A questionnaire study to assess and evaluate the common gingival problems faced by patients undergoing fixed orthodontic treatment

Introduction

Crowding or malaligned teeth is one of the most common forms of malocclusion.1 Animano et.al (1972) stated that the ability to maintain oral hygiene is more difficult around malaligned teeth.2 Fixed orthodontic appliances for treating malaligned teeth are also known to evoke soft tissue response due to the irritation caused by the appliances like orthodontic bands and resin-bonded attachments.3 This is usually associated with inability to maintain oral hygiene due to the hindrance of the orthodontic components which creates changes in the oral microbial ecosystem and alteration of the composition of the bacterial plaque qualitatively and quantitatively.3 The observation from study by Zachrisson et al. (1972) also confirms that patients undergoing orthodontic treatment usually experience mild to moderate gingivitis within 1 to 2 months from the start of the treatment inspite of repeated motivation and excellent oral hygiene as compared to subjects who haven’t undergone any orthodontic treatment.4 Gingival response to the local irritants in the form of inflammation results in bleeding, edema and slight pain in the gingiva. This can negatively affect the treatment outcome of orthodontic therapy and may also result in the failure of the treatment if the gingivitis progresses to periodontitis. During orthodontic treatment, it is indispensable to emphasis on the the importance of a daily brushing routine either by manual orthodontic toothbrush or by electric toothbrush, along with warm salt water rinses or mouthwashes form an integral part of the treatment.3 Maintaining meticulous oral hygiene during orthodontic therapy can definitely cause behavioural changes in patients motivating them to continue the same care and concern for the oral hygiene that was practised during the treatment.3, 5 To assess and evaluate the gingival response during and after the fixed orthodontic treatment experienced by adult patients was the aim of our study. Patient centered symptoms with regards to swelling, pain and bleeding gums during and post treatment is emphasised.

Aim

To evaluate and assess the common gingival problems patients face while undergoing fixed orthodontic treatment.

Objectives

Materials and Methods

Results

This survey analyzed the knowledge and application of Lingual Orthodontics among Orthodontists in their routine clinical practice in India. This questionnaire based study highlighted the following results:-

Discussion

Gingivitis is described as a result of an imbalance of the oral microbiota, in the dento-gingival area, and the host response leading to inflammation of gingival tissues in susceptible individuals.6 This study was being carried out to assess and evaluate the most common gingival problems that might arise when patients undergo Orthodontic treatment with fixed mechano-therapy. This questionnaire based study aimed at gauging the gingival related problems that the patient might face during the entire process of fixed orthodontic therapy and also enabled to assert and assess the oral hygiene protocols advocated by the patients undergoing braces treatment. Orthodontic appliances, as well as mechanical procedures, are prone to evoke local soft-tissue responses in the gingiva. These effects can either be of positive nature, helping  tooth movement, or negative ones like gingival problems, which should be avoided.3 The aim of the present questionnaire study was to evaluate the effect of orthodontic tooth movement on gingival status in patients undergoing orthodontic treatment. A set of questions were asked to both the groups. 1^st group included the participants who were currently undergoing orthodontic treatment and the 2^nd group included participants who had undergone orthodontic treatment in the past. Firstly, a sample size was estimated based on previous studies done related to the same topic. The sample size was calculated using software for sample size calculation. The sample size was estimated to be 148. A Questionnaire was then fabricated on Google Forms which was then circulated to age groups from 14 to 35 years via various Whatsapp groups. The consent of the participants was recorded on Google forms itself. After 148 participants filled the Google questionnaire form, the data was collectively analyzed. Out of 148 participants, 76 participants were included in group 1 (currently undergoing orthodontic treatment) and 72 participants were included in group 2 (past orthodontic treatment).

Figure 1

Age

Figure 2

Figure 3

How comfortable have you been since you started wearing braces

Figure 4

As you undergoing braces treatment?

Figure 5

How many times a day do you brush?

Figure 6

Do you experience spontaneous bleeding from your gums after brushing?

Figure 7

Do you experience swelling in your gums?

Figure 8

Do you experience etching of gums?

Figure 9

Do you experience food lodgement in your gums?

Figure 10

Do you experience pain in your gums?

Figure 11

Figure 12

How many times a day would you brush when you had braces?

Figure 13

Would you experience bleeding from your gums after brushing when you had braces?

Figure 14

Did you experience swelling in your gums when you had braces?

Figure 15

Would you experience itching of gums?

Figure 16

Would you experience food lodgement in your gums?

Figure 17

Would you experience pain in your gums?

Figure 18

Majority of the participants belonged to the age group of 18 to 22, which represents the most common age of undergoing orthodontic treatment (Figure 1). Most of participants were females (79.3%), with only a few male patients (20.7%) (Figure 2). A majority of 58.6% of the participants reported of having been moderately comfortable with the braces treatment (Figure 3) and only 13.6% of the participants reported of being very comfortable. The 148 participants were almost divided equally in 2 groups (Figure 4). Majority of the participants in both groups (Figure 5, Figure 12) brushed twice a day, suggesting that majority of the participants maintained an additional measure of good oral hygiene along with orthodontic treatment. A majority of 58.5% of the participants in group 1 (Figure 6) and 50% in group 2 (Figure 13) never experienced bleeding from gums after brushing. A whopping majority of the participants of Group 1 (ongoing treatment group) (Figure 7, Figure 8) polled of never having experienced swelling (65.9%) or itching (68.3%) of gums. Majority of the participants of Group 2 (past treatment group) (Figure 14, Figure 15) also experienced no swelling (64.7%) and itching (70.6%) of gums. A majority of both groups also sometimes experienced food lodgement and pain in gums (Figure 9, Figure 10, Figure 16, Figure 17). When asked about their experience with Orthodontic treatment, on a scale from 1 to 5, both groups gave a rating of 4, suggestive that they had a very good experience with orthodontic treatment with only minor areas of discomfort (Figure 11, Figure 18). Thus this questionnaire based study helped to evaluate and assess the common gingival problems patients face while undergoing fixed orthodontic treatment alongside assessment of oral health of patients undergoing orthodontic treatment.

Conclusion

Oral health lies majorly in the hands of the patient by ensuring correct, efficient and meticulous oral hygiene practices. Every orthodontic patient should be motivated and educated with regards to the changes that occur in the gingiva with respect to the orthodontic treatment and good oral hygiene practices.

Source of Funding

None.

Conflict of Interest

The authors declare that there is no conflict of interest.

Acknowledgement

We thank all the participants, for their contribution towards this survey, by helping us with their valuable inputs and insights while filling up and submitting the questionnaire.