Gingivitis in patients treated with fixed orthodontic appliances – literature review

Gingivitis associated with dental bacterial biofilm is one of the most common diseases of the oral cavity, and when untreated, it may lead to periodontitis. Patients receiving orthodontic treatment are especially at risk of periodontitis.

Aim
The aim of the paper is to discuss gingivitis occurring in patients treated with orthodontic appliances, its prevalence, etiopathogenesis, symptoms, clinical significance, potential complications and therapeutic management.

Material and methods
The publications from the orthodontic and periodontal literature from the years 2010-2021 containing observations of changes in the periodontal tissues during orthodontic tooth movement were selected for this review.

Results
After a fixed orthodontic appliance is placed, there is an increase in periopathogens in the patient's mouth due to the accumulation of dental biofilm and difficulties in maintaining proper hygiene. This can lead to an increase in the number of supra- and subgingival bacteria and a shift of the flora towards more pathogenic bacterial strains. The prolonged presence of periopathogens in the gingival margin induces an inflammatory response. As a consequence, gingivitis occurs, which is manifested by reddening of the marginal gingiva, swelling and enlargement of the interdental papillae, and gingival bleeding.

Conclusions
Persistent gingivitis during orthodontic treatment may lead to complications such as periodontitis, and may compromise the stability of the treatment results and even cause orthodontic treatment failure. Patients with fixed orthodontic appliances are at greater risk of periodontal tissue deterioration during orthodontic treatment than patients using removable appliances. Appropriate therapeutic management consisting in limiting the number of pathogenic bacteria allows to keep the periodontium in good condition and prevents complications after an orthodontic intervention.