Orthodontic Patients

Fixed orthodontic appliances present a unique challenge to standard homecare measures when it comes to removing plaque. Brackets are cumbersome and difficult to clean around effectively.^58,59 Where poor oral hygiene during orthodontic treatment can impact length of treatment, quality, and outcomes, preventive home care measures are of utmost importance.⁵⁸

With the majority of orthodontic patients being under 18 additional risk factors come into play.⁵⁸ These include consuming sugary snacks or beverages often, having more autonomy over their hygiene routines, and unfortunately noncompliance and lack of motivation is also greater in this age group.^23,24 However, a 2023 meta-analysis concluded, there is strong evidence for recommending electric toothbrushing to pediatric patients, as well as those patients undergoing orthodontic therapy and treatment.⁷¹

While use of a powered toothbrush in general helps to reduce plaque and gingivitis, when coupled with an interactive brushing experience and an orthodontic specific brush head, greater benefit has been seen in the home care outcomes of this population.^23,59,60 In one randomized control trial conducted by Erbe et al., a brush head designed for the unique contour of orthodontic brackets was compared to a regular brush head for an O-R power brush and a manual brush. Both the orthodontic and regular brush head produced statistically significant plaque reduction compared to the manual brush which is consistent with other literature.^13,59 However, when comparing the two power brush heads together, results showed the specifically designed ortho head produced significant results over the regular brush head alone due to its design and ability to adapt around brackets.

Another randomized control trial aimed to test the ortho specific brush head on an O-R power toothbrush to the regular head of a leading sonic brush. While both technologies reduced plaque post baseline significantly, (60.76% for sonic with regular head, 65.62% for O-R with orthodontic head (P<.001)), there was a statistically significant result of O-R over sonic (P=.017).⁶⁰

The novel Sonic-Fusion brush by WaterPik^® may prove to be a beneficial tool for this population as well. Research has shown that water flossing in addition to brushing alone increases effectiveness of reducing plaque, bleeding, and inflammation.^25,42 When the WaterPik^® Sonic-Fusion brush was compared to a standard sonic brush, and manual brush with flossing, the WaterPik^® Sonic-Fusion brush provided significant results overall and interproximally. However, since this product is new, there is no specific research data on using the WaterPik^® Sonic-Fusion brush on an ortho population.¹²

A recent RCT investigated two homecare regimens for orthodontic patients and their effects on reducing plaque, gingival inflammation, and bleeding in this population. Subjects were randomized into a control group, which was instructed to use a manual toothbrush and string floss with a threading device, or the intervention group, which was instructed to use a Philips Sonicare EasyClean power toothbrush with InterCare brush head and a Sonicare Airfloss Pro filled with BreathRx antimicrobial mouthrinse for interproximal cleaning. All products demonstrated safety on both the oral tissues and the orthodontic appliances, however, the powered regimen was significantly more effective at reducing plaque, inflammation, and bleeding after 3 and 6 weeks.⁵⁸

As previously mentioned, compliance and motivation to complete oral hygiene measures while in braces is often low in adolescents. A study conducted on plaque removal and compliance for this age group comparing a manual brush to an interactive power toothbrush showed very promising results. Bluetooth technology that connects the brush with an app was used to try to motivate this age group to brush longer and focus on problem areas. After a 6-week trial, brushing times increased an average of 55 seconds in the interactive power toothbrush group, who also had greater plaque removal overall and in focus areas.²³ With so many adolescents integrating the use of wireless technology into their daily lives, increased motivation and compliance in this population may be seen. This in turn, may show greater reduction in plaque and inflammation.²³