title: Orthodontic treatment with fixed appliances and biofilm formation--a potential public health threat?
abstract: OBJECTIVE
  Orthodontic treatment is highly popular for restoring functional and facial esthetics in juveniles and adults. As a downside, prevalence of biofilm-related complications is high. Objectives of this review are to (1) identify special features of biofilm formation in orthodontic patients and (2) emphasize the need for strong concerted action to prevent biofilm-related complications during orthodontic treatment.
  
  
  METHODS
  Literature on biofilm formation in the oral cavity is reviewed to identify special features of biofilm formation in orthodontic patients. Estimates are made of juvenile and adult orthodontic patient population sizes, and biofilm-related complication rates are used to indicate the costs and clinical workload resulting from biofilm-related complications.
  
  
  RESULTS
  Biofilm formation in orthodontic patients is governed by similar mechanisms as common in the oral cavity. However, orthodontic appliances hamper the maintenance of oral hygiene and provide numerous additional surfaces, with properties alien to the oral cavity, to which bacteria can adhere and form a biofilm. Biofilm formation may lead to gingivitis and white spot lesions, compromising facial esthetics. Whereas gingivitis after orthodontic treatment is often transient, white spot lesions may turn into cavities requiring professional restoration. Complications requiring professional care develop in 15 % of all orthodontic patients, implying an annual cost of over US$500,000,000 and a workload of 1,000 full-time dentists in the USA alone.
  
  
  CONCLUSIONS
  Improved preventive measures and antimicrobial materials are urgently required to prevent biofilm-related complications of orthodontic treatment from overshadowing its functional and esthetic advantages.
  
  
  CONCLUSIONS
  High treatment demand and occurrence of biofilm-related complications requiring professional care make orthodontic treatment a potential public health threat.
authors.affiliation: Department of Orthodontics, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands, y.ren@umcg.nl.
authors.forename: Yijin
authors.initials: Y
authors.lastname: Ren
authors.forename: Marije A
authors.initials: MA
authors.lastname: Jongsma
authors.forename: Li
authors.initials: L
authors.lastname: Mei
authors.forename: Henny C
authors.initials: HC
authors.lastname: van der Mei
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Busscher
mesh_terms: D018441:Biofilms; D006801:Humans; D009910:Oral Hygiene; D009967:Orthodontic Appliances / Q000009:adverse effects*; D009971:Orthodontics, Corrective; D011634:Public Health
references.citation: J Clin Periodontol. 2007 May;34(5):423-31
references.pmid: 17448045
references.citation: Angle Orthod. 2007 May;77(3):483-8
references.pmid: 17465657
references.citation: Am J Orthod Dentofacial Orthop. 2009 Feb;135(2):190-3
references.pmid: 19201325
references.citation: Am J Orthod. 1982 Jul;82(1):62-7
references.pmid: 6984291
references.citation: Am J Orthod Dentofacial Orthop. 2005 Apr;127(4):403-12
references.pmid: 15821684
references.citation: J Dent Res. 2010 Nov;89(11):1187-97
references.pmid: 20739698
references.citation: Orthod Craniofac Res. 2008 Nov;11(4):211-5
references.pmid: 18950317
references.citation: Caries Res. 2005 Jan-Feb;39(1):41-7
references.pmid: 15591733
references.citation: Eur J Orthod. 2000 Aug;22(4):401-7
references.pmid: 11029829
references.citation: Clin Oral Investig. 2013 May;17(4):1209-18
references.pmid: 22855266
references.citation: J Public Health Dent. 2009 Winter;69(1):9-17
references.pmid: 18662255
references.citation: Angle Orthod. 2011 Mar;81(2):206-10
references.pmid: 21208070
references.citation: Am J Orthod Dentofacial Orthop. 2004 Sep;126(3):325-30
references.pmid: 15356496
references.citation: Am J Orthod Dentofacial Orthop. 2003 Oct;124(4):373-8
references.pmid: 14560266
references.citation: Am J Orthod Dentofacial Orthop. 2007 Apr;131(4 Suppl):S43-51
references.pmid: 17448385
references.citation: Clin Oral Investig. 2013 Apr;17(3):687-709
references.pmid: 23001187
references.citation: Eur J Orthod. 2013 Oct;35(5):664-8
references.pmid: 23045306
references.citation: Angle Orthod. 2009 Mar;79(2):323-30
references.pmid: 19216589
references.citation: Eur J Orthod. 2010 Oct;32(5):481-9
references.pmid: 20551084
references.citation: Caries Res. 2010;44(5):459-64
references.pmid: 20838045
references.citation: Am J Orthod Dentofacial Orthop. 2007 Jan;131(1):27-33
references.pmid: 17208103
references.citation: Int J Artif Organs. 2012 Oct;35(10):854-63
references.pmid: 23065883
references.citation: J Dent Res. 2010 Jan;89(1):8-18
references.pmid: 19918089
references.citation: J Orofac Orthop. 2007 Sep;68(5):353-63
references.pmid: 17882363
references.citation: Eur J Oral Sci. 2001 Dec;109(6):388-92
references.pmid: 11767275
references.citation: Dent Mater. 2008 Jun;24(6):732-6
references.pmid: 17897707
references.citation: Proc Natl Acad Sci U S A. 2001 May 22;98(11):5981-5
references.pmid: 11353851
references.citation: Eur J Orthod. 2010 Aug;32(4):414-8
references.pmid: 20139131
references.citation: Am J Orthod Dentofacial Orthop. 2007 Apr;131(4):525-9
references.pmid: 17418720
references.citation: J Dent Res. 2010 Jul;89(7):657-65
references.pmid: 20448246
references.citation: Am J Orthod Dentofacial Orthop. 1989 Nov;96(5):423-7
references.pmid: 2816842
references.citation: Eur J Orthod. 1986 Nov;8(4):229-34
references.pmid: 3466795
references.citation: Am J Orthod Dentofacial Orthop. 2007 Dec;132(6):815-21
references.pmid: 18068602
references.citation: Angle Orthod. 2013 Jul;83(4):641-7
references.pmid: 23289733
references.citation: PLoS One. 2013 Apr 04;8(4):e61028
references.pmid: 23593379
references.citation: Am J Orthod Dentofacial Orthop. 1988 Jan;93(1):29-37
references.pmid: 3276146
references.citation: Am J Orthod Dentofacial Orthop. 2006 Jul;130(1):92-5
references.pmid: 16849078
references.citation: Eur J Oral Sci. 2009 Aug;117(4):419-26
references.pmid: 19627354
references.citation: Proc Natl Acad Sci U S A. 2010 Dec 21;107(51):22038-43
references.pmid: 21131569
references.citation: Nat Rev Microbiol. 2010 Sep;8(9):623-33
references.pmid: 20676145
references.citation: J Periodontol. 2008 Nov;79(11):2087-92
references.pmid: 18980517
references.citation: Am J Orthod. 1982 Feb;81(2):93-8
references.pmid: 6758594
references.citation: Ned Tijdschr Tandheelkd. 2010 Oct;117(10):507-12
references.pmid: 21077389
references.citation: J Am Dent Assoc. 2008 Apr;139(4):413-22
references.pmid: 18385025
references.citation: J Biomed Mater Res B Appl Biomater. 2005 May;73(2):347-54
references.pmid: 15736286
references.citation: Angle Orthod. 2007 Sep;77(5):881-4
references.pmid: 17685773
references.citation: Eur J Orthod. 2001 Oct;23(5):475-84
references.pmid: 11668867
references.citation: Int J Oral Maxillofac Implants. 2009 Jul-Aug;24(4):616-26
references.pmid: 19885401
references.citation: Eur J Oral Sci. 2010 Apr;118(2):177-82
references.pmid: 20487007
references.citation: J Biomed Mater Res B Appl Biomater. 2005 Oct;75(1):200-4
references.pmid: 16034988
references.citation: Angle Orthod. 2000 Feb;70(1):11-4; discussion 15
references.pmid: 10730670
references.citation: Eur J Orthod. 2012 Oct;34(5):633-9
references.pmid: 21750245
references.citation: Eur J Orthod. 2009 Apr;31(2):202-6
references.pmid: 19304761
references.citation: Am J Orthod Dentofacial Orthop. 2009 Oct;136(4):547-53
references.pmid: 19815157
references.citation: Angle Orthod. 2003 Jun;73(3):249-58
references.pmid: 12828433
references.citation: J Dent. 2009 Aug;37(8):591-5
references.pmid: 19403228
references.citation: Am J Orthod Dentofacial Orthop. 2011 Jul;140(1):e17-24
references.pmid: 21724067
references.citation: Am J Orthod Dentofacial Orthop. 2009 Apr;135(4):426.e1-9; discussion 426-7
references.pmid: 19361723
references.citation: Dent Clin North Am. 2010 Jul;54(3):441-54
references.pmid: 20630188
references.citation: Am J Orthod Dentofacial Orthop. 2010 Aug;138(2):188-94
references.pmid: 20691360
references.citation: Eur J Oral Sci. 2010 Jun;118(3):298-303
references.pmid: 20572865