Sobouti Farhad, Rakhshan Vahid, Heydari Mohaddeseh, Keikavusi Shohreh, Dadgar Sepideh, Shariati Mahsa
Orthodontics department, dental faculty, Mazandaran university of medical sciences, Sari, Iran.
Iranian tissue engineering and graft bank and research center, Tehran university of medical sciences, Tehran, Iran; Department of dental anatomy and morphology, dental school,Azad University, Tehran, Iran.
Int Orthod. 2018 Mar;16(1):12-30. doi: 10.1016/j.ortho.2018.01.027. Epub 2018 Feb 23.
Routine brushing protocols might not suffice to reduce the increased plaque accumulation in orthodontic patients. Antimicrobial mouth rinses are favorable in this regard. This two-phase study evaluated the effects of orthodontic treatment and the application of two mouthwashes not studied before on oral health indices.
In this two-phase study (a prospective cohort followed by a parallel randomized controlled trial), plaque index (PI), gingival index (GI), gingival bleeding index (GBI), and pocket probing depth (PPD) were measured in 54 orthodontic patients before orthodontic treatment and 4 months later. Then patients were randomized into three groups of mouthrinses: Persica (herbal), Ortho-Kin (containing diluted chlorhexidine), and Placebo (n=18×3). The effects of orthodontic treatment and mouthrinses were analyzed statistically (α=0.05).
All the 4 indices increased between the baseline and 4th month of treatment (P values<0.01, paired t-test). They decreased back to baseline levels or below them, after one month of mouthwash application (P values<0.002). Both mouthwashes showed therapeutic effects compared to placebo in terms of PI and GBI. In the case of GI, only Persica showed significantly better results compared to placebo. Regarding PPD, only Ortho-Kin acted better than placebo (P values≤0.05, Tukey).
LIMITATIONS OF THE RANDOMIZED CONTROL TRIAL (RCT) PHASE: Lack of positive control (regular chlorhexidine mouth rinse) and negative control (a group with no mouthwashes, even without the placebo). Lack of sample size predetermination based on a priori power calculations. The difference between the regime of Persica with that of Ortho-Kin and placebo (which had similar application protocols) disallowed perfectly effective blinding of the patients (hence, single-blind).
Fixed orthodontic treatment might disrupt gingival health. Antimicrobial mouthwashes might reverse this. Both evaluated mouthwashes might have therapeutic effects.
常规刷牙方案可能不足以减少正畸患者牙菌斑堆积的增加。在这方面，抗菌漱口水是有利的。这项两阶段研究评估了正畸治疗以及两种以前未研究过的漱口水对口腔健康指标的影响。
在这项两阶段研究（前瞻性队列研究，随后是平行随机对照试验）中，对54名正畸患者在正畸治疗前和4个月后测量菌斑指数（PI）、牙龈指数（GI）、牙龈出血指数（GBI）和牙周袋探诊深度（PPD）。然后将患者随机分为三组漱口水：波斯菊（草药）、正畸健（含稀释洗必泰）和安慰剂（n = 18×3）。对正畸治疗和漱口水的效果进行统计学分析（α = 0.05）。
在治疗的基线期和第4个月之间，所有4项指标均升高（P值<0.01，配对t检验）。在使用漱口水1个月后，它们降至基线水平或低于基线水平（P值<0.002）。就PI和GBI而言，与安慰剂相比，两种漱口水均显示出治疗效果。就GI而言，与安慰剂相比，只有波斯菊显示出明显更好的结果。关于PPD，只有正畸健比安慰剂效果更好（P值≤0.05，Tukey检验）。
随机对照试验（RCT）阶段的局限性：缺乏阳性对照（常规洗必泰漱口水）和阴性对照（一组不使用漱口水，甚至不使用安慰剂）。缺乏基于先验效能计算的样本量预先确定。波斯菊与正畸健和安慰剂（应用方案相似）之间的差异使得无法对患者进行完全有效的盲法（因此，为单盲）。
固定正畸治疗可能会破坏牙龈健康。抗菌漱口水可能会逆转这种情况。两种评估的漱口水可能都有治疗效果。
