title: Halitosis, oral health and quality of life during treatment with Invisalign(®) and the effect of a low-dose chlorhexidine solution.
abstract: OBJECTIVE
  This study examined how halitosis, oral dryness and general oral health were impacted during treatment with the Invisalign(®) system. Furthermore, the effect of a lowdose chlorhexidine solution (CHX) was evaluated.
  
  
  METHODS
  Thirtyone patients with good periodontal health participated in this crossover study and were divided into two groups (group 1: CHX/no CHX, group 2: no CHX/CHX). The following parameters were recorded during the first 8 months of Invisalign(®) treatment: stimulated saliva flow rate, organoleptic index, tongue coating index, measurement of the oral volatile sulfur compound level (ppb), modified gingival and plaque index and bleeding on probing index. Professional oral cleaning was performed at the beginning of each period lasting 3 months. The patients received a questionnaire at the first, third, fourth, sixth and eighth control visits.
  
  
  RESULTS
  The very low volatile sulfur compound level was significantly decreased by CHX (0.06%) during the first examination period (p = 0.02), i.e. for the first group of patients only. Neither halitosis, nor oral dryness, nor high plaque or gingival index measurements were observed. Oral health-related quality of life was hardly influenced by wearing aligners and oral hygiene habits were very good.
  
  
  CONCLUSIONS
  This study provides evidence that Invisalign(®) treatment is characterized by only minimal impairment of overall oral health and the associated quality of life. Consequently, it appears unnecessary to recommend the general adjunctive use of a low-dose chlorhexidine mouthwash during treatment with Invisalign(®).
authors.affiliation: Department of Orthodontics, University of Cologne, Cologne, Germany. isabelle.schaefer@uk-koeln.de
authors.forename: Isabelle
authors.initials: I
authors.lastname: Schaefer
authors.forename: Bert
authors.initials: B
authors.lastname: Braumann
mesh_terms: D000293:Adolescent; D000328:Adult; D002710:Chlorhexidine / Q000008:administration & dosage*; D003773:Dental Plaque / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D017267:Dental Prosthesis Design; D004202:Disinfectants / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D019544:Equipment Failure Analysis; D005260:Female; D005891:Gingivitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006209:Halitosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage; D009909:Oral Health; D009968:Orthodontic Appliances, Removable / Q000009:adverse effects*; D017060:Patient Satisfaction; D011788:Quality of Life; D016896:Treatment Outcome; D014987:Xerostomia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D004202:Disinfectants; D009067:Mouthwashes; D002710:Chlorhexidine