Download During orthodontic treatment, the development of white spot lesions

THE ANTI-PLAQUE EFFICACY OF LISTERINE USED IN COMBINATION
WITH TOOTHBRUSHING AND FLOSSING IN ORTHODONTIC PATIENTS
Specific Aims
To determine whether Listerine® (Pfizer, Morris Plains, NJ) mouthrinse when added to
the standard oral hygiene regimen (brushing + flossing) would have an added benefit in
reducing plaque and gingivitis development in orthodontic patients over a six-month
period.
Background and Significance
During orthodontic treatment, the development of white spot lesions is almost inevitable
when oral hygiene is poor (Tufekci et al., 2004; O’Reilly and Featherstone, 1987;
Lundstrom and Karasse, 1987). Decalcification is more commonly seen on the buccal
surfaces of orthodontically treated teeth than untreated teeth. This is due to prolonged
plaque retention around the brackets. These incipient lesions can appear in as little as 2
to 3 weeks after plaque accumulation in bucco-gingival areas of the teeth. Previous
studies have shown that there are increased levels of bacteria in the oral cavity after the
bonding of orthodontic attachments (Beyth et al., 2003; Mitchell, 1992; Gorelick et al.,
1982, von der Fehr et al., 1970). The presence of these microorganisms, namely S.
mutans and lactobacilli increases the risk for decalcification as these are the main
pathogens in dental caries (Mitchell, 1992; Schwaninger and Schwaninger, 1979).
Furthermore, the development of gingivitis and gingival overgrowth are also wellrecognized problems during orthodontic treatment with fixed appliances. Therefore,
adherence to oral hygiene recommendations is essential to minimize dental caries and
gingival inflammation. Tooth brushing and flossing are the most common ways for
facilitating plaque control. However, patient cooperation has long been recognized as an
important factor in maintaining optimal oral hygiene.
Many orthodontic patients
especially children and adolescents fail to floss because they find this procedure timeconsuming and tedious in the presence of the orthodontic archwires. Recently, it has
been reported that Listerine® antiseptic mouthrinse is as effective as flossing at reducing
interproximal plaque and gingivitis in subjects who brush twice a day (Charles et al.,
2002; Bauroth et al., 2002). The use of Listerine® in addition to the standard oral
hygiene regimen may be beneficial for orthodontic patients in maintaining proper oral
health.
Materials and Methods
50 orthodontic patients who agreed to participate in the study will be randomly assigned
either to the brush + floss (N= 25) or brush + floss + rinse with Listerine® (N = 25)
groups. Subjects chosen will be in orthodontic treatment for about 6 months at the
beginning of this study, and in good health and without a medical history or medication
that would otherwise affect the outcome of the research. They will be expected to be
treatment at least 6 more months in order to ensure the completion of the study.
Prior to the start of the study, ethical approval will be obtained from the Institutional
Board Review and volunteers will be asked to sign a consent form to participate.
Subjects will be informed that they will be given $25 at the completion of the study in
order to encourage compliance in the study. At the beginning of the study, all of the
volunteers will be given instructions on how to brush and floss and will receive initial
prophylaxis. At this time (T1), buccal measurements for the Ramfjord teeth will also be
recorded for the gingival index, plaque index and bleeding index. Gingivitis will be
scored according to the modified gingival index (MGI) (Lobene et al., 1986) on the
buccal marginal gingiva. (0: absence of inflammation, 1: mild inflammation, 2: mild
inflammation, 3: moderate inflammation and 4: severe inflammation. Bleeding index
(BI) will be assessed as described by Saxton and van der Ouderaa (0: absence of bleeding
after 30 s, 1: bleeding observed after 30s, 2: immediate bleeding). Plaque area will be
scored according to the Turesky modification on the Quigley-Hein plaque index (PI) (0:
no plaque, 1: discontinuous band of plaque at the gingival margin, 2: up to 1 mm
continuous band of plaque at the gingival margin, 3: band of plaque wider than 1 mm but
less than 1/3 of the surface, 4: plaque covering 1/3 or more of the surface, but less than
2/3s of the surface and 5: plaque covering 2/3s or more of the surface.
Individuals in both groups will be asked to brush twice and floss once daily. Subjects in
the rinse group in addition to their main oral hygiene regimen will rinse for 30 seconds
twice daily with 20 ml of Listerine®.
All subjects will be monitored monthly for compliance with their assigned regimen. All
clinical measurements will be performed by one and the same blinded examiner under the
same conditions at 3 (T2) and 6 months (T3). Mean MGI, BI and PI will be statistically
compared between the groups using Wilcoxon non-parametric test at T1, T2 T3.
References
1) Bauroth K, Charles CH, Mankodi SM, Simmons K, Zhao Q and Kumar LD. The
efficacy of an essential oil antiseptic mouthrinse vs. dental floss in controlling
interproximal gingivitis: a comparative study. JADA 2003;134:359-65.
2) Beyth N, Redlich M, Harari D, Friedman M and Steinberg D. Effect of sustainedrelease chlorhexidine varnish on Streptococcus mutans and Actinomyces viscosus
in orthodontic patients. Am J Orthod Dentofacial Orthop 2003;123:345-348.
3) Charles CH, Naresh SC, Galustians HJ, Mcguire JA and Vincent JW.
Comparative efficacy of an antiseptic mouthrinse and an antiplaque/antigingivitis
dentifrice. A six-month clinical trial. JADA 2001;132:670-675.
4) Gorelick L, Geiger AM and Gwinnett AJ. Incidence of white spot formation after
bonding and banding. Am J Orthod Dentofacial Orthop 1982; 81:93-8.
5) Lundstrom F and Karasse B. Caries incidence in orthodontic patients with high
levels of Streptococcus mutans. Eur J Orthod 1987; 9:117-21.
6) Mitchell L. Decalcification during orthodontic treatment with fixed appliances –
an overview. Br J Orthod 1992;19:199-205.
7) O’Reilly MM and Featherstone JDB. Demineralization and remineralization
around orthodontic appliances: an in vivo study.
Am J Orthod Dentofacial
Orthop 1982;92:33-40.
8) Quigley G and Hein J. Comparative cleansing efficiency of manual and power
brushing. JADA 1962;65:26-9.
9) Saxton CA and van der Ouderaa FJ. The effect of a dentifrice containing zinc
citrate and triclosan on developing gingivitis. J Periodontal Res 1989; 24:75-80.
10) Schwaninger B and Schwaninger NV. Developing an effective oral hygiene
program for the orthodontic patient: review, rationale and recommendations. Am
J Orthod 1979;75:447-52.
11) Tufekci E, Merrill TE, Pintado MR, Beyer JP and Brantley WA. Enamel loss
associated with orthodontic adhesive removal on teeth with white spot lesions: An
in vitro study. Am J Orthod Dentofacial Orthop 2004;125:733-9.
12) Turesky S, Gilmore ND and Glickman I. Reduced plaque formation by the
chloromethyl analogue of Victamine C. J Periodontol 1970; 41:41-3.
13) Von der Fehr FR, Loe H and Theilade E. Experimental caries in man. Caries Res
1970;4:131-48.
Institutional Board Review
The application for the IRB is underway.
Budget
Item
Quantity
Cost
Total
Compensation for participating in the study
50
$25/subject
$1250
Dental Floss
120
$40/ box of 144
$40
Poster Printing for Clinic Day and IADR
1
$115
$115
Fees for printing and binding
5
$17.50
$87.50
Grand Total:
$ 1492.50
Listerine® will be provided by Pfizer.