Controlling Oral Flora: BACTERIOLOGICAL STUDY OF ORAL FLORA WITH APPLICATION OF CHLORHEXIDINE VARNISH IN ORTHODONTIC PATIENTS By Ghada El Mehy, Lecturer of Orthodontics and Arafa Mohammad Arafa Khatab, BDS, MSc, PhD, Lecturer of Paediatric Dentistry, Faculty of Dentistry, Tanta University, Egypt C hlorhexidine is a prefer-able antiseptic agent used in dentistry. In this study, varnish of chlorhexidine was applied to the teeth of 15 patients aged from 13-15 years being treated with fixed orthodon-tic appliances. Saliva samples were collected at four stages (before application of the orthodontic appliance, one week after applica-tion of the fixed orthodontic appliance, one week after applica-tion of the chlorhexidine varnish and four weeks after application of chlorhexidine varnish. The samples were evaluated and there was an increase in bacterial levels after application of orthodontic appliances, then bacterial levels decreased after one week of appli-cation of chlorhexidine varnish, but increased slightly again after four weeks at a lower rate than the previous samples. It was concluded that chlorhexidine varnish had a good effect in the control of oral flora especially S. mutans and Candida thus it had a good role in reducing carious lesions, periodontal diseases and oral lesions. Chlorhexidine varnishes needed to be applied frequently, usually every four weeks after the initial application, to obtain the best results. INTRODUCTION Treatment with fixed orthodon-tic appliances may alter the ecology in the oral cavity by introducing new stagnant areas available for bacterial colonization and retention of substrates. The appliances may also interfere with oral hygiene practice and cover considerable parts of the tooth surfaces with metal and composite materials. In accordance, an increase of the total microbial population as well as microflora has been reported in relation to orthodontic treatment. 21 Fixed orthodontic appliances are considered to be a clinical risk factor in terms of enamel integrity because increased levels of microorganisms which have been identified as the main pathogens in dental caries, and periodontal disease increase the risk for decalcification. Furthermore, metallic brackets with bonding tech-niques have been found to induce changes in the oral environments, such as a decrease in pH. 14, 16 It was found that streptococcus plays a key role in the initiation of dental caries so this has led to a variety of experimental approaches directed at the suppression of this organism in patients undergoing orthodontic therapy. 17 Caries lesions, periodontal diseases and oral lesions can develop in patients undergoing prolonged orthodontic treatment despite reasonable oral hygiene including tooth brushing and daily mouth rinsing. 13 Thus attempts have been made to develop adju-vant means to assist these patients. Sustained – release devices are believed to contribute to oral health by maintaining prolonged thera-peutic levels of the drug at the target organ, other advantages of the sustained release devices are reduced toxicity, fewer side effects and minimal dosage. 22, 23 Chlorhexidine is one of the most common antimicrobial agents used for bacterial inhibition. It is available for use in the oral cavity as a rinse, gel or varnish. 9 Chlorhexidine varnish has the advantages of precise application on specific sites, thus diminishing side effects which occur in the use of mouth rinse or gel application as bad taste, irritation and staining. In addition, it adheres to the tooth surface for an extended period of time thus increasing its antimicrobial action. 1, 19 Sustained – release varnish (SRV) has been applied on partial dentures or directly on tooth surfaces. 23 Hildebrand et al, (1992) have demonstrated the use of chlorhexi-dine mouth guards in the suppres-sion of oral microflora as it has the 32 January/February 2012 JAOS
Journal of the American Orthodontic Society January-February 2012: Page 32
