There are many reasons why patients’ oral health may suffer at any given time. The first and most obvious is poor oral hygiene, which is often neglected due to a lack of time or awareness regarding its importance. This can be exacerbated when the patient undergoes certain dental treatments, such as orthodontics, which create further challenges in achieving and maintaining a high standard of oral health.
In order to optimise treatment outcomes and improve their oral health status, patients must fully appreciate their role in plaque control and oral health. For the dental team, this means successfully communicating the benefits of an effective at-home oral hygiene regime, as well as tailoring recommendations according to each individual’s needs and lifestyle preferences.
Oral health education and knowledge retention
Although the need for dental hygiene may feel like a simple message to the dental profession, it is not yet a universal standard among the general public. In some cases, people lack the education to recognise what must be done, when and how. Health literacy remains an issue across the UK, with more than 40% of adults not fully understanding everyday health advice. This number increasing to around 60% when the health advice requires numeracy skills.[i]
Another issue is information retention. Research has shown that patients struggle to recall details provided to them during a dental appointment, particularly those regarding future dental health recommendations or agreed actions.[ii] This could significantly affect their compliance with oral health recommendations and have a detrimental impact on both their at-home routine and long-term oral hygiene.
As such, it’s essential that the dental team considers these potential barriers and tailors their patient interactions accordingly. Information should be delivered in a way that each patient will understand. The use of visual aids or even video content has been shown to improve patient understanding of oral hygiene techniques and treatment procedures.[iii] Providing written instructions or diagrams for patients to take away with them can also help jog their memory and encourage their compliance at home.
Clinical and treatment considerations
Clinical and treatment considerationsOnce a patient appreciates the importance of excellent oral hygiene, it’s necessary to think about clinical barriers that also need to be overcome. For example, malalignment of the teeth and malocclusion have been associated with a higher of dental caries.[iv] Periodontal disease is also more likely, because misaligned teeth make it more difficult to mechanically remove plaque from all surfaces.[v]
However, the solution is more complex than simply aligning the teeth. For a start, orthodontic treatment can make oral hygiene even more difficult in the short-term. Clear aligners can harbour a number of pathogens. One study[vi] found that bacterial count – especially of those species associated with dental caries, gingivitis, periodontitis and enamel demineralisation – increased on the aligners and in the patient’s saliva between 7 and 14 days of wear. The plaque biofilm also increased at 14 days, becoming more diverse and more pathogenic. This makes it vital for patients to frequently and adequately clean their aligners, removing bacterial biofilm and protecting their teeth and gums from problems.
When it comes to fixed appliances, food debris can get stuck between the brackets and wires, increasing biofilm formation and the risk of periodontal disease.[vii] The literature has found oral status to deteriorate in up to 60% of patients with fixed appliances.[viii]
These can be a little more difficult to remove plaque from, often requiring patients to add a step to their daily oral hygiene routine to mechanically remove biofilm. This should be communicated at the outset of treatment so patients understand their responsibilities, but maintaining enthusiasm and compliance throughout an extensive course of treatment remains a challenge.
Making the at-home routine as simple and as pleasant as possible is, therefore, a must. The introduction of a clinically-proven solution like the Waterpik™ Ultra Professional water flosser can make a significant difference to these patients’ oral health before, during and after any type of orthodontic treatment. It’s part of a product portfolio that removes 99.9% of plaque from the treated area in just three seconds,[ix] with 10 pressure settings available for patients to customise their cleaning experience. With a dedicated Orthodontic Tip, the water flosser is also three times as effective as string floss for orthodontic patients.[x]
Simple but essential
Orthodontic treatment remains a common solution for both children and adults across the UK who wish to enhance the function, cleansability and aesthetics of their teeth. However, it is crucial that they maintain good oral hygiene to achieve the best treatment outcomes. Despite the challenges that can be faced – whether undergoing treatment with clear aligners or fixed appliances – a few simple adjunctive oral hygiene steps can be all they need to help their smile really shine.
For more information on WaterpikTM water flosser products visit www.waterpik.co.uk. WaterpikTM products are available from Amazon, Costco UK, Argos, Boots and Tesco online and in stores across the UK and Ireland.
Bio: Anne Symons
Anne Symons is a Dental Hygienist currently working in a Specialist Periodontal/implant practice and also a busy NHS surgery. She has previously worked in a Max Fax unit, and also taught Oral Health care to staff in Nursing and Residential homes.
[i] Public Health England. Local action on health inequalities. Improving health literacy to recue health inequalities. September 2015.
[ii] Misra S, Daly B, Dunne S, Millar B, Packer M, Asimakopoulou K. Dentist-patient communication: what do patients and dentists remember following a consultation? Implications for patient compliance. Patient Prefer Adherence. 2013 Jun 17;7:543-9. doi: 10.2147/PPA.S43255. PMID: 23814463; PMCID: PMC3693916.
[iii] Turkdogan S, Roy CF, Chartier G, et al. Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2022;148(2):173–179. doi:10.1001/jamaoto.2021.3765
[iv] Gaikwad SS, Gheware A, Kamatagi L, Pasumarthy S, Pawar V, Fatangare M. Dental caries and its relationship to malocclusion in permanent dentition among 12-15 year old school going children. J Int Oral Health. 2014 Sep;6(5):27-30. PMID: 25395789; PMCID: PMC4229825.
[v] Javali MA, Betsy J, Al Thobaiti RSS, Alshahrani RA, AlQahtani HAH. Relationship between Malocclusion and Periodontal Disease in Patients Seeking Orthodontic Treatment in Southwestern Saudi Arabia. Saudi J Med Med Sci. 2020 May-Aug;8(2):133-139. doi: 10.4103/sjmms.sjmms_135_19. Epub 2020 Apr 17. PMID: 32587495; PMCID: PMC7305683.
[vi] Velliyagounder K, Ardeshna A, Shah S. An In Vivo Study on the Development of Bacterial Microbiome on Clear Orthodontic Retainer. Dent J (Basel). 2022 Dec 16;10(12):239. doi: 10.3390/dj10120239. PMID: 36547055; PMCID: PMC9777160.
[vii] Alsulaimani L, Alqarni H, Akel M, Khalifa F. The Orthodontics-Periodontics Challenges in Integrated Treatment: A Comprehensive Review. Cureus. 2023 May 14;15(5):e38994. doi: 10.7759/cureus.38994. PMID: 37323308; PMCID: PMC10262598.
[viii] Marincak Vrankova, Z., Rousi, M., Cvanova, M. et al. Effect of fixed orthodontic appliances on gingival status and oral microbiota: a pilot study. BMC Oral Health 22, 455 (2022). https://doi.org/10.1186/s12903-022-02511-9
[ix] Gorur A, Lyle DM, Schaudinn C, Costerton JW. Compend Contin Ed Dent 2009; 30 (Suppl 1):1 – 6.
[x] Sharma NC, Lyle DM, Qaqish JG, Galustians J, Schuller R. Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2008 Apr;133(4):565-71; quiz 628.e1-2. doi: 10.1016/j.ajodo.2007.12.008. PMID: 18405821.
