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WHICH ORAL HYGIENE PROTOCOL SHOULD BE FOLLOWED BY PATIENTS WITH FIXED ORTHODONTIC APPLIANCES? A RANDOMIZED CLINICAL
Mohammed A Elbanna1, Shahira A Elbanna2, Fatma Abdelsayed1
1Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt.
The Journal of Evidence-Based Dental Practice
|November 25, 2025
Summary
For orthodontic patients, combining manual brushing with interdental brushes, with or without chlorhexidine (CHX) mouthwash, effectively improves oral hygiene by managing Streptococcus mutans (S. mutans) levels.
Area of Science:
- Oral Health
- Microbiology
- Orthodontics
Background:
- Fixed orthodontic appliances can increase the risk of oral hygiene issues and bacterial colonization.
- Streptococcus mutans (S. mutans) is a key pathogen in dental caries, often found to increase with orthodontic treatment.
- Effective oral hygiene protocols are crucial for mitigating risks associated with orthodontic appliances.
Purpose of the Study:
- To compare the efficacy of three distinct oral hygiene protocols in reducing Streptococcus mutans (S. mutans) colonization.
- To evaluate the impact of manual brushing, interdental brushes, and chlorhexidine (CHX) mouthwash on S. mutans levels in orthodontic patients.
Main Methods:
- A randomized study involving 27 adult patients with fixed orthodontic appliances.
- Three groups were assigned: Group I (manual brushing + toothpaste), Group II (manual brushing + interdental brushes), and Group III (manual brushing + interdental brushes + CHX).
- Saliva samples were collected before appliance bonding (T0) and one month after (T1) to quantify S. mutans viable counts (CFU/mL).
Main Results:
- Manual brushing alone (Group I) led to a significant increase in S. mutans counts.
- Combining manual brushing with interdental brushes (Group II) showed no significant change in S. mutans levels.
- The addition of CHX mouthwash (Group III) resulted in a significant decrease in S. mutans counts.
- Both Group II and Group III protocols demonstrated a positive impact on oral hygiene.
Conclusions:
- Oral hygiene protocols combining conventional manual toothbrushing with interdental brushes are effective for orthodontic patients.
- The addition of chlorhexidine (CHX) mouthwash further enhances oral hygiene by significantly reducing S. mutans levels.
- Conventional manual toothbrushing alone is the least effective method for maintaining oral hygiene in patients with fixed orthodontic appliances.
