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      Effects of fixed orthodontic brackets on oral malodor : A systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses guidelines

      review-article
      Author(s): , MD a , , PhD b , , PhD a , ∗
      Editor(s):
      Publication date (Electronic):
      Journal: Medicine
      Publisher: Wolters Kluwer Health
      Keywords: meta-analysis, oral malodor, orthodontics, self-ligating brackets

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          Abstract

          Background:

          This systematic review and meta-analysis aimed to identify whether there is any relationship between fixed orthodontic appliances and malodor, and if self-ligating brackets (SLBs) prevent malodor better than conventional brackets (CBs).

          Methods:

          The electronic databases PubMed, Ovid, EMBASE, and the Cochrane Library were searched from inception to September 2016; a manual search was also performed. Randomized controlled and clinical controlled trials, in which experimental groups received fixed orthodontic therapy and malodor was measured, were included. Patients treated with fixed orthodontic brackets were compared with those without any treatment, and SLB systems were compared with CB systems. Two reviewers independently selected potentially relevant studies, evaluated the risk for bias, extracted essential data, and synthesized findings using Review Manager version 5.3 (Copenhagen: The. Nordic Cochrane Centre, The Cochrane Collaboration, 2014).

          Results:

          Four studies, involving a total of 152 participants, met the inclusion criteria. Fixed orthodontic appliances caused malodor from the initial visit to 2 to 3 months, but was only significant after the first week (mean difference 20.24 [95% confidence interval [CI]11.75–28.74]; P < .00001). Plaque index, gingival index, and periodontal pocket depths demonstrated no statistical differences between the SLB and CB groups after the first week. However, SLBs significantly controlled malodor better than CBs after the first week (mean difference 4.32 [95% CI 6.02 to 2.61]; P < .00001). The quality of the included studies was relatively low and relevant research in this field is quite scarce.

          Conclusions:

          Although the evidence base was relatively weak, fixed orthodontic treatment appeared to be a risk factor for malodor, independent of periodontal changes, and SLB systems controlled malodor better than CB systems.

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          Most cited references21

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          Production and origin of oral malodor: a review of mechanisms and methods of analysis.

          J TONZETICH (1976)
          Organoleptic studies indicate that the oral cavity is usually the principal source of physiologic malodor associated with the early morning halitosis. In all individuals, regardless of the age or health status of the oral tissues, the most intense oral malodor is exhibited after prolonged periods of reduced saliva flow and abstinence from food and liquid. This results from normal metabolic activity in the oral cavity and is accentuated in cases with periodontal involvement. Physiologic oral malodor is transient in duration as it can be controlled to varying degrees in most individuals by oral hygiene measures, such as tooth brushing, dental prophylaxis, tongue scraping and rinsing with antiseptic mouth washes. Experimental evidence strongly suggests that putrefaction of sulphur-containing proteinaceous substrates by predominantly gram-negative oral microorganisms is the primary cause of oral malodor. Optimum putrefactive activity occurs in low carbohydrate environment, physiological pH, and anaerobic conditions. Salivary sediment containing the exfoliated epithelial cells is the primary source of substrate which exists in a disulphide state. Proteolysis and reduction of disulphide bonds precedes the formation of odor. The odor intensity of putrescent saliva and plaque head-space vapor has been correlated with the concentration of volatile sulphur compounds consisting of hydrogen sulphide, methyl mercaptan, dimethyl sulphide and dimethyl disulphide. Except for dimethyl disulphide, the same sulphur-containing compounds have been found in mouth air of all tested individuals. Hydrogen sulphide and methyl mercaptan emanate an offensive putrid odor and account for approxiamtely 90% of the total sulphur content of mouth air. In half of the population tested, methyl mercaptan and hydrogen sulphide content of early morning mouth air is sufficiently high to account for the oral malodor. Brushing studies indicate that both plaque and tongue are important sources of malodor with most of the odor emanating from the dorso-posterior surface of the tongue. None of the gas chromatographic or mass spectrometric analyses have detected the presence of amines, indole, or skatole in the head-space, mouth air, or breath vapor samples.
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            Orthodontic appliances and enamel demineralization. Part 1. Lesion development.

            Mark J. Arends, G Rolla, B Øgaard (1988)
            A clinical trial was conducted to investigate carious lesion development associated with fixed orthodontic therapy. Specially designed orthodontic bands for plaque accumulation were attached to premolars scheduled to be extracted as part of an orthodontic treatment. Visible white spot lesions were seen within 4 weeks in the absence of any fluoride supplementation. Both microradiographic and SEM examinations showed surface softening of the enamel surface--that is, a surface layer was not seen in the lesions. The clinical significance of the present study is that enamel demineralization associated with fixed orthodontic therapy is an extremely rapid process caused by a high and continuous cariogenic challenge in the plaque developed around brackets and underneath ill-fitting bands. Careful inspection of the appliance at every visit and preventive fluoride programs are therefore required.
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              Prevalence of malocclusion and its relationship with socio-demographic factors, dental caries, and oral hygiene in 12- to 14-year-old Tanzanian schoolchildren.

              Pongsri Brudvik, Anne Åstrøm, Matilda Mtaya (2009)
              The aim of this study was to assess the prevalence of malocclusion and its association with socio-demographic characteristics, caries experience, and level of oral hygiene in 12- to 14-year-old schoolchildren residing in two socio-economically different districts of Tanzania. A total of 1601 children (mean age 13 years, 60.5 per cent girls) attending 16 primary schools in Kinondoni and Temeke districts participated in a clinical examination and were interviewed in school settings. Chi-square and multiple logistic regression models were used to test for statistically significant differences between different groups. The results showed that 63.8 per cent (62.6 per cent in Kinondoni and 66.0 per cent in Temeke) of the subjects had at least one type of anomaly, with a midline shift (22.5 per cent), spacing of at least 2 mm (21.9 per cent), and an open bite (16.1 per cent) being the most frequently recorded. The majority (93.6 per cent) of the children showed a Class I molar relationship. Class II and Class III malocclusions were registered in 4.4 and 2.0 per cent, respectively. Multiple logistic regression analyses, controlling for socio-demographic factors, showed that the odds ratio for having an open bite was 1.8 if residing in a less socio-economically privileged district. Subjects with decayed, missing, and filled teeth (DNFT) (>0) were 1.7, 2.1, 2.4, and 1.7, respectively, more likely to be diagnosed with a malocclusion, a midline shift, Angle Class II and III, and an open bite. Schoolchildren with fair/poor oral hygiene were less likely than their counterparts with good oral hygiene to be diagnosed with a midline shift. Malocclusions were prevalent in the Tanzanian children investigated and were associated with environmental factors in terms of caries experience and residing in a less affluent district. Preventive programmes to combat the prevalence of malocclusion are recommended.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: April 2018
                Publication date (Electronic): 06 April 2018
                Volume: 97
                Issue: 14
                Electronic Location Identifier: e0233
                Affiliations
                [a ]Department of Orthodontics
                [b ]Central Laboratory, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China.
                Author notes
                [∗ ]Correspondence: Jiu-Hui Jiang, Department of Orthodontics, Peking University School and Hospital of Stomatology, 22 South Zhongguancun Avenue, Haidian District, Beijing 100081, China (e-mail: drjiangw@ 123456163.com ).
                Article
                Publisher ID: MD-D-17-04840 Accession ID: 00233
                DOI: 10.1097/MD.0000000000010233
                PMC ID: 5902289
                PubMed ID: 29620635
                SO-VID: 1bec3cdd-b6ce-4a6f-a93a-cdd701cc7dda
                Copyright © Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0

                History
                Date received : 3 August 2017
                Date revision received : 6 February 2018
                Date accepted : 4 March 2018
                Categories
                Subject: 5900
                Subject: Research Article
                Subject: Systematic Review and Meta-Analysis
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: meta-analysis,oral malodor,orthodontics,self-ligating brackets
                Data availability:
                Keywords: meta-analysis, oral malodor, orthodontics, self-ligating brackets

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