ZhodnocenõÂ uâ stnõâ hygieny ortodontickyâ ch pacientuê Evaluation of oral hygiene in orthodontic patients

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1 ORTODONCIE rocïnõâk19 Zhodnocenõ uâ stnõâ hygieny ortodontickyâ ch pacientuê Evaluation of oral hygiene in orthodontic patients *MUC. Martina RÏ õâmskaâ, **MUDr. Dagmar MalotovaÂ, ***doc. MUDr. KveÏ toslava Nova kovaâ, CSc., *doc. MUDr. MilosÏ SÏ pidlen, Ph.D. * Ortodonticke oddeï lenõâ Kliniky zubnõâho leâ karïstvõâ, LF UP Olomouc, **LaboratorÏ klinickeâ mikrobiologie, SÏ ternberk, ***DeÏ tskeâ oddeï lenõâ Kliniky zubnõâho leâ karïstvõâ, LF UP Olomouc *Department of Orthodontics, Clinic of Dental Medicine, Medical Faculty, Palacky University, Olomouc ** Laboratory of Clinical Microbiology, SÏ ternberk ***Pedodontic Department, Clinic of Dental Medicine, Medical Faculty, Palacky University, Olomouc Souhrn Ortodonticka leâ cï ba fixnõâm aparaâ tem umozïnï uje pacientovi funkcï nõâ i estetickeâ zlepsï enõâ stavu chrupu, ale jejõâ pruêbeï h a vyâ sledek muê zï e byâ t negativneï ovlivneï n nedodrzï ovaâ nõâm dostatecï neâ uâ stnõâ hygieny. Tato studie je zameïrïena na sledovaâ nõâ a hodnocenõâ uâ stnõâ hygieny pacientuê s fixnõâmi aparaâ ty a na srovnaâ nõâ zjisï teï nyâ ch vyâ sledkuê s kontrolnõâ skupinou pacientuê bez fixnõâho aparaâ tu. Zvy sledkuê praâ ce vyplyâvaâ,zïe nosï enõâ fixnõâch aparaâtuê zteïzïuje provaâdeï nõâ kvalitnõâ uâ stnõâ hygieny. Byla zjisïteï na vysïsïõâ kumulace plaku, prïedevsï õâm na vestibulaâ rnõâch plosïkaâ ch zubuê, zvyâsï enaâ krvaâ civost daâ snõâ, a takeâ vysïsï õâ pruêmeï rneâ hodnoty plakoveâ ho indexu. Sledovana kvantita Streptococcus mutans a Lactobacilus species ve stimulovaneâ slineï vsï ak neukaâ zala veïtsïõâ rozdõâly u obou skupin. Lze proto usuzovat, zï e ortodontickaâ leâ cï ba fixnõâm aparaâ tem nemaâ prïõâmyâ vliv na kazivost chrupu (Ortodoncie 2010, 19, cï. 1, s ). Abstract Orthodontic treatment with fixed appliance results in the improved function and esthetics of dentition. However, the course and results of the treatment may be negatively affected by the lack of oral hygiene. Our study focuses on evaluation of oral hygiene in patients with fixed orthodontic appliances. The data obtained are compared with those found in the control group of patients without fixed appliances. The results suggest that fixed appliances make oral hygiene rather difficult. There is a higher accumulation of plaque (especially on vestibular surfaces of teeth), increased papilla bleeding, and higher mean values of plaque index. Nevertheless, there were found no greater differences in the quantity of Streptococcus mutans and Lactobacillus species in stimulated saliva in both groups. Therefore, we may conclude that the orthodontic treatment with fixed orthodontic appliance does not directly influence tooth decay (Ortodoncie 2010, 19, No. 1, p ). KlõÂcÏ ovaâ slova: fixnõâ ortodontickyâ aparaât, uâ stnõâ hygiena, indexy PI, PBI, CPITN, Streptococcus mutans, Lactobacilus species Key words: fixed orthodontic appliance, oral hygiene, PI, PBI, CPITN, Streptococcus mutans, Lactobacillus species

2 rocïnõâk19 ORTODONCIE U vod U stnõâ hygiena je neodmyslitelnou soucï aâ stõâ leâ cï by fixnõâmiortodontickyâ miaparaâ ty. U pacientuê sï kolnõâho veï ku, dospõâvajõâcõâch, cï idospeï lyâch vzï dy vznikaâ nasazenõâm fixnõâch aparaâtuê stejneâ riziko. TõÂm je vznik mnoha novyâ ch retencï nõâch mõâst pro zubnõâ plak (ortodontickeâ krouzï ky, zaâ mky, oblouky, ligatury, pruzï inky apod.) [1, 2, 3]. UlpõÂvajõÂcõ plak je nebezpecï nyâ prïedevsï õâm tõâm, zïe se v neï m nachaâ zejõâ cï etneâ patogennõâ mikroorganismy. V dutineï uâ stnõâ bylo nalezeno võâce nezï 300 druhuê bakteriõâ [4]. Za nejvõâce patogennõâ z hlediska kariogenity jsou povazï ovaâ ny prïedevsï õâm Streptococcus mutans a Lactobacilus species [2, 5, 6]. U Streptococcus mutans je spojitost se vznikem kazu daâna prïedevsï õâm jeho vyâ jimecï nou metabolickou aktivitou v plaku, tj. schopnostõâ tvorïit kyseliny i prïiph 5,0-5,2 a tõâm ph daâ le snizïovat a prohlubovat demineralizaci [7]. Plak je nutneâ pravidelneï a co nejleâ pe mechanicky odstranï ovat. To je duê lezïiteâ jak z hlediska prevence posï kozenõâ zubnõâch tkaâ nõâ v pruêbeïhuleâcï by, tak ipro dosazï enõâ co nejlepsï õâch vyâ sledkuê po jejõâm skoncï enõâ [5, 8]. PruÊmeÏ rnaâ deâ lka leâcï by fixnõâm aparaâ tem je asi18 meïsõâcuê. V tomto obdobõâ nelze cï asto vznik kazu prokaâ zat. SnõÂmek bitewing je prïileâ cï beï teï zï ko zhotovitelnyâ a ne vzï dy pruê kaznyâ. Je nezbytneâ, aby pacient spraâ vneï ovlaâdal techniky cïisïteïnõâ.jetrïeba vyzdvihnout potrïebu hygienickyâch instruktaâzïõâ a to jizï prïed zapocï etõâm leâcï by. Po spraâ vneâm naâ cviku se staâvaâ pacient zrucïneïjsï õâ a je prïipraven na to, aby sisnadneï jiosvojil noveâ zmeï ny techniky cï i sïteï nõâ spojeneâ se zmeï namiv dutineï uâ stnõâ po nasazenõâ aparaâ tu. Pokud pacient nedodrzï uje hygienickaâ doporucï enõâ, je nejcï asteï jsï õâm projevem jeho nespraâ vneâho prïõâstupu demineralizace skloviny, v podobeï mleâ cï nyâ ch skvrn azï rozsaâ hlyâ ch defektuê, a hyperplastickaâ gingivitis (Obr. 1) [6, 7, 11]. Je snahou ortodontistuê, aby bylipacientina leâcïbu prïedem prïipraveni. Z hlediska motivace pacientuê je lze deï li t do trïõâ skupin na lehce motivovatelneâ, na pacienty vyzï adujõâcõâ intenzivneï jsï õâ uâ silõâ prïi jejich motivaci a na skupinu, u ktereâ se i prïes velkou snahu nepodarïõâ hygienu zlepsï it [4]. ZlepsÏ enõâ lze dosaâ hnout opakovanyâ mi a duê slednyâ mikontrolami, raâ mcovyâ m vysveï tlenõâm vzniku kazu, gingivitid cï i parodontitid a naâ zornyâ miinstruktaâ zï emi hygieny dutiny uâ stnõâ prïed zapocï etõâm leâ cï by iv jejõâm pruêbeï hu. TõÂm se vyârazneï snizïuje riziko vzniku naâ slednyâ ch komplikacõâ. Tato studie je zameï rïena na sledovaâ nõâ a hodnocenõâ uâ stnõâ hygieny pacientuê s fixnõâmi aparaâ ty a na srovnaânõâ zjisï teï nyâ ch vyâ sledkuê s kontrolnõâ skupinou pacientuê bez fixnõâho aparaâ tu. Introduction Oral hygiene is an inseparable component part of the treatment with fixed orthodontic appliance. In patients of school age, adolescents, and adults there is the same risk arising from the use of fixed appliance - creation of new retention areas for plaque formation (orthodontic bands, brackets, arches, ligatures, springs, etc.) [1, 2, 3]. The accumulated plaque contains a number of pathogenic microorganisms. More than 300 different bacteria were found in oral cavity [4]. Streptococcus mutans and Lactobacillus species are amongst the most pathogenic ones [2, 5, 6]. Streptococcus mutans is very active in plaque, i.e. able to form acids even at ph values The ph value is further reduced, demineralization increased and thus Streptococcus mutans is the leading cause of tooth decay [7]. It is necessary to remove plaque regularly, especially mechanically. This prevents the damage to dentition tissues during the treatment, and leads to favorable results [5, 8]. The treatment with fixed appliance takes 18 months, on average. During the time it is often impossible to identify caries formation. Bitewing shot is virtually impossible to take and not always evidential. The patient should be instructed in toothbrush techniques well before the beginning of the treatment. The patients are then prepared to learn new toothbrush techniques related to changes in the oral cavity after the application of fixed appliance. One of the symptoms of poor oral hygiene is enamel demineralization manifesting itself by white spots or larger defects, and hyperplastic gingivitis (Fig.1) [6, 7, 11]. Patients should be prepared for the treatment well before. They may be divided into three groups - patients well motivated, patients requiring more attention and motivation, and patients with poor oral hygiene [4]. Obr. 1: Na sledek nedodrzï ovaâ nõâ rïaâ dneâ uâ stnõâ hygieny vedoucõâ k hyperplastickeâ gingivitideï (obraâ zek laskavostõâ MUDr. J. Rohela). Fig. 1: Lack of oral hygiene - hyperplastic gingivitis (picture thanks to MUDr. J. Rohel)

3 ORTODONCIE rocïnõâk19 Materia l a metodika Soubor tvorïilo 100 pacientuê leâ cï enyâ ch na Klinice zubnõâho leâ karïstvõâ LF UP v Olomouci. PruÊ meï rnyâ veï k souboru byl 15,0 let v rozmezõâ let. Pacienti byli rozdeï lenina dveï skupiny. Ve skupineï A bylo 50 pacientuê leâ cï enyâ ch fixnõâm ortodontickyâ m aparaâ tem, ve skupineï B bylo 50 pacientuê bez ortodontickeâholeâcï enõâ. U obou skupin byla sledovaâ na kvalita jejich uâ stnõâ hygieny pomocõâ indexuê PI (Plaque Index), PBI (Papilla Bleeding Index) a CPITN (Community Index of Periodontal Treatment Need) [6] a sklon k tvorbeï kariesnõâch leâzõâ.daâ le byl proveden odbeï r slin a laboratornõâ rozbor na zjisï teï nõâ mnozï stvõâ Streptococcus mutans pomocõâ testu s bacitracinem a Lactobacilus species pomocõâ testu Dentocult LB [9]. SrovnaÂnõ uâ stnõâ hygieny pomocõâ indexuê PI, PBI a CPITN u obou skupin a srovnaâ nõâ kvantity vyâskytu bakteriõâ Streptococcus mutans a Lactobacilus species bylo provedeno oboustrannyâ m dvouvyâ beï rovyâ m t-testem. Vy sledky Hodnoty PBI Krva civost daâ snõâ (index PBI) võâce nezï 50 % se u pacientuê bez leâ cï by se teâ meï rï nevyskytuje, vyâ skyt indexu PBI nad 50 % je u pacientuê s fixnõâm aparaâ tem vysokyâ (Obr. 2). Za kladnõâ charakteristiky obou skupin se nachaâ zõâ v Tab. 1. Ve vysï etrïovaneâ skupineï pacientuê s fixnõâmi aparaâ ty byla pruê meï rnaâ hodnota krvaâ civosti daâ snõâ (PBI) 48 ± 29 % s minimaâ lnõâ nameïrïenou hodnotou 0 % a maximaâ lnõâ hodnotou 100 %. Media n byl 46 % U pacientuê bez fixnõâch aparaâtuê byla pruê meï rnaâ hodnota indexu 18 ± 16 %, minimaâ lnõâ hodnota 0 % a maximaâ lnõâ hodnota 81 %, mediaâ n 14 %. U hodnot indexu PBI byl nalezen statisticky vysoce vyâ znamnyâ rozdõâl (p < 0,001) meziobeï ma sledovanyâ mi skupinami pacientuê. Media n krvaâ civosti daâ snõâ je u leâcï enyâch pacientuê asi3x vysïsïõâ nezï u pacientuê bez aparaâtuê. Repeated and thorough check-ups, explanation of caries or gingivitis formation, and instructions in oral hygiene may improve the situation. Appropriate oral hygiene reduces the risk of further complications. The study focuses on the evaluation of oral hygiene in patients with fixed appliances. The results were compared with the condition in the control group of patients without fixed appliance. Material and methods The sample included 100 patients of Clinic of Dental Medicine, Medical Faculty of Palacky University in Olomouc. The mean age was 15.0 years, the range years. The patients were divided into two groups. Group A included 50 patients treated with fixed appliance, Group B included 50 patients without orthodontic therapy. In both groups the quality of oral hygiene was monitored, with the help of PI (Plaque Index), PBI (Papilla Bleeding Index), and CPITN (Community Index of Periodontal Treatment Need) [6]. Caries lesions formation was also observed. We took a sample of saliva; the sample then underwent the laboratory analysis for the amount of Streptococcus mutans (bacitracine test), and Lactobacillus species (Dentocult LB test) [9]. The comparison of the data of both groups was performed with t-test. Results PBI values Papilla bleeding (PBI) of more than 50% does not appear in patients without orthodontic treatment; PBI over 50% exists in patients treated with fixed appliance (Fig. 2). Table 1 gives characteristics of both groups. In the group of patients with fixed appliances the mean value of PBI was 48 ± 29%, the minimum value 0%, the maximum one 100%. Median 46%. In patients without fixed appliance the mean value of PBI was 18 ± 16%, the Frequency to to to to to to to to to to 100 PBI mean % fixed appliance without appliance Obr. 2: CÏ etnost vyâskytu hodnot PBI u 50 pacientuê s fixnõâm aparaâ tem a 50 pacientuê bez aparaâtu Fig. 2: Number of PBI values in 50 patients with fixed appliance and in 50 patients of the control group Tabulka 1: Index PBI u pacientuê s fixnõâm aparaâtem a pacientuê bez aparaâtu Table 1: Index PBI in patients with fixed appliance and in the control group Fixed appliance Control group Mean 48 % 18 % Median 46 % 14 % SD 29 % 16 % Minimum 0 % 0 % Maximum 100 % 81 % Number Mean - aritmetickyâ pruêmeï r. SD - standard deviation, smeï rodatnaâ odchylka. Number - pocïet

4 rocïnõâk19 ORTODONCIE Frequency CPITN 2 fixed appliance without appliance 3 Tabulka 2: Index CPITN u pacientuê s fixnõâm aparaâ tem a pacientuê bez aparaâtu Table 2: Index CPITN in patients with fixed appliance and in the control group Fixed appliance Control group Mean Median SD Minimum Maximum Number Mean - aritmetickyâ pruêmeï r. SD - standard deviation, smeï rodatnaâ odchylka. Number - pocïet Obr. 3: CÏ etnost vyâskytu nejvysïsï õâch hodnot CPITN u 50 pacientuê s fixnõâm aparaâ tem a 50 pacientuê bez aparaâtu Fig. 3: Number of the highest CPITN values in 50 patients with fixed appliance and in 50 patients of the control group Hodnoty CPITN CÏ etnost vyâskytu nejvysïsï õâch hodnot CPITN u 50 pacientuê s fixnõâm aparaâ tem a 50 pacientuê bez aparaâtuje na Obr. 3. Graf ukazuje mnozïstvõâ pacientuê, u kteryâch byla minimaâ lneï v jednom sextantu chrupu nalezena ta hodnota, u nõâzï jsou zapocï teni, jako nejvysïsï õâ nalezenaâ.u zïaâ dneâ ho pacienta (s leâcï bou, cï ibez leâcï by) nebyla nalezena hodnota 4 (parodontaâ lnõâ chobot nad 3,5 mm). Za kladnõâ charakteristiky obou skupin se nachaâ zõâ v Tab. 2. Ve skupineï pacientuê s fixnõâm aparaâ tem byla zjisïteï na pruêmeï rnaâ hodnota CPITN 0,8 ± 0,4 a u skupiny pacientuê bez aparaâ tu pruêmeï rnaâ hodnota CPITN 0,4 ± 0,4. Media n skupiny pacientuê s aparaâ ty je võâce nezï 3x vysï sï õâ (dosahuje hodnoty 1, tj. krvaâ cenõâ parodontu). U hodnot indexu CPITN byl nalezen statisticky vysoce vyâznamnyâ rozdõâl (p < 0,001) meziobeï ma sledovanyâmi skupinami pacientuê. Hodnoty PI U plakoveâ ho indexu (Obr. 4 a Obr. 5, Tab. 3 a Tab. 4) bylo k hodnocenõâ sledovanyâch zubuê (16, 21, 24, 36, 41, 44) vypocï õâtaâ no procentuaâ lnõâ zastoupenõâ v kazïdeâ skupineï zvlaâ sï t' a poteâ dohromady s nalezenõâm vyâ znamnyâch rozdõâluê u zubuê 24(p< 0,001), 36 (p < 0,05), a 44 (p < 0,05). RozdõÂl pruêmeï rnyâch hodnot PI byl na hranici vyâ znamnosti(p < 0,05). U PI s hodnotaminameï rïenyâ mi vestibulaâ rneï mezi skupinami byl rozdõâl statisticky vyâznamnyâ (p < 0,01), oraâ lneï byl rozdõâl takeâ statisticky vyâznamnyâ (p < 0,05). MeziobeÏ ma plosï kamibyl vyâ raznyâ rozdõâl ve skupineï pacientuê bez fixnõâch aparaâtuê u vsï ech sledovanyâ ch zubuê kromeï rïezaâ ku 21. U pacientuê s fixnõâm aparaâ tem byl rozdõâl meziobeï ma plosï kamiu zubuê 36 (p < 0,01), 41 (p < 0,01) a 44 (p < 0,001). U deï tõâ bez ortodontickeâ leâ cï by je vyâ razneï veï tsï õâ kumulace plaku na oraâ lnõâch plosï kaâ ch ve srovnaâ nõâ s plosï kamivestibulaâ rnõâmi(p < 0,001). minimum value 0%, the maximum 81%; median 14%. In the values of PBI, the statistically significant difference (p < 0.001) was found between the two groups. In patients treated with fixed appliance median is 3 times higher than in patients without the appliance. CPITN values The diagram shows the number of patients with the highest values found at least in one dentition sextant (Fig. 3). No patient had 4 (i.e. periodontal pocket over 3.5 mm). Table 2 shows the basic characteristic features of both groups. The mean value of CPITN 0.8 ± 0.4 was found in the group of patients with fixed appliance; the mean value of CPITN 0.4 ± 0.4 was recorded in the group of patients without fixed appliance. Median is more than thrice of the value in the group of patients with fixed appliance (the value is 1, i.e. periodontal bleeding). The statistically significant difference (p 0.001) of CPITN values was found. PI values For establishing the plaque index (Fig.4, 5, Table 3, 4) of the teeth monitored (16, 21, 24, 36, 41, 44) the proportion was calculated for each group separately, and then for both groups. The significant differences were found in teeth 24 (p < 0.001), 36 (p < 0.05), and 44 (p < 0.05). The difference of mean values of PI was on the level of significance (p 0.05). In PI values measured vestibularly there was the statistically significant difference between the groups (p < 0.01), as well as orally (p 0.05). There was a significant difference between the two surfaces in the group of patients without fixed appliance in all teeth with the exception of incisor 21. The difference between the two surfaces in the group of patients with fixed appliance was the following: 36 (p < 0.01), 41 (p < 0.01), and 44 (p < 0.001). Significantly larger accumulation of

5 ORTODONCIE rocïnõâk19 1,40 1,40 1,20 vestibular 1,20 vestibular oral 1,00 oral 1,00 Plaque Index 0,80 0,60 0,40 Plaque Index 0,80 0,60 0,40 0,20 0,20 0, , Teeth Teeth Obr. 4: Index plaku u pacientuê bez fixnõâch aparaâtuê Fig. 4: PI in patients without fixed appliance Tabulka 3: Index plaku u pacientuê bez fixnõâch aparaâtuê Table 3: PI in patients with fixed appliance Tooth Vestibular Oral Obr. 5: Index plaku u pacientuê s fixnõâmi aparaâty Fig. 5: PI in patients with fixed appliance Tabulka 4: Index plaku u pacientuê s fixnõâmi aparaâty Table 4: PI in the control group Tooth Vestibular Oral MnozÏ stvõâ Streptococcus mutans a Lactobacilus species ve slineï nebylo mezi skupinami signifikantneï rozdõâlneâ. U pacientuê s aparaâ ty je ve slinaâchveïtsï õâ pocïet streptokokuê, avsï ak nalezenyâ rozdõâl nebyl tak vyâ raznyâ, aby byla nalezena statistickaâ vyâznamnost. Diskuse PrÏiporovna vaâ nõâ vyâ slednyâ ch hodnot obou skupin se potvrdilo, zïeudeï tõâ s fixnõâmi aparaâ ty jsou vyârazneï vysïsïõâ hodnoty krvaâ civosti daâ snõâ. StejneÏ vyârazneâ rozdõâly byly zjisïteï ny iu pruêmeï rnyâch hodnot indexu CPITN. Pro porovnaâ nõâ hygieny v nejveïtsïõâmõârïe prïispeïlomeïrïenõâ plak indexu (PI). Vy razneâ rozdõâly byly zjisï teï ny u zubuê 24, 36 a 44 s nizïsï õâmihodnotamiu skupiny bez aparaâtuê. Da le byla porovnaâ na kumulace plaku na vestibulaâ r- nõâch plosï kaâ ch meï rïenyâ ch zubuê mezi skupinami. U skupiny pacientuê s fixnõâmi aparaâ ty byla prïõâtomnost plaku vyâ razneï vysï sï õâ s vyâ znamnyâ m rozdõâlem. Obdobne vyâsledky, ikdyzï s nizï sï õâ vyâ znamnostõâ, byly iu hodnocenõâ oraâ lnõâch plosï ek zubuê. Hodnoty meziplosï kamizubuê byly porovnaâ ny i v raâ m- cipacientuê kazïdeâ skupiny. Ve skupineï pacientuê s aparaâ ty byly zjisïteïnyvyârazneï vysïsï õâ hodnoty plaku na oraâlnõâch plosïkaâ ch zubuê dolnõâ cï elisti - tedy na zubech 36, 41 a 44. U skupiny bez aparaâtuê byly velkeâ rozdõâly hodnot uvsï ech meïrïenyâch zubuê pouze s vyâjimkou rïezaâ ku 21. Vy znamneâ bylo zjisï teï nõâ,zï e deï tibez ortodontickyâ ch aparaâ tuê majõâ plaku vyâ razneï võâce na oraâ lnõâch plosï kaâ ch zubuê. Sledovana kvantita Streptococcus mutans a Lactobacilus species ve stimulovaneâ slineï vsï ak neukaâ zala veïtsï õâ rozdõâly u obou skupin. Lze se proto se domnõâvat, plaque in oral surfaces was found in children without orthodontic treatment (p < 0.001). The amount of Streptococcus mutans and Lactobacillus species in saliva was virtually the same in both groups. There is a higher number of streptococcus in the saliva of patients treated with fixed appliance; however the difference between the groups is not statistically significant. Discussion When comparing the resulting values of both groups it was proved, that the values of PBI are significantly higher in children treated with fixed appliance. The same differences were found for mean CPITN values, too. For the comparison of hygiene, PI values were the most useful. Significant differences were recorded for teeth 24, 36, and 44; lower values were obtained in the group without fixed appliance. Plaque accumulation on vestibular surfaces of the teeth was also compared. The values were significantly higher in the group with fixed appliance; the difference between the groups was significant. Similar results (however - not so significant) were obtained also for oral surfaces. The values were also compared between the patients within each group. Significantly higher values of PI on oral surface of the teeth 36, 41 and 44 in the mandible, were found in the group treated with fixed appliance. Significant differences in all values of all teeth measured (with the exception of incisor 21) were found in the group of patients without fixed appliance

6 rocïnõâk19 ORTODONCIE zï e ortodontickaâ leâ cï ba nemaâ prïõâmyâ vliv na kazivost chrupu [9,10,11]. Ze zjisï teï nyâ ch skutecï nostõâ vyplyâ vaâ nutnost, aby se pacient aktivneï podõâlel na pruê beï hu leâcï by a snazïil se osvojit si naâ vyky adekvaâ tnõâ uâ stnõâ hygieny, pouzï õâval vhodneâ pomuê cky, prïõâpadneï podstupoval opakovaneâ hygienickeâ instruktaâ zï e. Ze strany osï etrïujõâcõâho zdravotnickeâ ho personaâ lu je nutnaâ duê slednaâ kontrola hygieny avyâbeï r pacientuê, kterïõâ si ji natolik osvojili, zïe mohou zacïõâtsleâcï bou bez obav ze vzniku nezïaâ doucõâch naâ sledkuê. NavõÂc je velkyâ m pozitivem, zï e pacienti se spraâ vneï osvojenyâ mi hygienickyâ mi naâ vyky pokracï ujõâ v peâ cï i o svuê j chrup ipo ukoncï enõâ leâcï by. ZaÂveÏr NosÏ enõâ fixnõâch aparaâ tuê zteï zï uje provaâ deï nõâ kvalitnõâ uâ stnõâ hygieny, cozï vyplynulo ze zjisï teï neâ vysï sï õâ kumulace plaku, prïedevsï õâm na vestibulaâ rnõâch plosï kaâch zubuê, zvyâsï eneâ krvaâ civostõâ daâ snõâ a takeâ vysï sï õâch pruêmeï rnyâch hodnot plakoveâ ho indexu. Z toho mohou vyplyâ vat idalsï õâ rizika v podobeï demineralizacõâ skloviny a hyperplastickeâhozaâneïtudaâ snõâ. Sledovana kvantita Streptococcus mutans a Lactobacilus species ve stimulovaneâ slineï vsï ak neukaâ zala veïtsï õâ rozdõâly u obou skupin. Lze proto usuzovat, zïe ortodontickaâ leâcï ba nemaâ prïõâmyâ vliv na kazivost chrupu. Literatura/References 1. KyralovaÂ, I.: Ora lnõâ hygiena u ortodontickyâ ch pacientuê. Ortodoncie 1996, 5, cï. 2, s TichaÂ, R., TichyÂ, J., BoÈ hmovaâ, H.: U stnõâ hygiena a ortodoncie - jak na to? CÏ es. Stomat. 2007, 107, cï. 3, s TichaÂ, R., BoÈ hmovaâ, H.: Vy znam uâ stnõâ hygieny prïileâ cï beï fixnõâm ortodontickyâ m aparaâ tem. Ortodoncie 2005, 14, cï. 1, s Hendriks, J., Schneller, T.: PatientenfuÈ hrung, Beratung und Motivierung in der Zahnarztpraxis. Berlin: Quintessenz, Ogaard, B., Rolla, G., Arends, J.: Orthodontic appliances and enamel demineralization. Part 1. Lesion development. Amer. J. Orthodont. dentofacial Orthop. 1988, 94, cï. 1, s Ogaard, B., Rolla, G., Arends, J.: Orthodontic appliances and enamel demineralization. Part 2. Prevention and Children without fixed appliance had significantly higher amount of plaque on oral surfaces. There were found virtually no differences between the groups in the amount of Streptococcus mutans and Lactobacillus species in stimulated saliva. Therefore, we may conclude that orthodontic treatment does not directly affect tooth decay [9, 10, 11]. From the above described it clearly follows that a patient has to take an active part during the therapy in terms of adequate oral hygiene, use of appropriate tools, and pass repeated hygienic instructions. Dental professionals should pay close attention to hygiene; patients should be indicated for the treatment only after they learn how to properly take care of their dentition and oral cavity. The patients with correct hygiene skills take care of their dentition even after the therapy is finished. Conclusion The use of fixed orthodontic appliance makes the oral hygiene more difficult (as proved by the values of PI, PB, and CPITN). This may result in other risks, e.g. enamel demineralization, hyperplastic gingivitis. However, there were not significant differences between the groups monitored in the quantity of Streptococcus mutans and Lactobacillus species in stimulated saliva. Therefore, we may conclude that orthodontic treatment does not directly contribute to tooth decay. treatment of lesions. Amer. J. Orthodont. dentofacial Orthop. 1988, 94,, cï. 1, s Kilia n, J. et al.: Prevence ve stomatologii, Praha: GaleÂn, Lovrov, S., Hertrich, K., Hirschfelder, U.: Enamel Demineralization during Fixed Orthodontic Treatment - Incidence and Correlation to Various Oral - hygiene Parameters, J. orofacial Orthop. 2007, 68, s Batoni, G. et al.: Effect of removable orthodontic appliances on oral colonisation by mutans streptococci in children. Eur. J. oral Sci. 2001,109, s Heinrich-Weltzien, R., Kneist, S., Fischer, T.: Je ortodontickaâ leâ cï ba prevencõâ zubnõâho kazu, nebo zvysï uje jeho vyâskyt? Quintessenz 1999, 50, cï. 11, s Pender, N.: Aspects of Oral Health in Orthodontic Patients, Brit. J. Orthod. 1986, 13, s MUC. Martina RÏ õâmskaâ Klinika zubnõâho leâ karïstvõâ LF FN Palacke ho 12, Olomouc

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