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Comparison Of Periodontal Health Of Orthodontic And Non-Orthodontic Patients JBUMDC 2020

Methodology: Those patients aged 14-30 under orthodontics treatment for about 3 months and were able to give consent were included in the study. Periodontal status among both groups (65 orthodontics and 65 non orthodontic) patients was evaluated with the help of CPITN probe on index teeth. To assess the oral hygiene status; the questionnaire was formulated regarding the use and frequency of toothbrush; use of interdental cleaners such as interdental brush, use of mouthwash, use of tongue cleaners and dental appointments. A single observer from periodontics department was appointed for observation and record data of patients coming to orthodontic department and to carry out a clinical examination. The data was scrutinized using SPSS 23, and using the chi-square test various other comparisons were performed.

The initial inflammation of gingival tissue occurring around the gums, surrounding the teeth is known as gingivitis, when left untreated progresses into periodontal disease. On the other hand; the fixed orthodontic appliances; when horn in the gingival sulcus rendered plaque accumulation; results in food deposition. This cementation of ortho appliance and the food accumulation results while brushing and at times it is difficult to clean that debris further deteriorating the oral health. 2 Since patient fails to maintain appropriate oral hygiene, they are likely to develop gingivitis as it progresses within 21 days of its occurrence. 1 Fixed orthodontic appliances increases the growth of microbial flora due to deposition of plaque and calculus and results in bleeding gums. [3][4][5][6][7] and other periodontal associated problems such as gingival recession, gingival hypertrophy, alveolar bone hammering, pocketing. 8,9 The predominant initiators of plaque are gram positive organisms which later get replaced by gram negative and then the anaerobes. 1 Oral hygiene preservation during orthodontic treatment is only possible by proper teaching to the patient, their enthusiasm, collaboration and their approach towards their treatment played an active role to maintain oral hygiene. 10 A lot of researches proved that patients either lack knowledge of proper hygiene maintenance or show carelessness in maintaining it. Despite having the knowledge some patients still fail to follow proper oral hygiene instruction. 11,12

INTRODUCTION:
Orthodontic treatment has extensive effect on dentofacial complex. It helps in proper alignment of dentition by orthodontic treatment modalities; improving occlusion, enhancing esthetics and maintaining oral hygiene. Oral hygiene can be affected by different abnormalities in teeth alignment. Plaque retention is one of the causative factor leads to imbalance in micro biota of oral cavity; further accumulation of plaque results in malocclusion which is more often seen in crowded dentition; commonly a feature In order to overcome caries and periodontal problems during orthodontic treatment; there is a need to educate patients regarding maintenance of oral hygiene and how to control the calculus deposition 13 and indeed it was the rationale of the study to assess the periodontal health among orthodontic patients and further to educate them accordingly. It is important to guide orthodontic patients about oral hygiene maintenance before starting the treatment. 14 To address this; it is essential to practice proper brushing technique regularly. Awareness regarding different types of orthodontic appliances and brushes should be provided to the patients especially the interdental brushes. 15 Therefore this study was aimed to compare the periodontal health status of orthodontic and non orthodontic patients.

METHODOLOGY:
All those patients who were aged between 14-30 years of age and visited to orthodontic and periodontics department for regular dental check-up in the Dental Hospital of BUMDC from January 2019 to June 2019 were examined for this study. This study was conducted after the approval obtained from Ethical Review Committee of BUMDC. Those patients aged 14-30 under orthodontics treatment for about 3 months and were able to give consent were included in the study; while those patients having pathological or congenital condition such as craniofacial anomalies because of the compromised periodontal tissue condition and those who were seeking prosthesis treatment specially removable prosthetic appliances were excluded from the study. The Sample size was calculated by considering the prevelance of 10% 1 . The calculated sample size was 139 subjects .Total 65 patients from each respective department were taken into consideration were divided into test group (orthodontic patients) and control groups (non-orthodontic patients). Gender distribution details filled in figure 1. A single observer from periodontics department was appointed for observation and record data of patients coming to orthodontic department and to carry out a clinical examination. To obtain intraexaminer reliability, ten patients were examined on two occasions at a 1-week interval using the Community Periodontal Index and kappa test value of 0.95 was obtained.
Periodontal status among both groups was evaluated with the help of CPITN probe on index teeth. 2 To assess the oral hygiene status; the questionnaire was formulated and included questionnaire were regarding the use and frequency of toothbrush; use of interdental cleaners such as interdental brush, use of mouthwash, use of tongue cleaners and dental appointments.
The periodontal condition of all the patients was assessed conferring to WHO protocol, by the use of an axenic CPITN probe on the index teeth and a mouth mirror under a favorable light source. A tooth was examined to obtain the pocket depth, spot calculus and to check any bleeding response. The areas chosen for examination were the distal, midline and mesial aspects of the facial and palatal/lingual areas. The measure of the depth of gingival sulcus or pocket was carefully examined with the tip of the probe. The probing depth was measured by introducing the probe alongside the long axis of the tooth, between the tooth and gingiva starting at the distobuccal area of the index tooth. The corresponding maximum score for each sextant was calculated and noted down in the appropriate box. The dentition was classified into 6 sextants. The CPITN code noted on the index teeth according to their status were 0,1,2,3,4, denoting healthy gums, bleeding gums on the use of probe, presence of calculus on the gingival surfaces, existence of a low pocket of about 4 to 6 mm or a profound pocket measuring about 6mm or more. While x decoded a sextant with less than 2 teeth (excluded sextant).
The collected data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23 and comparisons of CPITN codes were performed using the chi-square test, with a value of P < 0.05 regarded as significant.

RESULTS:
There were total 130 patients evaluated and comprised of 35 males and 95 females within 14-30 years of age. The periodontal pockets score was compared among both groups. It was revealed CPITN score was 57% in ortho group having periodontal pockets scoring of 3 and 4 on CPITN probe; and (17%) in non-orthodontic group pocket depth with same score (3 and 4 score) on CPTIN probe. The elevation in periodontal disease was found to be statistically significant between ortho and non-ortho groups (p < 0.05) ( Table-1).
A CPITN score of 3 and 4 indicated the presence of a pocket in 4(6%) patients of orthodontic group who were interdental brushers. At the same time the same CPITN score of 3 and 4 was also found in about 34 (52%) patients who were not using the interdental brushes-Graph-2.
According to the results; from the total 130 patients, 4 of 40 interdental brush users that was about 10% had 3 and 4 CPITN score along with the periodontal pockets. Periodontal pockets were present in 46 (51%) of the 90 patients who were not using any sort of interdental assistance and CPTIN score was 3 and 4. (Graph-3). Table 3-depicted the progression of periodontal disease (p < 0.05) among patients who are not using dental aids to the ones using it.
According to the responses revealed: both groups were brushing their teeth with a tooth brush ranging 66% of them doing it once every day while 30% did it twice daily and only 1% doing it thrice daily. Whilst when it came to the use of interdental cleaners, in the ortho group 47% were interdental brush users, and in the non-ortho group, only 15% patients used dental floss. Volunteered tongue cleaners were 12% from orthodontic group and 5% from nonorthodontic. At the same time use of mouth wash was practiced by 10% orthodontic patients and 38% normal patients not undergoing ortho treatment. Total 20% patients Interdental Aid Users Non-Interdental Aid Users of orthodontic follow up and 10% were routine diagnostic patients.

DISCUSSION:
The purpose of the study was to compare the periodontal health among patients seeking orthodontic help to the ones not undergoing orthodontic care. In this study; the CPITN score was increased among orthodontic treatment receiving patients. Momina et al. 16 revealed that the arrangement of brackets provides retentive sites and bionomic surroundings for accumulation of biofilm, furthermore the CPITN scores observed in this study harmonize with those fallouts. Excessive bleeding and inflammation worsen the periodontal health resulting in surveillance of noticeable raise in plaque and gingival index of test group. Three months after placement of fixed appliances there was foremost augment in clinical and microbial characteristics, comparable outcomes shown by Marda et al. 17 Undoubtedly, the CPITN score of orthodontic and non orthodontic groups were contradicting, admitting the fact that score for group using interdental brush were lower as compared to the ones not using brushing. Since orthodontic appliances placement hinder maintenance of proper oral hygiene causing deposition of plaque leading to increase in pocket depth, which directly contributes to increase in CPITN score and the same observation reported by Nasir et al. 18 As reported by Angelina et al, 19 the most affected area periodontally in orthodontic patient is the interdental area which agrees with the observation of this study. This truly confirms that orthodontic appliances are prone to plaque accumulation, eventually initiating periodontal problems. These results were in agreement with other studies. 20 A clinically healthy gingiva has ascertained depth which depicted by different methods as 1.5 mm and 1.8mm. 21 Radiographic analysis indicated the areas of bone loss presuming the formation of pockets. 22 This study agrees with Fatemah et al 23 who reported orthodontic patients bearing fixed appliances have slight attachment loss with increase in pocket depth.
The primary etiological and commencing factor for any gingival or periodontal regression is plaque and its cleanliness becomes a challenge by fixed appliances placement. Earlier colonies initiating plaque are gram positive rods and cocci, transforming into gram negative and anaerobic organisms introducing periodontal defects. 24 Orthodontic treatments render the patient to achieve appropriate oral hygiene during the treatment period. This in turn causes plaque accumulation   Encouraging the adolescents into proper oral hygiene maintenance can reduce the burden of dental distress. 25,26 Oral hygiene tools for orthodontic patients such as floss threaders, interdental brushes are available to control the plaque accumulation. 27 The limitation of the study was the effects of orthodontic treatment upon periodontal health. Further studies can be conducted to assess the periodontal health after the exclusion of orthodontic appliances. Therefore; in a nutshell, proper oral hygiene measures along with interdental brushes can reduce the plaque accumulation.

CONCLUSION:
It was concluded that the periodontal condition of ortho patients was deteriorating as compare to non ortho patient There was no noticeable attachment loss found that could lead to mobility of the tooth and its loss.