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Orthodontic treatment with fixed appliances and biofilm formation—a potential public health threat?

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Abstract

Objectives

Orthodontic treatment is highly popular for restoring functional and facial esthetics in juveniles and adults. As a downside, prevalence of biofilm-related complications is high. Objectives of this review are to (1) identify special features of biofilm formation in orthodontic patients and (2) emphasize the need for strong concerted action to prevent biofilm-related complications during orthodontic treatment.

Materials and methods

Literature on biofilm formation in the oral cavity is reviewed to identify special features of biofilm formation in orthodontic patients. Estimates are made of juvenile and adult orthodontic patient population sizes, and biofilm-related complication rates are used to indicate the costs and clinical workload resulting from biofilm-related complications.

Results

Biofilm formation in orthodontic patients is governed by similar mechanisms as common in the oral cavity. However, orthodontic appliances hamper the maintenance of oral hygiene and provide numerous additional surfaces, with properties alien to the oral cavity, to which bacteria can adhere and form a biofilm. Biofilm formation may lead to gingivitis and white spot lesions, compromising facial esthetics. Whereas gingivitis after orthodontic treatment is often transient, white spot lesions may turn into cavities requiring professional restoration. Complications requiring professional care develop in 15 % of all orthodontic patients, implying an annual cost of over US$500,000,000 and a workload of 1,000 full-time dentists in the USA alone.

Conclusions

Improved preventive measures and antimicrobial materials are urgently required to prevent biofilm-related complications of orthodontic treatment from overshadowing its functional and esthetic advantages.

Clinical relevance

High treatment demand and occurrence of biofilm-related complications requiring professional care make orthodontic treatment a potential public health threat.

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Acknowledgments

This study has been supported by the Departments of Orthodontics and BioMedical Engineering, University Medical Centre Groningen, University of Groningen, the Netherlands.

Conflict of Interest

H.J. Busscher is also director of a consulting company, SASA BV (GN Schutterlaan 4, 9797 PC Thesinge, The Netherlands). The authors declare no potential conflicts of interest with respect to authorship and/or publication of this article. Opinions and assertions contained herein are those of the authors and are not construed as necessarily representing views of the funding organizations or their respective employers.

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Authors and Affiliations

  1. Department of Orthodontics, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    Yijin Ren & Marije A. Jongsma

  2. Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands

    Li Mei, Henny C. van der Mei & Henk J. Busscher

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  1. Yijin Ren
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  2. Marije A. Jongsma
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  3. Li Mei
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Correspondence to Yijin Ren.

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Ren, Y., Jongsma, M.A., Mei, L. et al. Orthodontic treatment with fixed appliances and biofilm formation—a potential public health threat?. Clin Oral Invest 18, 1711–1718 (2014). https://doi.org/10.1007/s00784-014-1240-3

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  • DOI: https://doi.org/10.1007/s00784-014-1240-3

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