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Continuing Education

Ortho 101 for the Dental Professional
Course Author(s): Constance Konen, RDH, BS
CE Credits: 2 hours
Intended Audience: Dentists, Dental Hygienists, Dental
Assistants, Dental Students, Dental Hygiene Students, Dental
Assistant Students
Date Course Online: 01/16/2013
Last Revision Date: 05/25/2023
Course Expiration Date: 05/24/2026
Cost: Free
Method: Self-instructional
AGD Subject Code(s): 370
Online Course: www.dentalcare.com/en-us/ce-courses/ce413
Disclaimer: Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into theirpractice. Only sound evidence-based dentistry should be used in patient therapy.

Conflict of Interest Disclosure Statement• The author reports no conflicts of interest associated with this course. She has no relevant
financial relationships to disclose.
Short Description
This course will unveil helpful hints to utilize for the benefit of the orthodontic patient to prevent
detrimental effects of inadequate homecare. Within the course there will be an overview of thetypes of braces and fixed appliances to increase the knowledge of the dental professional inregards to orthodontics.

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Course Contents
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for dental care providers to understandthe challenge in maintaining proper oral
hygiene when working around orthodontic
appliances. By describing various componentsof orthodontic braces and appliances, devices
developed to assist in homecare, and products
available for caries prevention, the practitioner
can formulate a customized home careregimen with modified techniques. Throughthe understanding of the areas within themouth that are more at risk due to braces or
fixed appliance placement, the dental provider
can help patients improve the outcomes of
their orthodontic treatment by minimizing or
ultimately eliminating decalcifications, dental
caries and periodontal disease.

Overview
Learning Objectives
Terminology
Introduction
Orthodontic Braces & Appliances
Accessibility
Prevention of Disease
Biofilm
Toothbrushing• Manual Toothbrushes• Power Toothbrushes
Adjuncts• Flossing• Oral Irrigation• Sulcular & Interproximal Brushes
Products• Probiotics• Xylitol• Remineralization• Fluoride• Calcium Phosphate
Educating the Patient
Evaluation of SuccessConclusion
Course Test
References / Additional Resources
About the Author

Learning Objectives

Upon completion of this course, the dental
professional should be able to:• Identify the names of various components
involved in orthodontic treatment.
• Understand the challenges created inmaintaining good oral health.
• Be familiar with products available
specifically geared towards the orthodontic
patient to improve oral hygiene.
• Know the early signs of disease to assist
in preventing carious lesions and/or
periodontal conditions.
• Recognize the detrimental effects of specificbacterial biofilm and how to control its
effects.
• Appreciate the before, during, and after
treatment norms of hard and soft tissues.
• Establish a home care regimen to improveorthodontic outcomes.

Overview

This course will unveil helpful hints to utilize
for the benefit of the orthodontic patient toprevent detrimental effects of inadequate
homecare. Within the course there will be
an overview of the types of braces and fixed
appliances to increase the knowledge of thedental professional in regards to orthodontics.
There will be information on different adjuncts
to assist in accessing areas around braces andorthodontic appliances along with products tocontrol or prevent disease progression. The
increased knowledge of the dental provider
focusing on orthodontic care contained within
this course will improve patient outcomes in
the creation and maintenance of a beautiful
smile.

Terminology
Glossary of Orthodontic Terms1aligners – Clear, thin, removable trays that areformed to fit an individual’s teeth and are used
to straighten teeth. Patients are responsible for
insertion and removal.
appliances – Any device used by anorthodontist, attached to the teeth orremovable, designed to move the teeth, change
the position of the jaw, or hold the teeth.

Orthodontic treatment can create a challenge
in plaque removal and, consequentially, an
increased risk to dental disease. In order todevelop recommendations, it is necessary2
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archwire – The metal wire that is attached tothe brackets and used to move the teeth.

functional appliances – A type of orthodontic
appliance that uses jaw movement and muscle
action to place selective force on the teeth
and jaws. They are usually removable. They
are also known as orthopedic appliances withnames such as orthopedic corrector, activator,
bionator, Frankel, Herbst or twin block
appliances.

band – The metal ring, usually on a back tooth,that is cemented to a tooth for strength andanchorage.
braces – A word commonly used to describe afixed orthodontic appliance, usually comprisedof brackets, bands and wires.

headgear – An appliance worn outside of
the mouth to provide traction for growthmodification and tooth movement.

bracket - The small metal, ceramic, or plastic
attachment is bonded to each tooth with atooth-colored adhesive. The bracket has a slotthat the orthodontic wire fits into. Also known
as a “brace.”

Herbst appliance – This appliance is used tomove the lower jaw forward. It can be fixed or
removable. When it is fixed, it is cemented toteeth in one or both arches using stainless steel
crowns. An expansion screw may be used towiden the upper jaw at the same time.

buccal tube – A small metal part of the bracket
welded to the cheek side of the molar band.
The tube may hold an archwire, lip bumper,
headgear facebow or other type of appliance
an orthodontist may use to move the teeth.

ligature – A tiny rubber band, or sometimes avery thin wire, that holds the orthodontic wirein the bracket slot/brace.

chain – A stretchable series of elastic o-rings
connected together and placed around eachbracket to hold the archwire in place and close
the spaces between teeth. Also known as a“power chain.”palatal expander – A fixed or removabledevice used to make the upper jaw wider.
removable appliance – An orthodontic
appliance that can be removed from the mouthby the patient. Removable appliances are used
to move teeth, align jaws and to keep teeth
in their new positions when the braces are
removed (retainers).

decalcification (deminerialization) – White
marks on the teeth that can become cavities in
the future. They are caused by poor brushingand the consumption of sugary and acidic
drinks.

retainer – A fixed or removable applianceworn after the braces are removed or aligner
therapy is complete. A retainer is fitted toupper and/or lower teeth to hold them in theirfinished positions. When worn as prescribed,
retainers are the best tool available to minimize
unwanted tooth movement after active
treatment ends.

elastics – Rubber bands. During certain stagesof treatment, small elastics or rubber bands
are worn to provide individual tooth movement
or jaw alignment.
facebow – An orthodontic appliance worn withorthodontic headgear, used primarily to movethe upper first molars back, creating room forcrowded or protrusive front teeth. The facebow
has an internal wire bow and an external wirebow.

rubber bands – During certain stages oftreatment, small elastics (rubber bands) areworn to provide individual tooth movement or
jaw alignment.

fixed appliances – An orthodontic appliancethat is bonded or cemented to the teeth andcannot be or should not be removed by thepatient.

separators – An elastic o-ring or small wireloop placed between the teeth to create spacefor placement of bands. Separators are usually3
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placed between the teeth a week before bands
are scheduled to be placed on the teeth.

orthodontic treatment is approximately two
years with a six-month variable depending on
the difficulty of the case. However, this does
not include the retention phase, which could
include removable or permanently cemented
retainers. If the retainers are cemented on the
lingual aspect of the anterior teeth, they cancreate a lifetime challenge to the patient inproviding adequate plaque removal in this area.
During active treatment, the patient shouldhave 3-4 preventive visits every 6 months toinclude a caries exam, prophylaxis, and fluoride
treatment. These visits are opportunities for thedental professional to educate, evaluate, andemphasize the importance of good oral hygiene
as well as providing a home care regimen.

space maintainer – A fixed appliance used tohold space for an unerupted permanent tooth
after a primary (baby) tooth has been lostprematurely, due to accident or decay.
tongue crib – A fixed appliance used to help
a patient stop habits or undesirable tongue
forces exerted on the teeth and bone that
supports the teeth.
wax – Orthodontic wax is placed on thebrackets or archwires to prevent them fromirritating the lips or cheeks.

Introduction

When the dental professional understands the
purpose of orthodontic braces and appliances,it provides an appreciation for the process andmotivation to assist with patient compliancein oral hygiene instruction and orthodontic
recommendations. It is also necessary to know
the names of the different parts of the braces
and appliances to communicate consistently
with the patient any areas needing extra
attention.

Understanding the challenges orthodontic
patients face in maintaining good oral hygiene
is necessary for dental professionals to assist
these patients in achieving optimal oral health.
Many of us can relate to solving problems
in our daily lives whether at work or home.
Sometimes it is just a minor interference
creating a slight change in our routine.
However, on occasion there may be several
obstacles in the path of our journey towards
the goal and we need to redirect ourselves.

Braces consist of several components. Brackets
are small oval or square pieces made of either
metal or ceramic material bonded directly tothe buccal or sometimes lingual portion of atooth. Typically, brackets are utilized in theanterior region. However, they may also be
used in the posterior areas. They hold thearchwire in place with a ligature tie. Ligatureties can be either a tiny rubber band, also
known as an o-ring, which typically comes indifferent colors, or a thin, metal wire. They
are tightened around the wings of the bracket
to hold the archwire in place (Figure 1). Also
self-ligating brackets with doors or clips may
be used to eliminate these ligature ties. In
most instances, bands are utilized in the molar
regions due to greater forces exhibited formovement in these areas.

Orthodontic treatment could be considereda double-edged sword. On one hand thetreatment will align the teeth and lead to abeautiful smile, but on the other hand the lackof easy access to perform good oral hygiene
from orthodontic appliances can be a causative
factor in carious lesions and gingivitis. The
creation of one or multiple obstacles inattaining an aesthetically pleasing smile withoutcompromising the integrity of the enamel orthe health of the gingiva is the challenge facedby orthodontic patients.
The key to prevention of disease within theorthodontic patient lies within the dental
professionals’ knowledge of the challenges
faced by the patient and the patient’s desire to
be compliant to the recommendations set forth
by the experts.

Sometimes hooks are present on brackets
and most often on orthodontic bands. Rubberbands are attached to the hooks to create
additional force in specific areas. Rubber bands
are changed at least daily and sometimes more

Orthodontic Braces & Appliances

The average length of time a patient undergoes

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Accessibility

frequently because they lose their elasticity
over time. The bands contain tubes so wires
and other appliances, such as headgear, can beinserted. These tubes tend to harbor food andbacteria, so it is important to clean these areas
thoroughly.

Given the fact fixed orthodontic appliances
increase the surface area within the mouthand subsequently cause the accumulation ofplaque, it is no wonder the orthodontic patient
struggles to maintain good oral hygiene. Studies
have shown it is important to perform rigorous
home care during orthodontic treatment toprevent excessive plaque accumulation creating
caries and periodontal disease. The increased
amount of retentive plaque surfaces from fixed
appliances causes an acidic pH and increased
bleeding of tissues.2
Considering orthodontic appliances consist ofwires, hooks, and tubes positioned about 1-2
millimeters above the tooth surface creating justenough space to harbor thousands of species ofbacteria within plaque, it is no wonder plaqueremoval is so difficult. Finding devices with theability to reach into these tiny locations canbe difficult, but not impossible. Sometimes
modification of existing tools is necessary. Thiscan be done by either changing the device tosuit the need better or by redefining the use ofa product. For instance, to change an existing
device, one could heat up a toothbrush handle
and bend it to create better angulation forplacement in a specific area. In order to redefine
the use of a product, the dental professional
could recommend using a device in a waythat was not part of the original intent of the
product.

Figure 1.
A. Ligature – Either a tiny elastic or twisted wire
to hold the archwire to the bracket.
B. Archwire – wire that is tied to the bracket
creating force and proper alignment.
C. Brackets – directly bonded to the tooth andholds the archwire.
D. Metal Band – cemented ring of metal thatwraps around the tooth.
E. Elastic Hooks & Rubber bands – used for
attaching rubber bands, which help teeth
toward their final position.

There are a variety of orthodontic appliances.
Some of them are fixed, while others are
removable. Removable appliances are easy toclean using a denture brush or toothbrush,
toothpaste and enzymatic tablets specificallydesigned for this purpose. Be sure the patientis performing daily removal of bacteria andplaque from these appliances. Fixed appliances
may also be functional in nature using theorofacial muscles of eating, swallowing,
and speaking to create additional force formovement. These appliances tend to be bulky
in nature and make access to adequate plaqueremoval very difficult. However, the fixed
functional appliances eliminate the dependence
on cooperation and deliver a constant force.
This constant force results in quicker treatment
results, therefore reducing the treatment time
for the patient.

Prevention of Disease

Healthy oral cavities are free from disease.
Disease-free gingival tissue appears flat, pink,
and stippled. Healthy enamel appears free ofcavitation with no white spot lesions (WSL).
A quick assessment of these areas provides
the dental professional with the foresight toformulate home care recommendations as
preventive treatment is being performed.
Before one can try to prevent disease fromoccurring, they must have an understanding ofwhat is the cause of a particular disease. The
biggest concerns for disease with an orthodontic
patient are decalcifications, dental caries andperiodontal disease. These are caused from thelack of comprehensive plaque removal. Over
700 microbial species of bacteria have been

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identified in dental plaque with some specific todental disease.3

The ability of the bacteria within the biofilm
to adjust the environment to assist themin their mission to destroy tissue is typical.6
One example of this capability can be seen
with Streptococcus mutans ability to createan acidic environment causing the enamel
to demineralize and allowing Lactobacillus toproliferate and cause dental caries. In studies
examining carious lesions, a complex blendof Lactobacillus species were found in theadvancing front of this area.7 These bacteria
communicate with one another within thebiofilm to assist each other in a specific mission.

Within Dr. Esther Wilkins’ dental hygiene
textbook “Clinical Practice of the Dental
Hygienist” there are four pages of information
regarding care of dental appliances pertaining
to orthodontic appliances. Quite frankly, thisis a great overview, but in order to really help
the orthodontic patient the dental practitioner
needs to learn how to clean around theseappliances hands-on. It is no secret the key
to good oral health revolves around the
reduction of harmful bacteria present within
the mouth. This bacteria is contained withinplaque and can cause destruction of the tooth
enamel or the periodontium depending on thetype of bacteria present. The prevention ofdental disease is not just about brushing andflossing to remove plaque, but also throughunderstanding the disease process and the
products available to assist in arrestment of the
progression.

WSL are the result of demineralization aroundthe brackets or under the bands. It’s estimatedbetween 45% and 68% of patients will develop
WSL during the course of treatment. WSL candevelop in as little as four weeks, althoughcavitation typically doesn’t occur until 6 months.
While most WSL can be found in the maxillaryanterior teeth, the most commonly affected
teeth are the maxillary canines. Although,banded teeth also have a high incidence of WSL,in particular the premolars and first molars.8

Biofilm

Dental professionals are very familiar
with the term “plaque.” However, the new
buzzword defining plaque is biofilm. Biofilm
was first described in the late 17th century
when the inventor of the microscope, Anton
Von Leeuwenhoek, saw the aggregation ofbacteria within his own dental plaque.4 It is
understood plaque consists of a matrix ofcolonizing bacteria. This matrix of hundredsof bacterial species found within dental
plaque is called biofilm. Biofilm consists of
microbial societies with their own defense andcommunication systems. Infections createdby these bacterial biofilms can be targetedwith therapeutic agents geared towards theircommunication system and bacterial type.5
Some of these therapies include antimicrobial
usage to eliminate bacteria or probiotics toincrease the amount of beneficial bacteria.
The pathogenesis of dental biofilm creating
dental disease either as decalcifications, caries
or periodontal disease is the most common
example of disease progression caused bybiofilm within the human body. This pathogenic
biofilm consists of gram (+) acidogenic coccicausing dental caries and gram (–) anaerobic
bacteria causing periodontal disease.

Toothbrushing
Manual Toothbrushes
When it comes to tooth brushing several studies
have evaluated the efficacy of manual andpower toothbrushes. They have been comparedagainst each other in a variety of ways. When
comparing conventional and orthodontic
manual toothbrushes, studies have shown there
is a difference in the effectiveness of plaqueremoval and gingival bleeding dependent upon
the configuration of the bristles. Typically,
orthodontic toothbrushes have central bristles
set at a lower height than the outermost
bristles. This arrangement allows space for the
protrusion of the bracket and the outer bristlesof the toothbrush to reach the tooth aroundthe bracket. Utilizing an orthodontic toothbrushdecreases the amount of visible plaque aroundthe bracket and also decreases the amountof gingival bleeding. However, the study alsosuggested that the oral hygiene improved
from baseline data with both the conventionaland orthodontic manual toothbrushes due tothe study groups increased awareness of theimportance of good oral hygiene.9 Therefore,

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the demonstration of a modified tooth brushingtechnique is important to all orthodontic
patients and cannot be underestimated.

easier without the use of a floss threader. The
Platypus® Orthodontic Flosser may look likeany disposable flosser, but when looked atclosely it has a thin spatula end on one side of
the floss bow. This thin area of the floss holder
simply slides in between the archwire and tooth
allowing floss to access the interproximal area
(Figure 3).

Power Toothbrushes
A Cochrane Collaboration study concluded
oscillating power toothbrushes were more
effective than manual brushes in plaquereduction and gingivitis by 11% and 6%,
respectively, in the short-term. And after 3
months, gingivitis was reduced by 11%.10 Since
orthodontic patients have more challenges withkeeping their mouths free of harmful biofilms,
it is important to provide information andtraining on methods to improve the patient’s
ability to reduce harmful bacteria. There are avariety of power brushes available to patients. A
toothbrush head with the capability of reaching
into interdental areas with a tip small enoughto penetrate into tight areas around archwires,brackets, and bands is ideal (Figure 2).

Figure 3.

Gumchucks ORTHOgami is a flossing device
that has handles similar to numchucks with adisposable end for flossing upon it that easily
slips under the archwire (Figures 4 and 5).

Figure 2.

Adjuncts
Figure 4.

Flossing
Explaining how to floss using a floss threader
is quite easy. Demonstrating the use of thethreader on an anterior tooth is not too
difficult. But, try to get in between the molars
with the threader. Now, this is a challenge,
especially if you are trying to perform this on
your own mouth. This explanation gives someinsight into the daily trials of an orthodontic
patient. There have been floss handles andfloss picks out on the market for years to help
non-orthodontic patients floss and reach theposterior teeth. And, finally there have beensome newer products released in the market forthe orthodontic patient to use to make flossing

Figure 5.

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Figure 6.

Figure 7.

Oral Irrigation
When cleaning out the buccal tube, a thinproxabrush can be used to reach this area. Thisis one example of repurposing an oral hygiene
adjunct for a use contrary to its original intent.
The buccal tube is fairly large and tends toharbor food, so the use of an oral irrigator inthis area is highly recommended. The pulsing
pressure of water can also be very therapeutic
for tissues by stimulating circulation anddecreasing inflammation. Studies have shown
significant reductions of plaque and bleeding inorthodontic patients after 4 weeks of use.11

alternative. Complete plaque removal cannot
be accomplished with toothbrushing alone. It
is recommended to utilize interdental brushes
or monotufted brush heads.12 Using this tool
to assist in reaching around brackets and in
between the teeth and archwire is useful inplaque removal. However, using the brush for
its original purpose is helpful to stimulate thegums interdentally. End tuft toothbrushes canalso be used for this purpose although they are
typically larger in diameter (Figure 7).

Rubber Tip Stimulation
Recalling the properties of healthy tissue, a
few terms should come to mind. Such as pink,knife-edged, and stippled. When interdental
tissue is bulbous, it is necessary to stimulate
the tissue to increase circulation and tighten
up the tissue. The rubber tip stimulator is agreat tool to succeed in performing this task.
When placing the rubber tip stimulator into
the interdental area, it is important to havethe tip near the edge of the tissue and theproximal portion against the tissue. Imagine
how the knife-edged tissue should look andlay the rubber tip parallel to the tissue to allow
for blanching of the tissue when pressure isapplied (Figure 6).

Probiotics
People frequently say they wish they could
just take a pill to fix something. The useof probiotics has become more popular inincreasing the supportive bacteria, while
decreasing the harmful bacteria. Probiotics
are live microorganisms, which are believed
to be beneficial to the host in a symbiotic
relationship that tends to identify withcommensalism. Specific probiotic bacteria
can assist in areas of dental caries prevention
rather than the prevention of periodontal
disease. For instance, studies have shown
increasing the levels of Lactobacillus paracasei
can inhibit the growth of Streptococcus mutans,which is responsible for dental caries. This
process usually occurs after two weeks ofroutinely taking the probiotic designated forthis purpose.13

Products

Sulcular & Interproximal Brushes
In order to reach into tight areas, one would
need a smaller head of bristles. The sulcular
toothbrush’s original purpose was to brushthe sulcular areas of the teeth. However,repurposing the brush because of its size
to reach in smaller areas is an excellent

When it comes to probiotic use for theprevention of periodontal disease, it becomes
more complicated due to the different bacteriathat attach to bone versus the soft tissues.

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For simplification in regards to orthodontic
treatment and an increased probability ofdeveloping gingivitis, lets focus on the presenceof Streptococcus oralis and Streptococcus uberis.
If these bacteria are present, it indicates good
periodontal health.14 While the use of probiotics
is fairly new in the dental arena, the idea ofutilizing them in situations where patients are
at greater risk for dental disease is a great
concept.

understanding the crystalline structure iscomprised of hydroxyapatite and fluorapatite
crystals, helps one to appreciate the strengthand beauty of this structure. Fluorapatite ismore structurally and chemically sound thanhydroxyapatite making it more resistant todecay.16 Knowing this piece of information
naturally motivates us to recommend the useof fluoride.
Utilizing fluoride varnishes for the orthodontic
patient is beneficial for a variety of reasons.
Fluoride varnishes are considered easy to
use and safe as well as having substantivity.
Varnish was first available in Europe in 1960,
and did not receive FDA approval in the UnitedStates until the late 1990’s. This approval was
originally for sensitivity in adults; although a
lot of recent data has shown it more effective
than older technologies in decay prevention.17
One of the wonderful benefits of fluoride
varnish is its ability to have a longer contact
time with the tooth due to its varnish effect.
It has been discovered a high level of fluoride
is released from fluoride varnishes during thefirst 24 hours after application.18 Several typesof orthodontic cements are glass ionomer
based and have the ability to release fluoride
into the enamel. It is important to have fluoride
applied to these areas to recharge the cement
providing continual fluoride release in areas
more prone to decay at the parameters oforthodontic brackets and bands. Obviously,
providing a more flowable varnish is ideal.
There are liquid varnishes available to provide
flowability in these caries susceptible areas.

Xylitol
Xylitol is a five-carbon sugar alcohol
sweetener found in the fibers of many fruits
and vegetables as well as cornhusks andbirch. Use of xylitol products have shown todecrease cariogenic Streptococcus levels while
not affecting beneficial oral Streptococcus
bacterial levels.15 As we know, the Streptococcus
species responsible for the caries process is
Streptococcus mutans. This bacteria has theability to create an acidic environment aidingin the decalcification of enamel. While theenamel becomes weakened, the Lactobacillus
proliferate and lead the caries process within
the lesion development. Xylitol is available inchewing gum, mints, candies, and granulatedsugar substitute form. While all of the forms
are beneficial, patients in active treatment
should avoid chewing gum to prevent
loosening brackets and bands.
Remineralization
There is a plethora of products available toremineralize enamel. It is important to realize
the challenges orthodontic patients face withplaque removal while understanding the goalsof Streptococcus mutans and Lactobacillus
paracasei that destroy enamel, so appropriate
measures can be taken to locate demineralized
areas and recommend appropriate therapies
to remineralize them.

The apatite compound contains calcium
and phosphate. Therefore, replacing thesechemicals will assist in the process ofremineralization and rebuild the apatite
crystalline structure. Some remineralization
products contain a combination of fluoride withcalcium phosphate and have been found to besignificantly more effective in remineralization
than fluoride alone. In one particular study
the remineralization depth of 1150 ppm F
dentifrice was comparable to 500 ppm F
plus functional tricalcium phosphate (fTCP)
dentifrice. Respectively, the amount of fluoride
was less, but with the addition of the fTCP, theremineralization depth was the same.19

Fluoride
The use of fluoride in caries prevention has
been studied for over 100 years. Its safety andefficacy has been studied extensively over thistime period, and water fluoridation becameroutine in many cities to reduce cavities. There
have been a lot of studies and discussions
on the use of fluoride for remineralization.
When looking at the structure of enamel and9
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Comparative studies of acidulated phosphatefluoride (APF) oral rinses and neutral sodium
fluoride in orthodontic patients with fixed
appliances have proven that the APF oral rinse
was more effective in reducing gingivitis andpreventing white spot lesions over a six-month
period. Therefore, it can be concluded that
adding an oral rinse to the prevention regimen
for the orthodontic patient would be beneficial
in maintaining oral health.20

an evaluation of the patient’s understandingof the home care instructions. For younger
patients, it is best to get the parents involved.
Be sure to provide home care instructions foreach of the products recommended to thepatient. It is helpful to show the patient where
the directions are located on the packaging
and to explain the directions step-by-step toavoid any confusion. Thorough researching
and understanding of the product’s
effectiveness will make you more comfortablemaking recommendations to patients; also,
you will be looked upon as “an expert in thefield” by the patient.

Calcium Phosphate
There are many pastes available containing
calcium phosphate and it is up to the dental
professional to recommend the appropriate
one. The decision may depend upon
application method, frequency, or taste. Some
calcium phosphate pastes are considered
all-in-one toothpastes while others are tooth
creams to be used very sparingly. There area few that do not contain fluoride and somethat contain fluoride within the formulation.
They can be applied using a tray method or
as easy as using one of your fingers to apply it
onto the teeth. Considering all of these factors
and the patient’s preference will forecast
compliance. It is important for the dental
professional to always try products before
making recommendations. This will help makethe recommendation more valid from firsthand use.

Evaluation of Success

An opportunity for evaluation of success exists
every time a patient is seen in the operatory.
This achievement cannot lie within the patientalone, but is also an assessment of the dental
professionals teaching skills. One cannot
make someone perform a task they do notwant to do. A key component to success lies
within the manner the patient is educated bycreating desire to complete a task through theunderstanding of consequences.

Conclusion

Orthodontic patients face a difficult challenge
in adequate plaque removal to prevent
dental caries and periodontal disease.
The dental professional can assist in theprevention of disease through education,
demonstration, and a better understanding oforthodontic needs. The more knowledge about
orthodontics the dental professional can apply
to treatment and homecare recommendations,the better chance the patient has in attaining
a beautiful smile free of unnecessary dental
caries and gum disease manifested from lackof satisfactory plaque removal.

Educating the Patient

When educating the patient on home caretechniques, it is best to perform the “showand tell” method. Studies have provenbetter plaque removal when the patient
received supervised home care instructions
versus giving the patient the tools with no
explanation.21 When a technique is shownwithin the patient’s mouth, a hand mirror
should be provided for the patient to watch
the dental professional’s demonstration. The
dental professional should explain how toposition the toothbrush or adjunct and why
it needs to be in this particular position. The
patient should then perform the techniquewhile the dental professional checks andcorrects, if needed. This method is used as

By making educated decisions regarding homecare recommendations through the knowledgeof the variety of toothbrushes, adjuncts, andproducts, the dental professional can makethe difference in the orthodontic patient’s
achievement of optimal oral health.

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Course Test Preview

To receive Continuing Education credit for this course, you must complete the online test. Please
go to: www.dentalcare.com/en-us/ce-courses/ce413/test
1. Fixed orthodontic appliances _______________.
A. allows easy access for plaque removal
B. may be functional in nature through using orofacial muscles to add force for movement
C. are only used in order to prevent relapse
D. will not assist in compliance of wear time
2. Biofilm is _______________.
A. matrix of microbial societies, which communicate with one anotherB. an orthodontic radiograph
C. a functional appliance that is cemented in the patient’s mouth
D. used on brackets to prevent injury to the soft tissues
3. In the Cochrane Study, orthodontic patients had ______% reduction of gingivitis after 3
months of power toothbrush usage as compared to manual toothbrushing.
A. 6
B. 17
C. 11
D. 50
4. _______________ are living microorganisms used in dentistry to help decrease incidences ofdental caries and periodontal disease.
A. Fluoride lozenges
B. Chemotherapeutics
C. Probiotics
D. Ligatures
5. Fluorapatite is considered _______________ as compared to hydroxyapatite.
A. higher in calcium ionsB. higher in phosphate
C. a stronger bonding agent
D. more structurally and chemically sound
6. Streptococcus mutans assists Lactobacillus in the caries process by _______________.
A. increasing an acidic environment causing demineralization allowing easier penetration
B. creating a by-product to feed and energize it
C. eliminating competing bacteria
D. facilitating the amount of plaque present
7. The presence of _______________ demonstrates good periodontal health.
A. Lactobacillus paracasei
B. Streptococcus mutans
C. Lactobacillus rhamnosus
D. Streptococcus oralis
8. Xylitol is _______________.
A. only present within a tropical fruit found in the rain forests of the Amazon
B. used to kill all streptococcus bacteria
C. present in all toothpastes
D. a product used to prevent caries
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9. _______________ was originally approved by the FDA for sensitivity use.
A. Xylitol
B. Probiotics
C. Fluoride varnish
D. Chemotherapeutics
10. _______________ is used as an orthodontic cement having the ability to release fluoride.
A. Varnish
B. Xylitol
C. Glass ionomer
D. IRM
11. A functional appliance is one that utilizes jaw movement and muscle action to produce___________________.
A. a higher flow of saliva to prevent decay
B. an outcome that does not require any retention
C. selection force on the teeth and jaws
D. additional room in the jaw to eliminate 3rd molar removal
12. A five-carbon sweetener that is considered a sugar alcohol is _______________.
A. Sucrose
B. sorbitol
C. xylitol
D. fructose
13. _______________ has shown to decrease the amount of fluoride needed in theremineralization process.
A. Tricalcium phosphate
B. Streptococcus uberis
C. Xylitol
D. Triclosan
14. A ligature is _______________.
A. used to tie the wire to the bracket
B. an orthodontic appliance
C. used to help improve pronunciation in orthodontic patientsD. another term for archwire
15. Oral irrigation has shown significant reductions in plaque and bleeding in as little as______ weeks of use.
A. 2
B. 6
C. 4
D. 8

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References

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20. Pilli, Lakshmi Narayana, Singaraju, Gowri Sanlar, Nettim, Venkatesh, et al. An Extensive
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Additional Resources•

No Additional Resources Available.

About the Author
Constance Mergener, RDH, BS
Constance Konen received her Associates in Applied Science – Dental Hygiene
from Milwaukee Area Technical College and Bachelor of Science degree inBiomedical Science from Marquette University. She studied Orofacial Myology
in Los Angeles, CA and completed her internship in Pacific Palisades, CA. She
is a Director of Field Operations for Affordable Care LLC. She has experiencein dental assisting, dental hygiene, field operations management, and dental
benefit administration. She has worked not only in general dentistry, butalso orthodontics, pedodontics, prosthodontics, and periodontics. Constanceis a published author with several articles in print within professional dental journals. She haspresented countless programs relating to new technologies in dentistry and increasing revenue inthe practice. Her passion for dentistry and leadership skills continue to grow through mentoringand networking with other dental professionals.
Email: constancerdh01@gmail.com

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