In vivo investigation of gingival health and oxidative stress changes in patients undergoing orthodontic treatment with and without fluoride use.

Background and Aims: We aimed to investigate gingival index changes and oxidative stress in orthodontic patients with and without the use of fluoridated agents over a 6-month period. Materials and Methods: Ninety subjects divided into three groups (30 untreated controls, 30 with fixed appliances using nonfluoridated toothpaste, and 30 with fixed appliances using fluoridated toothpastes and mouthwashes ) comprised the sample. The Loe gingival index was used to rank gingival health at four specific time periods in the groups to determine differences (before, at 7 days, 30 days, and 6 months). Gingival crevicular fluid was evaluated for cytokines (interleukin [IL]-1ß and tumor necrosis factor [TNF]-α) to determine differences in oxidative status between the groups. Results: Controls showed no changes in gingival index throughout the 6-month observation period. There was a deterioration in gingival health in both the fluoridated and nonfluoridated groups till 6 months. IL-1ß levels in the fluoridated group increased from the 7th day, reached a peak at 30 days, and remained slightly elevated at 6 months. The nonfluoridated group also showed elevated levels at all tested time periods, but levels were lower as compared to fluoridated samples. The differences in IL-1ß values between the fluoridated and nonfluoridated treated groups were significant. TNF-α levels in the three groups also showed a similar pattern with elevated levels seen in both the treated groups at the 7th, 30-day, and 6-month periods. The fluoridated group showed the highest levels at three time periods which was statistically significant. Conclusions: Gingival health of subjects treated with fixed orthodontic appliances deteriorated from appliance placement till a 6-month time period. Cytokines such as IL-1ß and TNF-α associated with oxidative stress during orthodontic treatment increased in both the treated groups, with higher levels in fluoridated subjects. Long-term consequences of oxidative stress changes need further investigation.