Evaluation of Caries Risk Using Cariogram Among Orthodontic Patients Before and During Treatment: A Comparative Study.

Objective The primary objective was to examine the Cariogram parameters among orthodontic patients with fixed appliances and evaluate the impact of preventive measures on mitigating the risk of dental caries during orthodontic therapy. Materials and methods Patients visiting the representative orthodontic clinics across 14 districts of Kerala participated in the comparative cross-sectional study from January 2023 to January 2024. The sampling method employed in this study was convenience quota sampling, where study subjects were allocated from each of the low, moderate, and high caries risk profiles until the sample size reached the minimal requirement within each group. The baseline Cariogram scores were used to divide the consented participants into two distinct groups. The intervention group was provided with preventive initiatives, including toothpaste comprising 1,450 ppm fluoride, 0.2% NaF mouthwash, pre-cut strands of SuperFloss, an orthodontic toothbrush designed for orthodontic braces, and an interdental flexible brush, as well as videos, pamphlets, and brochures that promoted oral health habits. In contrast, the control group received normal oral health education solely through the use of pamphlets and brochures. After six months, the Cariogram elements were re-evaluated for individuals in both groups. The independent sample t-test and paired t-test were applied to evaluate statistically significant differences between and within the two groups, respectively, using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, NY, US). The distribution of patients based on their caries risk profiles was compared between groups at the commencement of the study and six months later using the Chi-square test. Results While the intervention group had 20 males and 22 females, the control group consisted of 21 males and 21 females. The average age in the intervention and control groups was 20.7±3.56 years and 21.2±3.12 years, respectively. Between the two groups, age (t=-0.68; p=0.50) and gender differences (λ2=0.05; p=0.83) were statistically insignificant. The percentage mean of the "Chance to avoid caries" associated with the intervention group increased significantly from 46.15±0.96 to 57.88±1.91, (p<0.001). On the other hand, the chance to avoid caries in the control group at the commencement of the treatment and six months later was found to be statistically insignificant. A statistically highly significant differences for all the Cariogram parameters were found when contrasted between the groups after six months of orthodontic treatment. The distribution of caries risk categorization between the control and intervention groups after six months of orthodontic treatment was found to be statistically significant (λ2=20.16; p<0.0001). Further, a statistically significant difference was observed during the pre-treatment phase and six months later in the intervention group (λ2=13.02; p=0.001). Conclusion The study findings reveal that it would be prudent to utilize 0.2% sodium fluoride mouth rinse, SuperFloss, an orthodontic toothbrush designed for orthodontic braces, and an interdental flexible brush, along with toothpaste containing 1450 ppm fluoride daily, to mitigate the risk of dental cavities during orthodontic treatment, in comparison to the control group.

Impact of Low-Level Laser Therapy on Orthodontic Tooth Movement and Various Cytokines in Gingival Crevicular Fluid: A Split-Mouth Randomized Study.

BACKGROUND AND OBJECTIVES: A few investigations have detailed the influence of low-level laser therapy (LLLT) on orthodontic tooth movement (OTM), with varying results. The objectives of this study were twofold: to assess the impact of LLLT on OTM and various cytokine levels in gingival crevicular fluid and to contrast the pain levels experienced by patients receiving orthodontic treatment with and without LLLT. MATERIALS AND METHODS: This split-mouth randomized controlled prospective study comprised 40 patients with an average age of 19.7±2.4 years with Angle Class I malocclusion combined with bimaxillary protrusion who were advised for extraction of the maxillary first premolar and bilateral canine distalization. The control-side canine was distalized solely by the coil spring. On the test arm, a low-level gallium-aluminum-arsenide semiconductor diode laser operating at 980 nm and 100 mW with a continuous-wave energy of 8 J/cm2 was used. The canine distalization on either side was measured with a digital caliper following the first premolar extraction (TO), one month after treatment (TOTM1), two months later (TOTM2), and three months later (TOTM3). The gingival index and the level of various cytokines were determined by an enzyme-linked immunosorbent assay at the beginning of the study, on the third and seventh days, and at four, eight, and 12 weeks following the canine distalization. The intra-group and inter-group comparisons were carried out using one-way analysis of variance (ANOVA) and t-tests, respectively, at a 5% significance level. RESULTS: The results show a highly statistically significant difference in the extent of canine distalization in the test group (TOTM1=2.92±0.44; TOTM2=1.04±0.1; TOTM3​=0.62±0.21 mm) in contrast to the control group (TOTM1=3.23±0.8; TOTM2=2.65±0.2; TOTM3​​​​=2.11±0.24 mm) (p<0.01). After three months of canine distalization, the laser and control group had 34 and 27 patients with mild gingivitis, respectively. Interleukin-1ß and interleukin-6 concentrations surged with values of 0.74±0.13 and 0.049±0.001 pg/g at seven days following treatment in the laser group, respectively. The difference in tumor necrosis factor concentration between the groups was shown to be highly statistically significant in all treatment phases (p<0.001). The differences in the epidermal growth factor and microglobulin levels were found to be statistically significant within both groups from T0 to T5. The average visual analog scale (VAS) scores at several subsequent evaluations of the laser and control groups were found to be highly statistically significant. CONCLUSION: The findings imply that when the periodontal microenvironment is stimulated by orthodontic force, several paramount cytokines are released, triggering an ordered sequence of biological processes that appear to expedite OTM with reduced associated pain.