithelium natural colonization index (BENCI).

Results

The lowest oral microflora adhesive activity was noted for cold-cure acrylic resin Villacryl Ortho® (Everall7, Poland): S. sanguinis — 0.41±0.18, S. epidermidis — 0.36±0.08, C. albicans — 0.14±0.05, and C. krusei — 0.10±0.09. The fixed orthodontic appliances with a base made from this material, did not maintain stable oral hygiene. In both groups, the oral hygiene status one month after initiating orthodontic treatment was 1.73±0.22 and 1.71±0.24 respectively (р 0.05). Probiotic administration during treatment led to stabilization and improvement of hygienic status: at six months, the OHI-S scores were 1.21±0.20 and 0.62±0.11 (p 0.0001), and at 12 months they were 1.02±0.18 and 0.71±0.13 (p 0.0001); the six-month BENCI scores in both groups were 0.79±0.42 and 1.54±0.56 respectively (p 0.0001).

Conclusion

This study confirms that the oral hygiene during the orthodontic treatment depends on the adhesion activity of structural materials and the extent of dysbiotic disturbances. The use of low-adhesion materials and resolution of dysbiosis via probiotics, create favorable conditions for maintaining optimal oral hygiene and colonization resistance during orthodontic treatment.