According to Dr Jean-Marc Dersot, plaque control is a crucial but often neglected factor in successful orthodontic treatment. Dr Dersot is a past president of the French Society of Periodontology and Oral Implantology, but his favourite topic remains the relationship between orthodontics and periodontics, and his output on the subject as a researcher is prolific. “In order to avoid side effects, orthodontists need to safeguard the periodontal tissue,” he stressed.
Dr Dersot, where do problems during orthodontic treatment usually arise?
For several decades, orthodontists and periodontists have claimed that orthodontic treatment holds no harmful consequences for a healthy periodontium. However, a systematic review of the literature undermined this common refrain and concluded that, even when periodontal conditions are optimal, slight adverse effects are to be observed. According to the overview, 12 studies, including 11 non-randomised ones, showed 0.03 mm gingival recession, 0.13 mm bone loss and 0.23 mm pocket depth at minimum. The conclusions of this meta-analysis are clear: there is no reliable evidence of the benefits of orthodontic treatment for periodontal health, and at best, mildly adverse effects are to be expected.
What should orthodontists do to avoid the worst problems?
In order to minimise the side effects of orthodontic treatment on the periodontium, orthodontists must be able to distinguish between patients they can immediately offer orthodontic treatment to and those who need periodontal treatment first. Before starting treatment, orthodontists should see their patients through the eyes of a periodontist.
Firstly, it should be a basic competence of all orthodontists to be able to recognise the eight signs of periodontitis: gingival bleeding, pain and sensitivity, abscesses and suppuration, gingival recession, tooth mobility, secondary migrations, food impaction and bad breath.
Secondly, orthodontists should know the six risk factors of periodontitis: a family history of periodontitis, a negative response to psychological stress, tobacco consumption, susceptibility to infections, partial or total cario-resistance, and a history of acute necrotising ulcerative gingivitis.
If any of these signs or risk factors are present, the orthodontist should send the patient to the periodontitis before any other treatment is undertaken in order to avoid further problems. Integrating periodontal concerns into orthodontics is essential, and having hygienists in orthodontic clinics is a huge help.