**5. Conclusions**

174 Contemporary Approach to Dental Caries

level with 1 mg/dL of occult blood in saliva (incipient periodontal disease) and one month

>106 0 1 0 2 0.3741

106 2 0 2 2 0.6905

< 4.4 0 0 0 0 0.5467

Periodontal disease present 5 4 6 5 0.0305\*

Table 2. Distribution of bacterial markers, plaque pH and occult blood in saliva by gender in

0.5432 0.2733

NC or <103 6 4 4 4 <105 3 3 4 6 >105 to 106 5 8 6 8

pb 0.8137 0.6416

pb 0.4431 0.6832

pb 0.0430\* 0.4414

Pa value between before vs. after placement of appliances, based on X2 test

No periodontal disease 1 1 0 0 Incipient periodontal disease 8 15 8 15

5.8 – 7.2 4 14 3 7 5.4 + 0.3 9 6 11 12 4.8 + 0.3 1 0 0 1

NC 4 8 0 1 103 3 5 4 4 104 3 4 5 5 105 2 3 8 8

Stages

Male Female Male Female

Pa Before After

later the periodontal disease present increase (Table 2).

Marker

Bacterial markers

*Lactobacillus* counts

Plaque pH

Occult blood in saliva

NC = negative at culture

the study (n = 34)

\* P < 0.05

Pb value between genders, based on X2 test

*SM* counts

The clinical markers showed that males had lower DMFS index than females, nevertheless, the plaque index by O´Leary showed more plaque in males of this study.

The stimulated salivary flow increased after the placement of orthodontic appliances. In the present study it was greater in males, which is similar to international reports (Chang et al., 1999; Bretz et al., 2001; De Vigna et al., 2008).

The mean salivary flow rate for both genders was found in normal parameters: 1-3 mL/min in stimulated saliva and from 0.25-0.35 mL/min in unstimulated saliva. The variability of salivary flow rate has been established by other researchers (Torres et al, 2006).

The results support a direct and prolonged stimulatory effect after one month of treatment with fixed orthodontic appliances on salivary flow.

The saliva buffer capacity presented a significant increase in females after the orthodontic therapy. Males showed higher buffer capacity than females, this difference between genders have been demonstrated previously.

The salivary buffer capacity prevents the settling of pathogenic microorganisms in mouth, being an important risk indicator, because it reveals the response of the host.

Salivary pH demonstrated a significant increase in the 1st month of treatment, as opposed to other studies in which it has been demonstrated that the pH suffers alterations after 3 months of orthodontic treatment (Chang et al., 1999).

Males showed a more acid plaque pH at the beginning of the treatment, nevertheless an increase in acidity was demonstrated 1 month with orthodontic appliances in females. The plaque pH had significant differences between genders when the patients already were in orthodontic treatment.

The orthodontic appliances protected the plaque from the tooth brushing action, the mastication, and the salivary fluid. Accumulating more on the cervical region of the brackets or below the arches wire, which is the zone where a major demineralization can be found (Migale et al., 2009).

The present study showed an increase of CFU after placement of the orthodontic appliances, which has been demonstrated also by Chang (1999). Nevertheless, these changes in the 1st month of study were not statistically significant, as opposed to report by this same author.

Before initiating treatment, the majority of patients showed incipient periodontal disease detected trough the Salivaster® test, possibly caused by crowding, which in the majority of patients is the principal motivation for the orthodontic treatment. Likewise, a significant increase of periodontal disease was observed 1 month after initiating orthodontic therapy

Clinical, Salivary and Bacterial Markers on the Orthodontic Treatment 177

In this study it was observed that most patients showed interest in the results of their samples, from the very beginning knew the purpose of continually assessing their clinical characteristics, salivary and bacterial, asked if he had improved his health and brushing

Because orthodontic appliances patients with an increased risk of tooth decay and/or periodontal disease problems, it is necessary to reduce the time in which these patients are at risk, the clinician will have the commitment of the good course of treatment, but the

Another recommendation is to give greater publicity to the importance of oral health markers studied here can not only be applied in orthodontic patients, but in any patient is desirable to determine the risk of cavities that may have to take action convenient and proper preventive their clinical characteristics, salivary or bacterial infections, and especially

Anderson P., Hector M.P. & Rampersad M.A. (2001). Critical pH in resting and stimulated

Ansai T., Yamashita Y., Shibata Y., Katoh Y., Sakao S., Takamatsu N., Miyasaki H. &

Anusavice K.J. (2005). Present and future approaches for the control of caries. *Journal of Dental Education*, Vol. 69, No. 5 (May, 2005), pp. 538-554, ISSN 0022-0337. Bollen A.M., Cunha-Cruz J., Bakko D.W., Huang G.J. & Hujoel P.P. (2008). The effects of

Bretz W.A., do Valle E.V., Jacobson J.J., Marchi F., Mendes S., Nor J.E., Cancado M.F. &

Butler B.L., Morejon O. & Low S.B. (1996). An accurate, time-efficient method to assess

Chang H.S., Walsh L.J. & Freer T.J. (1999). The effect of orthodontic treatment on salivary

Dawes C. (2003). What is the critical pH and why does a tooth dissolve in acid? *Journal of the* 

*Dentistry*, Vol. 11, No.4 (July, 2001), pp. 266-273, ISSN 0960-7439.

*Dentistry*, Vol. 4, No.1 (March, 1994), pp. 13-17, ISSN 0960-7439.

whole saliva in groups of children and adults. *International Journal of Paediatric* 

Takehara T. (1994). Relationship between dental caries experience of a group of Japanese kindergarten children and the results of two caries activity tests conducted on their saliva and dental plaque. *International Journal of Paediatric* 

orthodontic therapy on periodontal health. A systematic review of controlled evidence. *Journal of the American Dental Association*, Vol. 139, No. 4 (April 2008), pp

Schneider L.G. (2001). Unstimulated salivary flow rates of young children. *Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics*, Vol 91, No. 5

plaque accumulation. *Journal of the American Dental Association*, Vol. 127, No. 12

flow, pH, buffer capacity, and levels of mutans streptococci and lactobacilli. *Australian Orthodontic Journal*, Vol. 15, No. 4 (April 1999), pp 229-34, ISSN 0587-

*Canadian Dental Association*, Vol. 69, No. 11 (December 2003), pp 722-724, ISSN

frequently controlled by plaque control record.

patient also plays an important role.

those in which systemic disease is added.

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**6. References** 

(2.5 mg/dL of saliva). Inflammation of the adjacent connective tissue has been considered a consequence of the use of orthodontic bands, determining that the condition of the gum deteriorates during the treatment with fixed appliances, even in patients with good oral hygiene. (Lara-Carrillo et al., 2010a)

Checking the quality, pH and buffer capacity of saliva can be valuable as part of an overall clinical assessment, thus also monitoring bacterial counts, plaque and periodontal inflammation.

In conclusion, orthodontic treatment changes the oral environmental factors: promotes a major salivary stimulated flow and increases its buffer capacity and salivary pH, which increase the anticaries activity of saliva. Plaque pH did not demonstrate significant changes before and 1-month into orthodontic treatment. The bacterial levels did not increase significantly in the first month of the orthodontic treatment but, the increased of retentive surfaces rinsed the bleeding in saliva by periodontal injury.

Patients with orthodontic appliances require special care in terms of prevention caries and periodontal disease. For optimal patient care, it is necessary to analyzed if the changes during orthodontic treatment persist or change upon discontinuation of treatment.

The following markers emerged as protective factors: patients without active caries injuries increased significantly stimulated salivary flow, buffer capacity, and salivary pH, after placement orthodontic appliances.

In contrast, the following markers were negative risk factors to the oral environment: slightly increase in the infection levels of *SM* and *Lactobacillus*, and of occult blood in saliva.

Oral environment has the capacity of adjustment to the presence of a foreign body, increasing the salivary flow which contributes to the autoclisis and modifying the salivary composition to raise the pH and buffer capacity, it prevents colonization by potentially pathogenic microorganisms by denying them optimization of environmental conditions.

It is necessary to establish the parameters that the patient presents at the beginning and during the treatment, and determine which stages may show major changes, if these changes are kept or reversed during the course of the therapy, with the purpose of preventing in an opportune and effective way.

So it is advisable to develop a prevention protocol for the development of dental caries or enamel demineralization in patients at risk, as is the case of those who undergo orthodontic treatment with fixed appliances.

It is recognized that this type of treatment has the potential to cause damage to hard and soft tissues of the oral cavity. In patients undergoing orthodontic treatment with fixed appliances increases bacterial counts due to the favorable environment for the accumulation of plaque and food debris that increase the risk of tooth decay, coupled with the difficulty of plaque removal by conventional means of oral hygiene.

However, the best way to combat tooth decay and periodontal disease is the strict control of plaque, for which it has recommended the use of electric toothbrushes, mouthwashes, oral irrigators, and others. But one of the most important parts to maintain oral health is the motivation of the patient.

In this study it was observed that most patients showed interest in the results of their samples, from the very beginning knew the purpose of continually assessing their clinical characteristics, salivary and bacterial, asked if he had improved his health and brushing frequently controlled by plaque control record.

Because orthodontic appliances patients with an increased risk of tooth decay and/or periodontal disease problems, it is necessary to reduce the time in which these patients are at risk, the clinician will have the commitment of the good course of treatment, but the patient also plays an important role.

Another recommendation is to give greater publicity to the importance of oral health markers studied here can not only be applied in orthodontic patients, but in any patient is desirable to determine the risk of cavities that may have to take action convenient and proper preventive their clinical characteristics, salivary or bacterial infections, and especially those in which systemic disease is added.
