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Journal of Dental Herald
Journal of Dental Herald
www.dherald.in
(July 2015) Issue:3, Vol.:2
E ISSN No. : 2348 – 1331
P ISSN No. : 2348 – 134X
Original Article
Survey On Oral Hygiene Protocols Among Orthodontic Correction Seeking Individuals
Mayuresh J Baheti1, Nandlal Girijalal Toshniwal2, Sudeep H.M.3, Uday N. Soni4
1
P.G. Student, Department Of Orthodontics & Dentofacial Orthopedics, Rural Dental College, Pravara Institute Of Medical Sciences, Loni, Maharashtra
Prof. & Head, Department Of Orthodontics & Dentofacial Orthopedics, Rural Dental College, Pravara Institute Of Medical Sciences, Loni, Maharashtra
Consultant Periodontist And Implantologist, Banglore.
4
P.G. Student, Department Of Orthodontics & Dentofacial Orthopedics, Rural Dental College, Pravara Institute Of Medical Sciences, Loni, Maharashtra
2
3
Abstract
Aim: Awareness on oral hygiene is important during orthodontic phase.The aim of the present study was to assess the effectiveness of an oral
hygiene program(knowledge, attitude, and practice of oral hygiene) for patients seeking fixed orthodontic treatment. Evaluating the knowledge,
attitude, and practice on gingival health was the aim of the present study.
Materials & methods: sample consisted of 150 patients having a full complement of permanent dentition150 orthodontic patients from Department
of Orthodontics and dentofacial orthopedics, Rural Dental College, Loni,Maharashtra were included in the questionnaire study. Questions were
based on the knowledge, attitude and practice on oral hygiene i.e. gingival health in the time of orthodontic treatment. All answers were recorded
and analysed statistically.
Results: The results of the study showed that nearly 50% of patients were unaware about gingival health, 78% doesn’t follow the oral hygiene
instructions, despite given with instructions, most of them are reluctant in practicing them strictly. It is very good that all patients uses the toothbrush
as a aids used to clean teeth and 72% of patient didn’t have any previous dental exposure.
Conclusion: The knowledge, attitude, practice of oral hygiene among orthodontic patients were poor and showed the need of better education and
motivation. Many factors may be responsible in non-maintenance of gingival health practices. There is a need to incorporate and evaluate more
intense oral hygiene programs in future.
Key Words
Key Words: Oral hygiene, Orthodontic correction, gingiva
Introduction
Orthodontic treatment is widely acknowledged and accepted
in everyday dental practice due to the positive effects it has on
dentofacial complex. With fixed orthodontic appliances,
clinicians can offer patients the establishment of functional
occlusion, improvement of oral health and aesthetic
improvement of dentofacial complex. Anomalies in
development of the face and jaws, as well as orthodontic
treatment, can influence oral health. Deviations from an ideal
arrangement and position of teeth (lack of space, tooth rotation
or open bite, a deep bite and cross-bite) facilitate dental plaque
accumulation. It has to be pointed out that malocclusion is not a
primary etiological factor, but an auxiliary factor which
facilitates dental plaque accumulation. The main principle of
orthodontic therapy is to correct tooth and jaw position and
thus indirectly improve the health of periodontium and
durability of teeth.[1]
By accepting an orthodontic treatment, a patient makes a firm
commitment to maintain oral hygiene regularly and thus
prevent potential iatrogenic damages which may occur during
therapy. Importance of oral hygiene in orthodontic patients is
always intensified to prevent any further periodontal disease.
Numerous studies show a significant increase in the quantity of
dental plaque as well as in the occurrence of gingivitis in
Quick Response Code
Address For Correspondence:
Dr. Mayuresh J Baheti
P.G. Student
Department of Orthodontics & Dentofacial
Orthopedics
Rural Dental College,
Pravara Institute of Medical Sciences, Loni – 413736
Maharashtra, India
[email protected]
©Journal of Dental Herald (July 2015 Issue:3, Vol.:2).
patients with fixed orthodontic appliances because they make
removal of dental plaque difficult.[2] Fixed orthodontic
appliances, such as orthodontic braces, arches and rings,
increase the number of retention places for dental plaque
accumulation. All these factors make it even more difficult to
maintain oral hygiene.[3] Self-cleaning is also more difficult
because of the reduced effect of mechanical chewing and
rinsing the food residues off by saliva. All preventive
programmes referring to prevention and treatment of a
gingivitis and parodontopathy include regular removal of
dental plaque as a part of an adequate daily oral hygiene.
The following factors are necessary for adequate oral hygiene:
adequate devices (equipment), correct technique of using
those devices, regular toothbrushing and sufficient length of
brushing every single tooth. Recommendations for adequate
devices for oral hygiene maintenance include the following
factors: specific needs of patients (disease predisposition or
state of the mouth) and individual characteristics (age,
affinities, manual dexterity or lifestyle). All these factors
should be adjusted to individual patients in order to enable
perfect oral hygiene at home. Individual preventive
programmes should be implemented for patients with fixed
orthodontic appliances and they should, apart from health
education, include education about the importance of regular
and correct oral hygiene maintenance and checkups. Patients
need to be demonstrated the correct technique and frequency
of toothbrushing. They also need to learn about the right
toothbrushes, interdental and orthodontic brushes, as well as
about auxiliary devices for oral hygiene maintenance
(adequate toothpaste and mouthwash).[4]
Active cooperation of orthodontic patients is essential over a
prolonged treatment and involves keeping appointments and
maintenance of an adequate level of oral hygiene and refrain
004
from hard and sticky foods.[5] The choice of patients,
education and training about a regular and correct oral hygiene
maintenance together with preventive and prophylactic
measures and patients’ motivation will increase the comfort of
patients undergoing orthodontic therapy and contribute to the
functional and aesthetic success of it. Regular oral hygiene
maintenance is of great importance for the preservation of
gingival health until the end of orthodontic therapy as well as
after its ending. Apart from having a regular dental arch, the
habit of regular oral hygiene will help preserve the health of
gingiva and contribute to lifelong oral health.But the level of
gingival health knowledge among orthodontic patients is not
adequate. Poor maintenance of oral hygiene is due to either
lack of knowledge or negligence by patients
themselves.Patients are not given with proper instructions,[6]
may be one big reason for patient's non-compliance. However,
despite receiving appropriate instructions, many individuals
fail to follow instructions; also many of them lack knowledge
on maintenance. During a fixed orthodontic appliance therapy,
the technique and duration of toothbrushing and constant
motivation of patients are key factors of oral hygiene
maintenance. It is always needed to assess the knowledge of
orthodontic patients on oral hygiene.
The aim of this study was to assess knowledge, attitude and
practice of oral hygieneprotocols amongst orthodontic
patients.
Materials and methods:
Study Design : Questionnaire
The present survey doneby simple random sampling method,
around 150 orthodontic patients were selected from
Department of Orthodontics & Dentofacial Orthopedics,
Rural Dental College, Loni, Maharashtra, India for the
questionnaire survey study. Bothmale / female patients were
included.
Both open and closed end questions were included in the
questionnaire survey. To assess awareness on gingival health,
questionnaire was covered about knowledge on gingival
health, practices of oral hygiene, attitude towards dental
treatment. Questions were given with choice answers, easily
understandable and brief in manner. Questionnaire was given
to all selected patients to complete the answers, with prior
explanation to fill the questionnaire. One investigator was
available while filling questions, and participants were
encouraged to approach investigator for any clarification. All
answers were kept confidential, and no individual patients
were identified. Patients who completed their minimum 6
months of orthodontic treatment included in the survey.
The study was conducted from December 2013-July
2014,open and closed ended questionnaire which consisted of
13 questions was assessing the awareness of gingival and oral
health and attitude of orthodontic correction seeking
individuals treating in Rural dental college, Loni. The
inclusive criteria were patient treating for orthodontic
malocclusion more than four months and should be on fixed
appliances.
Ethical Clearance:
Ethical Clearance was obtained from institutional review
board PIMS Ethical committee
All answers were collected and recorded. All recorded data
were statistically analysed using SPSS version 15 data
©Journal of Dental Herald (July 2015 Issue:3, Vol.:2).
analyser ( IBM Company). Chi-square test was used and the
level of significance is P<0.05.
Results:
Chart 1 shows that the participant population sample
consisted of 60% of 13-20yrs age group population, 32% of
21-28 yrs of age group and 8% of more than 28yrs. art Chart 2
shows knowledge on gingival health 52.77% of the
participants feel that they see their gingiva in good condition
after starting of orthodontic treatment, 34.16% of the
participant feel that their gingiva in fair condition & 13.05% of
the participants feel that they see their gingiva in bad condition
after starting of orthodontic treatment. Chart 3 shows effects
of prolonged brushing were known by only 8.5% while most of
them (91.5%) were not aware of that shown in the survey. Also
nearly 5.7% felt halitosis in the study.Only 28% of individuals
had previous dental exposure before this orthodontic treatment
and 21.33% individuals follow the oral hygiene instruction
strictly. (Table 1) 91.33% individuals’ uses toothpaste &
8.66% uses toothpowder for cleaning teeth and most of them
brush twice daily. On other oral hygiene practices, only
31.33% individuals using mouthwash in their oral hygiene
practice & 22.66% individuals uses interdental toothbrush as a
cleaning aid during orthodontic treatment. (Table 1)
31.33% uses soft type of bristle, 58.66% uses medium type &
10% uses hard type of bristle. OHI reiterate about bed time
brushing importance, more than two third (86%) brushes twice
Chart 1 Age Group
Chart 2 Opinion on look of Gingiva
005
Table No.1 Orthodontic Patients Attitude towards Dental Exposure
Yes
No
Previous Dental Exposure
28% (42)
72% (108)
Scaling
42.85% (18)
57.54% (24)
Yes, Strictly
Yes, Very Often Not At All
Following Oral Hygiene Instructions 21.33% (32)
Toothbrush
67.33% (101) 11.33% (17)
Toothpaste
Tooth Powder Mouth Rinse
100% (150) 91.33% (137) 8.66% (13) 31.33% (47)
Aids Used To Clean Teeth
Interdental Brush
22.66% (34)
Table No.2 Knowledge on aids for oral hygiene
Type
Bristle Type
Frequency
Frequency of Changing The Brush
Mechanical
Powered
Interdental
100% (150)
0
22.66% (34)
Soft
Medium
Hard
31.33% (47)
58.66% (88)
10% (15)
Once
Twice
Thrice
8% (12)
86% (129)
6% (9)
1-3 Months
3-6 Months
6-12 Months
60.66% (91)
31.33% (47)
8% (12)
Table No.3 Knowledge On Uses Of Mouthwash
How Often
When do you Use
Once
Twice
More than twice
65.95% (31)
34% (16)
0
After Brushing
When Needed
When No Brushing
25.53% (12)
57.44% (27)
17.02% (8)
Table No.4 Knowledge on uses of Interdental toothbrush
How Often
When do you Use
Sometimes
Once
More than once
11.76% (4)
64.70% (22)
23.52% (8)
Before Meal
After Meal
When Needed
0
76.47% (26)
23.52% (8)
Chart 3 Knowledge on Gingival Health
daily. 60.66% change brush in 1-3 months interval, 31.33%
change brush in 3-6 months interval, 8% change brush in more
than 6 months. (Table 2) Amongst mouthwash user, 65.95%
uses mouth wash once daily & 34% uses twice a day.
Regarding usage of mouthwash, 57.44% uses when needed,
25.53% uses once daily after brushing & 17.02% uses when no
brushing. (Table 3) Those who uses the interdental toothbrush
in that, 64.70% uses interdental brush once a daily, 23.52%
uses more than once & 11.76% uses sometimes. 76.47% uses
interdental toothbrush after meal & 23.52% uses when needed.
(Table 4).
Discussion:
The periodontal status of patients receiving fixed orthodontic
appliances has been the focus of attention, both by the
©Journal of Dental Herald (July 2015 Issue:3, Vol.:2).
orthodontists and periodontists. It is believed that greater
plaque retentive nature of orthodontic appliances aid in plaque
accumulation at gingival margins, contributing to gingival
inflammation[7],[8],[9],[10],[11]Monitoring of gingival and
periodontal status by orthodontists throughout the treatment
period and enforcement of an acceptable oral hygiene program
has become an integral part of modem orthodontic treatment.
[12],[13]
Mostly young patients are referred for orthodontic treatment
and they often suffer from plaque related gingivitis. An
obvious sign of periodontal disease in adults is a hindrance to
being referred for orthodontic treatment. Almost every fixed
orthodontic patient develops gingival disease at some time
during treatment.[14] Gingival enlargement and inflammation
are often transient and resolves within weeks of deband.
Contemporary bonded orthodontic appliances cause less
gingivitis than bandedappliances.[12] Adolescents have
certainly been shown to suffer worse gingivitis than adults
during orthodontic treatment.[15]
Primary aim before any orthodontic intervention isto stabilize
the periodontal condition.[16] Stable gingival health status
throughout the orthodontic treatment would deliver accurate
treatment result. Delivering proper instructions on gingival
health maintenance to orthodontic patients plays vital role in
this aspect. Motivating and making them to practice oral
hygiene measures in young age groups will certainly enhance
the levels of oral hygiene standards.[16], [17] It takes a lot of
patience, effort and time for the patients with fixed orthodontic
appliances to master a quality technique of toothbrushing. At
the beginning, it takes up to 15 or 20 minutes to brush teeth if
three different brushes are used. In time, when patients master
the technique of performing oral hygiene, the duration of
toothbrushing shortens.Many patients don't exactly know how
to maintain high oral hygiene standards which may be
conducive to excellent orthodontic treatment outcome.[18]
Proper brushing is ideal for good gingival health, while
prolong brushing may distort the gingival tissues. Wasting
diseases like abrasion are mainly caused by improper
brushing.In a study by Dr. Elanchezhiyan et.al.[19] showed the
effects of prolonged brushing were known by only 8.5% while
91.5% were not aware of that shown in the survey. Nearly 5.7%
felt halitosis in the study.In our study, effects of prolonged
brushing were known by only 7% while most of them (93%)
were not aware of that shown in the survey. Also nearly 33%
felt halitosis in the study. On awareness of gingival health,
comparatively very few are having awareness while most of
them are not aware of that.
Attitude towards dental exposure:
Among all participants, 28% only have previous dental
exposure, while 72% not have any experience. Among having
exposure, only 42.85% underwent scaling which was once
only, while others have not experienced any professional
cleaning. Following and maintaining OHI will be the vital part
in gingival health status, despite given proper instructions,
non-compliance of instructions by patients may be the reason
for tissue destruction. In the survey, only 21.33% persons
follow the instructions in strict manner, major portion
(67.33%) also following instructions, but very often. Certain
portion of patients (11.33%), even given with proper
instructions, never concerning it.
The study shown some good signs as all are using toothbrush,
006
91.33% individuals’ uses toothpaste& 8.66%uses
toothpowder for cleaning teeth and most of them brush twice
daily. Because this study conducted in rural place so some
people are using toothpowders as cleaning aid. On other oral
hygiene practices, in a study by Berlin-Broner Y et.al[20] only
31.5% uses mouthwash as oral hygiene aids while in our study
only 31.33% individuals using mouthwash in their oral
hygiene practice & 22.66% individuals uses interdental
toothbrush as a cleaning aid during orthodontic treatment.
Practices of Oral Hygiene maintenance:
The study shown that all individuals use the mechanical type of
toothbrush for cleaning the teeth. In that 31.33% uses soft type
of bristle, 58.66% uses medium type & 10% uses hard type of
bristle. OHI reiterate about bed time brushing importance,
more than two third (86%) brushes twice daily & 6% brushes
thrice daily shows good aspect. Brush change, if bristles are
worn out as indicated by OHI, nearly 60.66% change brush in
1-3 months interval, 31.33% change brush in 3-6 months
interval. Few (8%) take more than 6 months shown by the
study indicate concern on gingival health. Amongst
mouthwash user, 65.95% uses mouth wash once daily & 34%
uses twice a day. Regarding usage of mouthwash, 57.44% uses
when needed, 25.53% uses once daily after brushing &
17.02% uses when no brushing.Somewhat similar findings
were noted by these authors in an another study.[21]
Those who uses the interdental toothbrush in that, 64.70% uses
interdental brush once a daily, 23.52% uses more than once &
11.76% uses sometimes. 76.47% uses interdental toothbrush
after meal & 23.52% uses when needed.
The survey indicates that knowledge on their gingival health is
poor, in that many of them not aware of gingival diseases, gum
problems and effects of prolong brushing. All are using tooth
paste, brush and nearly 2/3 brush twice daily indicate good
aspect of oral hygiene maintenance. Many (65.5%) practicing
scrub method of brushing indicated the inadequate knowledge
on oral hygiene practice and need of more intense OHI
delivery and motivation. Also survey indicated that only less
than 1/3 (28%) having previous dental exposure, which shows
only look alone acting as an important factor drive individuals
into orthodontic correction and they were not aware or concern
on other dental issues. The duty of orthodontist or dental
surgeon, whom the patients approach for orthodontic
corrections, will be instructing and motivating individuals in
oral hygiene practices. Since following of instructions is the
most important aspect in gingival health management,
following is inadequate since nearly 67.33% persons
following very often, not strict.Study done by Fredrik
Lundstrom, Sven-Erik Hamp
and Sture Nvman [22] also supports Somewhat similar
findings.
The final picture of this study gives inadequate awareness and
inappropriate practice of oral hygiene among orthodontic
patients. The need of educating and motivating orthodontic
patients on oral hygiene is elicited by end of the study.
Conclusion:
The knowledge, attitude, practice of oral hygiene among
orthodontic patients showed the need of better education and
motivation. Many factors may be responsible in nonmaintenance of gingival health practices. There is a need to
incorporate and evaluate more intense oral hygiene programs
©Journal of Dental Herald (July 2015 Issue:3, Vol.:2).
in future. Extra attention should be given in educating and
motivating the patients on the oral hygiene practices during
orthodontic treatment in proper manner, which will definitely
be helpful to the patients in maintaining their gingival health&
oral hygiene.
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Source of Support : Nill, Conflict of Interest : None declared
©Journal of Dental Herald (July 2015 Issue:3, Vol.:2).
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