Effect Of Elastomeric Separator On Microbial Count In Gingival Crevicular Fluid.

BACKGROUND: The separators are a preliminary step for band insertion, but there is a potential risk of bacteraemia during their placement, particularly in susceptible patients. The objective of the study is to determine the effect of separators on the bacterial count in gingival crevicular fluid (GCF) and to assess the efficacy of chlorhexidine mouth rinse and saline irrigation in the reduction of the bacterial count. METHODS: This randomized controlled trial was conducted on 51 participants who were divided into three equal g roups randomly (brushing only/control, saline irrigation, and 2% chlorhexidine mouthwash rinse). The inclusion criteria were age between 18-25 years, good oral hygiene, gingival and plaque index <1, no previous orthodontic treatment, and healthy individuals. The bacterial count was obtained from GCF samples after two hours, on the third day, and on the seventh day. Kruskal Wallis test was used to compare the bacterial count among the three groups, and post hoc analysis was done using Dunn's test. Friedman test was applied to see the difference at three-time points in each group. RESULTS: In both saline and chlorhexidine groups the mean bacterial count decreased significantly from baseline to 3rd day and 7th day after separator placement (p<0.001). For the third day, a significant difference was found in control versus saline and control versus chlorhexidine. No significant difference was found between saline and chlorhexidine on the third day. Similar results were found on the 7 thday. For controls, the bacterial count increased with time and for both saline and chlorhexidine groups the bacterial count decreased. The highest decrease in the bacterial count was found for the chlorhexidine group. CONCLUSIONS: After the placement of separators, there was an increase in the bacterial count in GCF. Notably, chlorhexidine was found to be more effective than saline irrigation in reducing the bacterial count.

Effects of probiotics on salivary Streptecoccus mutans and Lactobacillus levels in orthodontic patients.

INTRODUCTION: In this study, we aimed to determine the effect of regular probiotic consumption on microbial colonization in saliva in orthodontic patients and to comparatively evaluate the difference between the systemic consumption of probiotic products and the local application. METHODS: This study included 3 groups with 15 orthodontic patients in each. The control group included patients who had no probiotic treatment, the subjects in the kefir group consumed 2 × 100 ml of kefir (Atatürk Orman Ciftligi, Ankara, Turkey) per day, and the subjects in the toothpaste group brushed their teeth with toothpaste with probiotic content (GD toothpaste; Dental Asia Manufacturing, Shah Alam, Selangor, Malaysia) twice a day. Samples were collected at 3 times: beginning of the study, 3 weeks later, and 6 weeks later. The salivary flow rate, buffer capacity, and Streptococcus mutans and Lactobacillus levels in the saliva were evaluated. Chair-side kits were used to determine the S mutans and Lactobacillus levels. RESULTS: A statistically significant decrease was observed in the salivary S mutans and Lactobacillus levels in the kefir and toothpaste groups compared with the control group (P <0.05). A statistically significant increase was observed in the toothpaste group compared with the control and kefir groups in buffer capacity. Changes in the salivary flow rate were not statistically significant. CONCLUSIONS: The regular use of probiotics during fixed orthodontic treatment reduces the S mutans and Lactobacillus levels in the saliva.

Effect of a single-tufted toothbrush on the control of dental biofilm in orthodontic patients: A randomized clinical trial.

OBJECTIVE: To compare the effect of a single-tufted toothbrush combined or not with a conventional toothbrush to control dental biofilm in healthy orthodontic patients. MATERIALS AND METHODS: Twenty orthodontic patients were randomly assigned to receive three different treatments: Group 1-conventional toothbrush; Group 2-single-tufted toothbrush and Group 3-combination of single-tufted and conventional toothbrushes. Stained plaque index (SPI), visible plaque index (VPI) and gingival bleeding index (GBI) were recorded. The data were analysed by Kolmogorov-Smirnov test. Wilcoxon test was used for intragroup comparison and Friedman test for the intergroup comparison (α = 5%). RESULTS: Intragroup analysis showed that VPI and SPI significantly decreased (P < 0.05) after 72 hour in Group 3. Anterior and posterior teeth did not show any significant statistical differences after 72 hour (P > 0.05), but VPI values in the labial surfaces were different to Group 3 (P < 0.05) in comparison with the other groups after 72 hour. Group 3 showed a statistically significant reduction (P < 0.05) for SPI in the interproximal surfaces when compared with Group 1. CONCLUSION: The combination of single-tufted and conventional toothbrushes was effective for controlling dental biofilm formation in orthodontic patients.

Viridans streptococcal infective endocarditis associated with fixed orthodontic appliance managed surgically by mitral valve plasty: A case report.

RATIONALE: Streptococcus viridans, a heterogeneous group of alpha-hemolytic streptococci, is part of the normal flora of the mouth, usually responsible for dental caries (Streptococcus mutans, Streptococcus sanguinis), and pericoronitis, as well as for subacute infective endocarditis. They are responsible for 40-60% of the endocarditis cases occurring on the normal valves, especially in male patients and over 45 years of age. A change in the bacterial flora of the oral cavity is taking part after orthodontic fixed appliances are introduced into the oral cavity, change that is associated with an increased concentration of the acidogenic bacteria. Bacteraemia is the consequence of oral cavity infections, the association of infective endocarditis with fixed orthodontic appliance, as it has been described by us for the first time, caused by Abiotrophia defectiva. PATIENT CONCERNS: We present the case of a female Caucasian patient, aged 22 years, who developed infective endocarditis with Streptococcus viridans associated with fixed orthodontic appliance, located on the mitral valve, without previous cardiac pathology, and the therapeutic difficulties associated with allergic reactions (to vancomycin, and spironolactone). DIAGNOSES: Repetitive haemocultures were positive with Streptococcus viridans, while transthoracic echography revealed a severe mitral failure through anteromedial segment of the anterior mitral valve leaf prolapse with eccentric jet to the posterior wall. INTERVENTIONS: During hospitalization, the decision to undergo surgical intervention was taken after obtaining negative haemocultures. The patient underwent surgically intervention, and a mitral valve plasty with insertion of neochords was performed. OUTCOMES: Intraoperative and subsequently post-discharge transesophageal echography, highlighted normofunctional mitral plasty with a remaining regurgitation grade I-II of IV, with good openness, minor tricuspid regurgitation, and mild pulmonary hypertension. LESSONS: Endocarditis with oral streptococci associated with fixed orthodontic appliance seems to be not so unlikely even in young or without previous cardiac pathology patients, requiring attention in identifying possible pre-existing cardiac conditions like mitral valve prolapse with clinical and echographic monitoring of such cases. Educating and motivating the patient to observe the oral hygiene represent key steps for an optimal oral health during orthodontic treatment. Mechanical tooth cleaning helps maintaining a good oral hygiene during fixed orthodontics and decreasing the oral health risks.

Prevalence of fimA genotypes of Porphyromonas gingivalis in adolescent orthodontic patients.

BACKGROUND: The placement of fixed orthodontic appliances may alter the composition of oral microbiota and has the potential risk of periodontal complication. Porphyromonas gingivalis fimbriae play a critical role in colonization of P. gingivalis in subgingival regions. In this study, we investigated the association between the prevalence of P. gingivalis-specific fimA genotypes and periodontal health status in adolescent orthodontic patients, to identify the pathogencity of P. gingivalis during orthodontic therapy. METHODS: Sixty-one adolescent orthodontic patients were enrolled in the case group, while the control group consisted of 56 periodontally healthy adolescents. At baseline (T0), clinical parameter (gingival index) was tested, and subgingival plaque samples were obtained from the lower incisors. The incidences of P. gingivalis and fimA genotypes were detected by polymerase chain reaction. All parameters were reassessed after 1 month (T1), 2 months (T2), 3 months (T3), and 6 months (T4) in the case group and then compared with those of the controls. RESULTS: Both microbiological and clinical parameters from orthodontic patients started to increase after placement of fixed appliances. Maximum values were reached at 3 months after placement and followed by their decreases at six months. However, the microbiological and clinical parameters in the case group were significantly higher than those of the control group. The GI of fimA II, IV-positive samples was significantly higher than that of negative samples. CONCLUSION: P. gingivalis carrying fimA II or IV was closely related to orthodontic gingivitis. In addition, proper oral hygiene control could lead to little increase in dental plaque accumulation, and exert a beneficial effect to periodontal tissues.

Changes in periodontal and microbial parameters after the space maintainers application.

AIM: This study aims to evaluate the clinical and microbiological changes accompanying the inflammatory process of periodontal tissues during treatment with space maintainers (SMs). MATERIALS AND METHODS: The children were separated into fixed (Group 1, n = 20) and removable (Group 2, n = 20) appliance groups. A full periodontal examination, including probing pocket depth (PPD), bleeding on probing (BOP), and plaque index (PI), was performed. Anaerobic microorganisms in the crevicular fluid were detected with the culture method. Clinical and microbial evaluations were performed before (T0) applications. as well as at three (T1), and 9 months intervals (T2) after the application of the fixed or removable appliances. RESULTS: The PI, PPD, and BOP scores at the testing sites of both groups increased significantly from before treatment (T0) to the 9 months' time frame (T2) (P < 0.05), The presence of anaerobic bacteria in the subgingival dental plaque increased from T0 (n = 13, 65%) to T1 (n = 16, 80%) in the fixed SM group, but not statistically significant. The same values were obtained in T1 and T2 (n = 16, 80%). CONCLUSION: Although, the results of this study demonstrate that the application of fixed or removable SM appliances in children induced an increase of clinical periodontal parameters, anaerobic microbiota consisting of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forshia were not observed in any of the samples in short-term. Further long-term and comprehensive investigations are necessary.

Evaluation of role of fixed orthodontics in changing oral ecological flora of opportunistic microbes in children and adolescent.

OBJECTIVE: To determine the prevalence and counts of Streptococcus mutans and Candida species in orthodontic fixed appliance therapy patients and comparison of the efficiency of manual and electronic toothbrushes on minimizing plaque by reducing S. mutans and Candida species in above-mentioned patients. MATERIALS AND METHODS: The study was carried out on total number of sixty patients scheduled for orthodontic treatment (age group: 13-18). Plaque samples were collected to determine oral carriage of S. mutans and Candida of these patients, and readings were noted at T0 (before appliance placement), 2nd and 3rd month after the placement of appliances (T1 and T2). Counts of S. mutans were determined using Dentocult SM kit. Candida was cultured on Sabouraud's dextrose agar. The participants in the study group (orthodontic patients) were then divided into two groups each of 30: Group 1 (manual toothbrush), Group 2 (electronic toothbrush), and plaque samples were taken at the end of 1st, 2nd, and 3rd month to determine the efficacy of manual versus electronic toothbrushes. RESULTS: After orthodontic treatment, colonization of S. mutans and Candida increased dramatically. Results for S. mutans counts and Candida clearly showed superiority of electronic tooth brushing over manual tooth brushing during orthodontic treatment. CONCLUSION: Results clearly showed that orthodontic appliances increase colonization of S. mutans and Candida albicans in oral cavity over the period of treatment time which can be controlled with proper timely brushing. The study also concludes superiority of electronic tooth brushing over manual tooth brushing.

Factors affecting dental biofilm in patients wearing fixed orthodontic appliances.

BACKGROUND: The aim of this study is to investigate the amount and the distribution of biofilm in patients wearing fixed appliances and its relation with age, gender, frequency of tooth brushing, and patient motivation. METHODS: The sample comprised 52 patients (15.5 ± 3.6 years old, 30 females and 22 males) wearing fixed orthodontic appliances. Dental biofilm was assessed using a modified plaque index (PI). A questionnaire was used to collect patient's information, including gender, age, treatment motivation, and frequency of tooth brushing. RESULTS: Gingival (PI score = 0.9 ± 0.7), mesial (0.8 ± 0.6), and distal (0.8 ± 0.5) areas accumulated more biofilm than occlusal areas (0.3 ± 0.3) (P < 0.038). The maxillary lateral incisors (1.1 ± 0.8) and maxillary canines (1.0 ± 0.8) had more biofilm than other teeth (P < 0.05). The maxillary arch (0.8 ± 0.7) had significantly more biofilm than mandibular arch (0.6 ± 0.6) (P = 0.042). No significant difference was found between the right side (0.7 ± 0.7) and left side (0.7 ± 0.6) (P = 0.627). Less biofilm was found in females (0.6 ± 0.5), adults (0.3 ± 0.3), and "self-motivated" patients (0.3 ± 0.3), compared with males (0.9 ± 0.5), children (0.8 ± 0.6), and "family-motivated" patients (1.1 ± 0.5) (P < 0.001). The amount of biofilm was associated with self-report of the frequency of daily tooth brushing (P < 0.001). CONCLUSIONS: Patients wearing fixed orthodontic appliances have the highest biofilm accumulation on the maxillary lateral incisors and maxillary canines, particularly in the gingival area and areas behind arch wires. Less biofilm was observed in female and adult patients and in those who were self-motivated and brushed their teeth more often.

Effects of chlorhexidine varnish on caries during orthodontic treatment: a systematic review and meta-analysis.

This study aimed to perform a systematic review and meta-analysis to evaluate the effectiveness of chlorhexidine varnish on the reduction of caries incidence during fixed orthodontic treatment. The literature searches involved The Cochrane Library, Medline, Scopus, OpenSigle databases and manual searches. The search on OpenSigle did not produce any additional articles. Clinical studies conducted in patients with orthodontic fixed appliances that used professional application of chlorhexidine varnish were included. The effect-size was calculated and a meta-analysis was performed. From 182 abstracts, a total of six articles fulfilled the inclusion criteria. After reading the full articles, one was excluded because of lack of a control group. Three articles were used for continuous data analysis, and two articles were used for the dichotomous data analysis. The pooled meta-analysis with continuous data demonstrated chlorhexidine varnish effectiveness on caries reduction (p = 0.003), with a mean difference and confidence interval of -1.49 [-2.47, -0.51]. On the basis of the pooled meta-analysis of continuous data, we were able to conclude that professional application of chlorhexidine varnish is effective in caries incidence reduction during fixed orthodontic treatment.

Eficacia antimicrobiana del primer ortodóncico adicionado con nanopartículas de plata: Estudio transversal in vitro / Antimicrobial efficacy of orthodontic primer added with silver nanoparticles: Cross-sectional in vitro study

Se evaluó la eficacia antimicrobiana de las nanopartículas de plata (NPsAg) incorporadas al adhesivo (primer) colocado en el esmalte dental adyacente a la aparatología ortodóncica fija (brackets). Se realizó un estudio experimental in vitro en 40 premolares, los cuales se dividieron en dos grupos con brackets, uno cementado con primer convencional y otro adicionado con NPsAg; se colocaron en medios de cultivo, previamente inoculados con Streptococcus mutans, y se tomaron muestras para hacer cultivos y conteo de unidades formadoras de colonias (UFC) al día 1, 15 y 30. Se observó una disminución de la presencia de Streptococcus mutans en las muestras a los 15 días de colocado el primer con la agregación de nanopartículas, aunque tal efecto se redujo a los 30 días. Esta reducción del efecto de las nanopartículas puede deberse a la inexistencia de limpieza mecánica, lo cual favoreció la agregación bacteriana sobre el biofilm, afectando su efecto antimicrobiano. Esto sugiere la necesidad de realizar estudios in vivo que permitan observar el comportamiento de los biomateriales en el medio bucal. Las NPsAg agregadas al primer resultan una herramienta eficaz para prevenir la desmineralización del esmalte alrededor de la aparatología ortodóncica fija.

The antimicrobial efficacy of the silver nanoparticles (NPsAg), incorporated into the adhesive (primer) placed in the enamel adjacent to fixed orthodontic appliances (brackets), was evaluated. An experimental study was performed on 40 premolars in vitro, which were divided into two groups with brackets, one cemented with conventional primer and another added with NPsAg, placed in culture media previously inoculated with Streptococcus mutans, and sampled for culturing and counting colony forming units (UFC) on days 1, 15 and 30. A decrease in the presence of Streptococcus mutans in the samples after 15 days with nanoparticle aggregation was observed, and a reduction in the effect of said nanoparticles after 30 days. This reduction of the nanoparticles effects can be due to the absence of mechanical cleaning, which favored the bacterial aggregation on the biofilm, affecting its antimicrobial effect. This suggest the need for realizing studies in “vivo” which will allow the observation of the behavior of the biometals on the buccal medium. The NPsAg added to the primer are an effective tool to prevent the demineralization of the enamel around the fixed orthodontic appliances.

Microbiological assessment of aerosol generated during debond of fixed orthodontic appliances.

INTRODUCTION: The aims of this study were to describe bacterial load and diversity of the aerosol created during enamel cleanup after the removal of fixed orthodontic appliances and to assess the effect of a preprocedural mouth rinse. METHODS: The study involved the sampling of ambient air adjacent to the patient's mouth during adhesive removal using a slow-speed handpiece and a spiral fluted tungsten carbide bur without water irrigation. Sampling was carried out during enamel cleanup with or without a preprocedural mouth rinse of either sterile water or chlorhexidine. Airborne particles were collected using a viable inertial impactor simulating the human respiratory tree. The bacteria collected were analyzed using both culture and molecular techniques. RESULTS: Bacteria produced during debond and enamel cleanup can reach all levels of the respiratory tree. The use of a preprocedural mouth rinse, either sterile water or chlorhexidine, increased the numbers and diversity of the bacteria in the air. CONCLUSIONS: When using a slow-speed handpiece and a spiral fluted tungsten carbide bur for enamel cleanup after orthodontic treatment, the bacterial load and diversity of the aerosol produced are lower when a preprocedural mouth rinse is not used.

[Influence of orthodontic appliances on the occurrence of Candida spp. in the oral cavity]. / Influencia de la aparatología ortodóntica sobre la ocurrencia de Candida spp. en la cavidad oral.

INTRODUCTION: Use of orthodontic appliances creates favorable conditions for growth of dental bacterial plaque. AIM: To establish if use of orthodontic appliance affects the presence of Candida species in the oral cavity in a group of pediatric patients. MATERIALS AND METHODS: We studied 60 patients between 4 and 10 years old, requiring treatment with orthodontic appliances. Samples were taken of the oral cavity before orthodontic treatment and six months after use began. Samples were inoculated in Sabouraud Dextrose Agar and Candida CHROMagar®. Candida species confirmation and identification was done by multiple PCR, and results analyzed with a chi-squared test. RESULTS: Candida presence was greater (p < 0,001) in the samples taken six months after use began than in the initial samples. Before treatment, the most frequently found species (percentage of studied patients) was C. albicans (8.3%), while after treatment it was C. tropicalis (20.0%). CONCLUSIONS: Use of orthodontic appliances in children increases Candida species presence in the oral cavity. Preventative measures should be taken to avoid oral candidiasis, particularly in immunosuppressed patients.

Oral Decontamination of Orthodontic Patients Using Photodynamic Therapy Mediated by Blue-Light Irradiation and Curcumin Associated with Sodium Dodecyl Sulfate.

OBJECTIVE: The aim of this study was to investigate the effects of the antimicrobial photodynamic therapy (aPDT) using the association of curcumin with the surfactant sodium dodecyl sulfate (SDS) for oral decontamination in orthodontic patients. BACKGROUND DATA: The installation of the orthodontic appliances promotes an increase in the retentive area that is available for microbial aggregation and makes difficult the oral health promotion. However, aPDT is one possible approach that is used for the reduction of oral microbial load. MATERIALS AND METHODS: Twenty-four patients (n = 24) were randomly distributed into four groups: Light group: which was treated only with the blue light, no drug; PDT group, which was treated with curcumin and blue light; PDT + S group, which was treated with curcumin plus surfactant and irradiated with blue light; and Chlorhex group, which was treated with chlorhexidine. The photosensitizer agent was prepared by adding 0.1% of SDS to a curcumin solution of 1 g/L. Two distinct LED devices emitting blue light (450 ± 10 nm) were used as follows: extra-oral irradiation (200 mW, 80 mW/cm(2), 36 J and 14 J/cm(2)) and intra-oral irradiation (1200 mW, 472 mW/cm(2), 216 J and 85 J/cm(2)).The collection of nonstimulated saliva (n = 3; 3 mL/collection) was performed at the following steps: (1) immediately before swishing (curcumin, chlorhexidine, or water); (2) after swishing; and (3) after performing aPDT treatments. The colony-forming units (CFU) were counted visually, and the values were adjusted to CFU/mL. RESULTS: There was significant Log reduction for PDT (from 6.33 ± 0.92 to 5.78 ± 0.96, p < 0.05), PDT + S (from 5.44 ± 0.94 to 3.83 ± 0.71, p < 0.01), and Chlorhex (from 5.89 ± 0.97 to 2.55 ± 1.80, p < 0.01) groups. The survival rate was significantly reduced in both PDT + S and Chlorhex groups compared with all situations (p < 0.05). However, there was no significant difference between PDT + S and Chlorhex groups (p ≥ 0.05). CONCLUSIONS: These results indicate that when associated with the surfactant SDS, the aPDT can be used as an adjutant and a convenient agent to promote the oral decontamination in clinical practice.

Influencia de la aparatología ortodóntica sobre la ocurrencia de Candida spp. en la cavidad oral / Influence of orthodontic appliances on the occurrence of Candida spp. in the oral cavity

Introducción: El uso de aparatología ortodóntica crea condiciones favorables para el incremento de la placa bacteriana. Objetivo: Evaluar si el uso de aparatología ortodóntica influye en la presencia de especies de Candida en la cavidad oral, en un grupo de pacientes pediátricos. Material y Métodos: Se estudiaron 60 pacientes entre 4 y 10 años de edad, que requirieron tratamiento con aparatología ortodóntica. Se tomaron muestras de la cavidad oral al inicio del tratamiento ortodóntico y a los seis meses de uso. Las muestras fueron sembradas en Agar Dextrosa Sabouraud y CHROMagar® Candida. Las especies de Candida se confirmaron por RPC múltiple. Los resultados se analizaron con la prueba estadística de chi cuadrada. Resultados: La presencia de Candida fue mayor en las muestras tomadas a los seis meses de iniciado el tratamiento (p < 0,001). La especie más frecuente antes del tratamiento fue C. albicans (8,3%) y después del tratamiento fue C. tropicalis (20,0%). Conclusiones: El uso de aparatología ortodóntica influye en la presencia de especies de Candida, por lo que deben tomarse medidas preventivas para evitar su conversión en candidiasis oral, en especial, en pacientes inmunodeprimidos.

Introduction: Use of orthodontic appliances creates favorable conditions for growth of dental bacterial plaque. Aim: To establish if use of orthodontic appliance affects the presence of Candida species in the oral cavity in a group of pediatric patients. Materials and Methods: We studied 60 patients between 4 and 10 years old, requiring treatment with orthodontic appliances. Samples were taken of the oral cavity before orthodontic treatment and six months after use began. Samples were inoculated in Sabouraud Dextrose Agar and Candida CHROMagar®. Candida species confirmation and identification was done by multiple PCR, and results analyzed with a chi-squared test. Results: Candida presence was greater (p < 0,001) in the samples taken six months after use began than in the initial samples. Before treatment, the most frequently found species (percentage of studied patients) was C. albicans (8.3%), while after treatment it was C. tropicalis (20.0%). Conclusions: Use of orthodontic appliances in children increases Candida species presence in the oral cavity. Preventative measures should be taken to avoid oral candidiasis, particularly in immunosuppressed patients.

Antimicrobial efficacy of orthodontic primer added with silver nanoparticles. Cross-sectional in vitro study. / Eficacia antimicrobiana del primer ortodóncico adicionado con nanopartículas de plata. Estudio transversal in vitro.

The antimicrobial efficacy of the silver nanoparticles (NPsAg), incorporated into the adhesive (primer) placed in the enamel adjacent to fixed orthodontic appliances (brackets), was evaluated. An experimental study was performed on 40 premolars in vitro, which were divided into two groups with brackets, one cemented with conventional primer and another added with NPsAg, placed in culture media previously inoculated with Streptococcus mutans, and sampled for culturing and counting colony forming units (UFC) on days 1, 15 and 30. A decrease in the presence of Streptococcus mutans in the samples after 15 days with nanoparticle aggregation was observed, and a reduction in the effect of said nanoparticles after 30 days. This reduction of the nanoparticles effects can be due to the absence of mechanical cleaning, which favored the bacterial aggregation on the biofilm, affecting its antimicrobial effect. This suggest the need for realizing studies in "vivo" which will allow the observation of the behavior of the biometals on the buccal medium. The NPsAg added to the primer are an effective tool to prevent the demineralization of the enamel around the fixed orthodontic appliances.

The antimicrobial effect of chlorhexidine varnish on mutans streptococci in patients with fixed orthodontic appliances: a systematic review of clinical efficacy.

OBJECTIVE: To conduct a systematic review aimed to determine the antimicrobial efficacy of chlorhexidine varnishes (CHX-V) on mutans streptococci (MS) in patients during orthodontic treatment with fixed appliances. MATERIALS AND METHODS: A systematic computerized database search was conducted using Ovid MEDLINE, Scopus and EMBASE up to September 2014. A Google search was also conducted to further identify articles that met the eligibility criteria. Clinical trials which used CHX-V alone as the intervention to investigate the antimicrobial effect of the varnish in subjects undergoing orthodontic treatment were included. Outcome measures included MS level reduction and/or decreased caries incidence from baseline data. RESULTS: Nineteen articles were identified for full-text reading; eleven articles met the criteria for inclusion in this review. Type and concentration of CHX-V, bacterial sampling method, application frequency, sampling schedule, risk of bias and study outcomes are presented. CONCLUSION: A limited number of studies with low risk of bias were available to address the antimicrobial efficacy of CHX-V on MS in patients during orthodontic treatment with fixed appliances. Therefore, while the majority of studies found CHX-V to be an effective antimicrobial against MS at an interval of 3-4 weeks, the strength of the recommendation is weak. Longitudinal studies are needed to determine whether this antimicrobial effect will contribute to clinically significant caries reduction in patients undergoing orthodontic treatment with fixed appliances.

High potential of adhesion to biotic and abiotic surfaces by opportunistic Staphylococcus aureus strains isolated from orthodontic appliances.

Orthodontic and other oral appliances act as reservoir of opportunistic pathogens that can easily become resistant to antibiotics and cause systemic infections. The aim of this study was to investigate the ability of Staphylococcus aureus strains isolated from healthy patients with orthodontic appliances, to adhere to biotic (HeLa cells) and abiotic surfaces (polystyrene and dental alloy). Adhesive ability to polystyrene was tested by crystal violet staining and quantitative biofilm production on dental alloy surfaces was evaluated by MTT reduction assay. In addition, the presence of icaA and icaD genes was achieved by polymerase chain reaction (PCR). Qualitative biofilm production revealed that 70.6% of strains were slime producers. The metabolic activity of S. aureus biofilms on dental alloy surfaces was high and did not differ between tested strains. Moreover, all the isolates were adhesive to HeLa cells and 94% of them harbor icaA and icaD genes. Considerable adhesion and internalization capacity to the epithelial HeLa cells and strong biofilm production abilities together, with a high genotypic expression of icaA/icaD genes are an important equipment of S. aureus to colonize orthodontic appliances and eventually to disseminate towards other body areas.

Effects of chlorhexidine varnish on caries during orthodontic treatment: a systematic review and meta-analysis

Abstract This study aimed to perform a systematic review and meta-analysis to evaluate the effectiveness of chlorhexidine varnish on the reduction of caries incidence during fixed orthodontic treatment. The literature searches involved The Cochrane Library, Medline, Scopus, OpenSigle databases and manual searches. The search on OpenSigle did not produce any additional articles. Clinical studies conducted in patients with orthodontic fixed appliances that used professional application of chlorhexidine varnish were included. The effect-size was calculated and a meta-analysis was performed. From 182 abstracts, a total of six articles fulfilled the inclusion criteria. After reading the full articles, one was excluded because of lack of a control group. Three articles were used for continuous data analysis, and two articles were used for the dichotomous data analysis. The pooled meta-analysis with continuous data demonstrated chlorhexidine varnish effectiveness on caries reduction (p = 0.003), with a mean difference and confidence interval of −1.49 [−2.47, −0.51]. On the basis of the pooled meta-analysis of continuous data, we were able to conclude that professional application of chlorhexidine varnish is effective in caries incidence reduction during fixed orthodontic treatment.

(Super)hydrophobic coating of orthodontic dental devices and reduction of early oral biofilm retention.

This study was designed to apply (super)hydrophobic crosslinked coatings by means of a sol-gel process on the surface of orthodontic devices and investigate the potential effect of these coatings in reducing the early retention of oral biofilm. Two organosilane-based hydrophobic solutions (HSs) were prepared containing hexadecyltrimethoxysilane diluted in ethanol (HS1) or 1H, 1H, 2H, 2H-perfluorodecyltriethoxysilane diluted in dimethyl sulfoxide (HS2). Stainless steel plates and ceramic discs were coated with HS1 or HS2 and heated at 150 °C for 2 h for condensation of a crosslinked SiO x network. Organosilane coatings were applied after previous, or no, surface sandblasting. Commercial stainless steel and ceramic brackets were used to evaluate oral biofilm retention after 12 h or 24 h of biofilm growth, using a microcosm model with human saliva as the inoculum. Surface roughness analysis (Ra, µm) indicated that sandblasting associated with organosilane coatings increased roughness for stainless steel brackets only. Analysis of the water contact angle showed that the stainless steel surface treated with HS1 was hydrophobic (~123°), while the ceramic surface treated with HS2 was superhydrophobic (~155°). Biofilm retention after 24 h was significantly lower in groups treated with hydrophobic coatings. An exponential reduction in biofilm accumulation was associated with increased water contact angle for both stainless steel and ceramic at 24 h. Application of (super)hydrophobic coatings on the surface of stainless steel and ceramic orthodontic devices might reduce the retention of oral biofilm.