The primary goal of dentistry is prevention of caries and periodontal disease.¹ Great changes occur in the oral biofilm, resulting from the increase in retention niches of the orthodontic appliances.^2-4 The patient might be predisposed to clinical and inflammatory alterations in the periodontal tissues, as the oral cavity is colonized by supragingival biofilm and bacteria that normally inhibit the gingival sulcus.⁵ When basic oral hygiene is poor, orthodontic appliances create areas of plaque stagnation, especially around brackets, bands, wires, and other attachments; this facilitates the development of white spot lesions.⁶ Levels of acidogenic bacteria , present in the plaque, notably Streptococcus mutans, are higher in orthodontic patients than non-orthodontic patients.^7,8 This causes demineralization around the brackets and leads to white spot lesions. They are most prevalent around the cervical region of the bands in the posterior region, whereas in the anterior region, the lateral incisors in both arches, followed by the canines, are the most commonly affected.⁶

By interruption, reduction, or elimination of the microorganisms, the dental microbial film can be controlled.⁹ Dentifrices help in the removal of dental microbial biofilm and antimicrobial agents are excellent vehicles for the release of therapeutic substances.¹⁰ The most common way of controlling caries is removal of the dental microbial biofilm mechanically by tooth brushing with dentrifices.¹¹  However, patients have difficulty in maintaining an acceptable level of oral hygiene, which is difficult to achieve by the mechanical method. Therefore, as supplements to traditional cleaning methods, antimicrobial agents are being incorporated into mouthwash solutions and dentrifices.¹²

Dental caries is strongly associated with Streptococcus mutans, while Lactobacilli are mainly associated with the progression of the carious lesion. Hence, the presence of these microorganisms at high levels indicates an increased risk of caries.¹³

The use of chlorhexidine digluconate toothpaste reduces the number of Streptococcus mutans dramatically which is highly sensitive to chlorhexidine in teenagers of a general population.¹³

The action of chlorhexidine mouthwashes has been reported in several studies.¹³ Nevertheless, there are no reports in the literature about chlorhexidine digluconate toothpaste in patients with fixed orthodontic appliances. Therefore, the aims of the study are to verify the antibacterial effect of the chlorhexidine digluconate toothpaste through clinical biofilm disclosure, and to quantify Streptococcus mutans in orthodontic patients.

null hypothesis:

 ^{source of the data:}

(1)   Healthy patients (both genders) in the group of 14 to 25 years.

(2)   Patients requiring fixed orthodontic treatment (MBT, 0.022– in slot; 3M Unitek,Monrovia,Calif).

(3)   Patients with good general health (no significant medical history or drug use in the last month).

(4)   Patients with permanent dentition.

(5)   Patients without any periodontal diseases.

(1)   Patients on systemic consumption of antibiotics or anti-inflammatory medications taken during the period of the study.

(2)   Patients with systemic diseases such as hormonal imbalances and bone diseases.

(3)   Patients with periodontal diseases.

(4)   Patients with carious or infiltrated restorations.

(5)   Patients with fractured teeth or presence of erosion

method of collection of data:

7.      Jose JE, Padmanabhan S, Chitharanjan AB. Systemic consumption of probiotic curd and use of probiotic toothpaste to reduce Streptococcus mutans in plaque around orthodontic brackets. Am J Orthod Dentofacial Orthop. 2013 Jul;144(1):67-72.

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