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Preliminary evidence on the efficacy of oral hygiene health promotion in patients undergoing fixed appliance orthodontic treatment Critical Summary Prepared by: Mina Chung DDS, BDS, MS 

OVERVIEW

  • Systematic Review Conclusion:

    Oral health promotion produced a short-term reduction in plaque and improvement in gingival health in patients before they underwent fixed appliance treatment.

  • Critical Summary Assessment:

    Limited evidence shows that oral hygiene promotion has a short-term positive effect and no negative effect on patients undergoing fixed orthodontic treatment.

  • Evidence Quality Rating:

    Limited

  • Clinical Questions:

    Do oral health promotion (OHP) interventions improve oral hygiene and gingival health for patients undergoing fixed appliance orthodontic treatment?

  • Review Methods:

    The authors conducted a comprehensive search of four electronic databases for publications that included gray literature from 1966 through May 2005. The initial search identified 218 abstracts, of which 37 full papers were reviewed. The authors included only randomized controlled trials (RCTs) and quasi-randomized controlled clinical trials (CCTs) that evaluated plaque levels and gingival bleeding in patients undergoing fixed orthodontic treatment. A total of six studies met the inclusion criteria, four RCTs and two CCTs, respectively.

  • Main Results:

    The authors identified a total of six studies, five of which evaluated educational interventions and the other which evaluated an environmental intervention. The authors used outcome measures that evaluated plaque levels and gingival bleeding, including a plaque index, a gingival index, a patient cooperation scale, an oral hygiene index, and a modified oral hygiene index. Four studies showed positive effects on plaque and gingival health and two studies showed no effect.

  • Conclusion:

    The majority of studies show that oral hygiene health promotion was effective in the short-term (up to 5 months); two studies showed no effect. None of the studies detected a negative effect of oral hygiene health promotion on gingival health.

  • Source of funding:

    No external funding.

Commentary:

  • Importance and Context:

    Fixed orthodontic treatment poses an oral hygiene challenge for both practitioner and patient. The increase of plaque retention on brackets, bands, gingival margins combined with poor oral hygiene can lead to chronic hyperplastic gingivitis (CHG). It has been postulated that CHG may also be caused by local cytotoxic reaction of metal in subgingivally placed bands. To reduce the effects of CHG associated with fixed orthodontic treatment, patient education on the importance of good oral hygiene is essential. This review examined two modalities of oral hygiene promotion for positive, negative, or no effects.

  • Strengths and Weaknesses of the Systematic Review:

    The review used accepted methods to identify and select studies, including a review of gray literature. The reviewers identified six studies for inclusion. The studies were selected by two independent reviewers who assessed the reduction in plaque levels and gingival bleeding in oral health promotion in patients receiving fixed orthodontic treatment. The studies were not limited by participant ages or publication language. Only RCTs and CCTs were included in the study. However, the risk of bias was not determined.

  • Strengths and Weaknesses of the Evidence:

    The six clinical studies had limited sample sizes with variability in study design and quality. The differing outcome measures made it difficult to evaluate the evidence. However, the reviewers were able to combine the data. Gingival health assessment was based on a visual scale and none of the studies quantified periodontal attachment loss or gingival probing. Only one study assessed environmental change as a method for oral hygiene promotion, and five studies evaluated the effects of educational intervention. All studies except one exceeded five months of follow up. The results provide limited evidence that oral hygiene health promotion improved the gingival health of patients undergoing fixed appliance orthodontic treatment.

  • Implications for Dental Practice:

    The benefits of promoting regular oral hygiene as a component of orthodontic treatment may be associated with a short-term improvement in gingival health. The current study suggests the effects are positive and short-term. No negative effects were found. . However, the most effective delivery of OHP remains to be determined. Further studies that use detailed periodontal evaluation and long-term evaluation should provide more definitive conclusions on the efficacy of oral hygiene health promotion and fixed appliance orthodontic treatment.

  • Critical Summary Publication Date: 8/6/2009

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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