Efficacy of Mouth Rinse in Maintaining Oral Health of Patients Attending Orthodontic Clinics


Shahana R.Y1, Muralidharan .N.P2

1Saveetha Dental College, Chennai

2Assistant Professor, Microbiology Department , Saveetha Dental College, Chennai

*Corresponding Author E-mail:



Aim: This study is designed to find out the spirochaete (Treponema denticola )  load in orthodontic patients and evaluate the benefit of mouth rinses containing chlorhexidine and hydrogen peroxide in reducing the bacterial load in the mouth. Objective : Orthodontic procedures are always long with the patients having the appliances placed in the mouth for longer duration. This will compromise the oral hygiene of the patients. Oral prophylaxis is very important to prevent the complications during the treatment period. Physical removal of the debris and plaque is difficult in orthodontic patients. In such case mouth rinses are widely used by many patients. Among the bacteria that colonises the mouth, treponemes dominate because they proliferate rapidly in devitalised tissue with the availability of simple source of nutrient. This study is done to know the presence of spirochetes and to evaluate the effects of mouth rinses containing chlorhexidine and hydrogen peroxide on reducing the spirochetes. Background: Placing orthodontic appliance leads increase in oral microbiota.  The spirochetes present in mouth increases due to incomplete removal  by normal brushing mechanism henceforth mouth washes provide a safe, effective means of reducing or eliminating the spirochetes found in oral cavity. Materials and methods : Patients undergoing orthodontic treatment are subjected in this study, they were made into three groups, group A:control group (orthodontic patients not taking antibiotics or mouth wash) group B using hydrogen per oxide local smear and group C chlorhexidine mouth wash Samples were collected using sterile tooth picks and transferred to glass slabs and  smears  are microscopically examined. Result: The variation in the effect of two different disinfectants over the spirochete count in oral flora of orthodontic patients wearing intra oral appliance is evaluated .


KEYWORDS: orthodontic patients , hydrogen per oxide , chlorhexidine mouth rinse , spirochaete



Orthodontic treatments comprise a large proportion of dental treatment and in most dental setup that are carried out during adolescence and early adulthood to solve malocclusion problems [1,2]. The relationship between the orthodontic procedures and oral microbial status is considered to be  a challenge , especially the health during and after the  orthodontic treatment .


It is well established that the patients undergoing orthodontic treatment have a high susceptibility to the plaque accumulation on their teeth because of the various orthodontic appliances like bands, brackets, wires which impair plaque removal by physical methods like normal tooth brush resulting in  poor oral hygiene and gingival health  [3]. There is a increased plaque accumulation ,elevation of microbial counts in the saliva and the bio film. The plaque deposition around the gingival margin constituting of bacteria that are anaerobic and aerobic is capable of initiating periodontal diseases and its destruction .[4,5] Plaque accumulation is the primary event in almost all periodontal and gingival pathology Orthodontic appliances present a challenge to the proper removal of plaque from tooth and gingival surfaces. The plaque may exist in equilibrium with the patient in oral environment However, this equilibrium  may become unstable over time and with alterations in the external environment. Organisms commonly present in an early plaque are Gram-positive rods and cocci. Over time, these organisms are replaced by more Gram-negative and anaerobic organisms, which may initiate various oral diseases for which the oral hygiene measures are very essential ., Three periodontal pathogens inhabiting the plaque are Porphyromonasgingivalis, Treponema denticola ,and Tannerella forsythia [6] . These bacteria are anaerobic periodontal pathogens capable of initiating the periodontal destruction . In many studies , the presence of these bacteria has been correlated with the common forms of adult periodontitis [7,8] Although most patients undergoing orthodontic therapy tend to be younger and are less likely to experience periodontal disease , the host resistance to bacteria is compromised in orthodontic patients due to appliances on the teeth .


These bacteria are termed the “red complex” among five bacterial complexes that group bacteria together based on relationships and associations. These three bacteria have a symbiotic relationship in a highly ordered system or biofilm, which serves as protection, facilitates communication, and promotes adhesion to the oral environment[8] Treponema denticola is a small spirochete which is considerably increased than the large spirochetes .In general bacterial loads can be decreased by the-usage of chemical solutions called the Mouth Rinse. Previous studies have found that the mouth rinse containing the chlorhexidine has prolonged antibacterial effect and arguably the most effective chemical method till date in controlling plaque accumulation , [9] but for orthodontic patients there is high count of spirochetes present in small and large forms which needs to be eradicated by a strong oxidizing agent, this study is aimed at targeting spirochetes and evaluating the effect of the different mouth rinse performing. Hydrogen per oxide is a chemical commonly used in clinics for disinfection and debriment. It is available in liquid as well as in gel form. Its usage is limited because of its adverse reaction. To avoid this instead of giving as mouth rinse it is applied as a smear on the bracers.



The samples were obtained from three groups ( group A, group B , group C )

Group A-

orthodontic patients not using any mouth rinses


Group B -

orthodontic patients using hydrogen peroxide local smear

Group C –


Collection method:

Sterile tooth picks used to take sample from the patients and transferred on to a clean glass slide and a smear is made



The smears were stained by simple staining method using dilute carbol fuchsin for 2 mins. Then the smears were air dried and examined under the oil immersion objective of the microscope



Total number of orthodontic patients -45


Number of patients

Percentage of samples showing positive to spirochaetes

A - Control



B -Hydrogen per oxide



C – chlorhexidine





Orthodontic treatment with fixed appliances alters the oral environment, increases the plaque amount, changes the composition of the flora, and obstruct the physical removal. Gingivitis, periodontal diseases and enamel decalcification around fixed appliances are frequent side effects when preventive measures have not been implemented. [10-12] There are many studies which also showed the detrimental effects of plaque accumulation around orthodontic brackets and bands leading to change in microbial flora. Therefore, an effective oral hygiene is essential for patients undergoing orthodontic treatment. The various oral hygiene methods used by the dentists are brushing, flossing, and mouth rinsing.[13-15] .


GROUP A – Control Group:

This group of patients are the one who have the orthodontic appliance for a minimum of six months. On examination of the oral cavity their health status was assessed. They were not using any mouth wash regularly. During the initial period of the placement of orthodontic appliances the bacterial flora is exclusively composed with cocci, spirochetes and rods present in low numbers but later stages there is a significant increase in the percentage of spirochetes, motile rods, filaments, and fusiforms; conversely, noted a decrease in cocci[16]. The swab taken randomly from the orthodontic patients attending the clinic and then stained using simple staining technique . The microscopic evaluation showed positive for spirochetes in almost 86.7% and 13.3% of negative among the 15 samples obtained , along with spirichetes other anaerobes were also found .


GROUP –B : Hydrogen Peroxide Local Smear used Group:

This group of patients were given hydrogen per oxide smear on the appliance after examining the oral health status. Hydrogen peroxide cotton swab applied onto their tooth surfaces around the intra oral appliances and its contact towards the tooth surface, then rinsed with drinking water Hydrogen peroxide is highly oxidising agent that causes the spirochetes to saturate with fullness of oxygen causing its immediate death reduces the total spirochetes load in oral cavity of orthodontic patients , only 20% of spirochetes were found among the orthodontic patients after the usage of the hydrogen peroxide , while 80% showed negative result to the presence of spirochetes while the other bacteria , cocci and yeast were found .


GROUP –C : Chlorhexidine Mouth Rinse:

Chlorhexidine are generally considered to be the second generation agents that have high antibacterial effect and prolonged effect in the oral flora [17] In this it is found that using chlorhexidine mouth rinse has reduced the spirochaete count in 40 % of the patients and nearly equal amount of other bacteria.



Oral hygiene can be maintained even after orthodontic placement of orthodontic appliances for a long duration by using the effective prophylactic measures. Many chemical agents are available in the market for this purpose. Their periodic use and assessment of the hygiene status will give specific relief from the complication. In this study after assessing the effect of hydrogen peroxide mouth rinse it is found that spirochaetes are more susceptible to the oxidizing agents than other bacteria. There is a reduction in the count of other species of bacteria. Studies have reported the adverse effect of hydrogen per oxide mouth rinses. To avoid this risk hydrogen per oxide smear is done to the patients. This is found to be safe and the patients were satisfied with complete debriment and an refreshing feel in the mouth.



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17.  EFFICACY OF DIFFERENT BRANDS OF MOUTH RINSES ON ORAL BACTERIAL LOAD COUNT IN HEALTHY ADULTS O.O. AKANDE*1, 3 A.R.A. ALADA1, G.A. ADERINOKUN2 AND A. O. IGE.1 Departments of 1Physiology, 2Preventive Dentistry and 3 Oral Pathology, College of Medicine University of Ibadan, Ibadan: African Journal of Biomedical Research, Vol. 7 (2004); 125 - 128 ISSN 1119 – 5096 © Ibadan Biomedical Communications Group Available online at http://www.bioline.org.br/md





Received on 31.07.2016             Modified on 03.08.2016

Accepted on 10.08.2016           © RJPT All right reserved

Research J. Pharm. and Tech 2016; 9(11): 1991-1993.

DOI: 10.5958/0974-360X.2016.00406.6