985H
Fig. 14.31 (a) Neglected fixed appliance
with associated gingival inflammation
and decalcification. (b) The
decalcification is obvious following
bracket removal.14.8.2 Orthodontics and periodontal health
Fixed appliances
Gingival inflammation is a frequent complication of fixed appliances (986HFig. 14.31), and
the patient must be encouraged to maintain good oral hygiene. They must recognize
that it takes longer to clean the teeth with fixed appliances than without. A standard
toothbrush with a fairly small two- or three-row head is suitable in most cases, or
special orthodontic brushes are available with a groove which is intended to facilitate
cleaning behind the archwire. Some patients find interspace brushes helpful,
especially for local problem areas.
Marginal gingival inflammation resolves when the brackets and bands are removed,
and there is no evidence that orthodontic treatment causes clinically significant long-
term damage to the periodontium (987HChapter 11). However, excessive arch expansion or
proclination of teeth, especially the lower incisors, should be avoided as there is a risk
of fenestration of the buccal alveolar bone or even gingival clefting.
Removable appliances
Mild palatal marginal gingivitis is quite common under removable appliances, but
resolves at the end of treatment. Good oral and appliance hygiene is very important.
The patient should take the appliance out to brush it and to clean the teeth at least
twice a day, and to rinse it after meals. More widespread candidal infection
occasionally occurs under the acrylic, but usually resolves if the patient wears the