**2. Particularities of the orthodontic treatment**

Malocclusion is the third place in the oral diseases, the occurrence of occlusal anomalies varies between 11 al 93%; the complications that it brings could be: psychological derived from the alteration of the dentofacial aesthetics; oral function problems, including difficulties in the mobility of the jaw, pain or disorders in the temporomandibular joint and problems to chew, to swallow or to speak; and finally, problems of major susceptibility to traumatism, periodontal diseases or dental decay (Proffit, 2008; Sidlauskas & Lopatiené, 2009).

The orthodontic treatment can correct orofacial alterations, which can influence the patient's psique and social integration of the same one. Importantly, the face, the smiles and the teeth are part of the first impression of another person (Trulsson et al., 2002).

The purpose of the orthodontic treatment is to move the tooth as efficiently as be possible with the minimum of adverse effects to the tooth and the support tissues.

The requirements before initiating an orthodontic treatment are:


Clinical, Salivary and Bacterial Markers on the Orthodontic Treatment 157

prevent disease; b) identify early disease-associated biochemical or physical changes prior to clinical signs of disease to halt the changes and reverse damage prior to loss of function; and c) determine which specific type of disease is involved to guide selection of the most

Risk markers are biologic markers that either indicate disease or disease progression but are not causal or represent historical evidence of the disease, risk factors are characteristics of the person or environment that, when present, directly result in an increased likelihood that a person will get a disease and, when absent, directly result in a decreased likelihood of

Risk factors for prediction of caries activity have been described by Featherstone (2000) and involve a balance between well-described pathological and protective factors. The pathological factors are primarily the levels of acidogenic bacteria, the frequency of fermentable carbohydrate ingestion, and the level of saliva flow. The protective factors include salivary proteins and antibacterial components, salivary composition of key minerals—for example, calcium and fluoride—and protective dietary components

To be able to evaluate the caries risk exist different markers, principally DMFT or DMFS index and bacterial counts (Streptococci mutans and Lactobacillus). The historical experience to caries that the patient presents by the DMFT or DMFS index is one of the most powerful predictor to caries risk. Nevertheless, it is well know that the caries is multifactorial and can change from a population to other one, from an individual to other

The DMFT index was developed by Klein, Palmer and Knutson during a study of the dental condition and the need of children's treatment in elementary schools in Hagerstown, Maryland, USA, in 1935. It has been the most important index in the dental researches to

The caries experience (past and present) indicates the teeth damages and treatments received before by the count of teeth decays or natural history of the dental caries, which it expresses as decayed, missing and filled teeth (DMFT index) or decayed, missing and filled surfaces (DMFS index), both indexes express numerically the caries prevalence. The sum of these three points is the index (Sánchez & Sáenz, 1998; World Health Organization [WHO],

For better analysis and interpretation it will be separate in each component and express it by

To obtain DMFT index in population, WHO recommended the next age groups: 5-6, 12, 15, 18, 35-44, 60-74 years. The index at 12 age is used to compare the oral health between

About caries risk factors that it must be valued we can mention the following ones:

effective therapy (Kornman, 2005; Sánchez & Sáenz, 2003).

(Kornman, 2005; Featherstone, 2000).

one even from a group of teeth to other one.

quantify the prevalence of tooth decay (Katz et.al., 1997).

percentage or mean. This is important to compare populations.

**3.1 Clinical markers** 

**3.1.1 DMFS index** 

1997; WHO, 2011b).

countries.

disease.

The patient must be motivated and cooperator.

When placed fixed appliances, besides the brackets, the orthodontic technique use other attachments as: bands (actually preformed), wires, springs or buttons.

The length of orthodontic treatment with fixed appliances has approximately 13-15 months; nevertheless, factors so far linked to increased treatment duration include anatomy, malocclusion, direction growth, molar class, extractions, use of fixed appliances in both arches, and others (Turbill et al., 2001).

Patients who undergo orthodontic therapy have oral ecologic changes because increased retentive sites for retention of food particles, which allows the bacterial growth.

Lesions developed during orthodontic treatment could be radicular resorption, gingival recession and increase of caries risk and periodontal diseases. The enamel decalcification is one of the most common and undesirable complications of the orthodontic therapy. Some authors (Chang et al., 1999; Heintze, 1999; Zárate et al., 2004) show increase of decalcifications or white spot lesions in patient on treatment.

Demineralization of the enamel around brackets can be an extremely rapid process, which appears most frequently on the cervical and middle thirds of the buccal surfaces of the maxillary lateral incisors, mandible canines and the first premolars. The prevalence of new enamel lesions in orthodontic patients treated with fixed appliances and using fluoride toothpaste is reported to be 13 to 75 % (Derks et al., 2007).

We can find periodontal alterations after orthodontic treatment such as: generalized gingivitis after bonding and light lost of alveolar bone level and of epithelial insertion (Bollen et al., 2008).

It seems, that the bone lost could be more serious when more complex and extensive will be the orthodontic movement.

That is the reason because the maintenance of an effective oral hygiene is critical during the treatment.

We can considerate the next preventive measures in orthodontic patients:


When we do a good orthodontic treatment and with a correct regime of oral hygiene, we do not have important periodontal complications.

It has been demonstrated that children who receive orthodontic therapy, at the end of this treatment, presents lower dental plaque levels and gingival bleeding that children who did not receive treatment; it could be because they have better dental alignment, but also to that the subjects modify his oral personal hygiene and attitude (Gwinnett & Ceen, 1979).
