title: Factors affecting dental biofilm in patients wearing fixed orthodontic appliances.
abstract: BACKGROUND
  The aim of this study is to investigate the amount and the distribution of biofilm in patients wearing fixed appliances and its relation with age, gender, frequency of tooth brushing, and patient motivation.
  
  
  METHODS
  The sample comprised 52 patients (15.5 ± 3.6 years old, 30 females and 22 males) wearing fixed orthodontic appliances. Dental biofilm was assessed using a modified plaque index (PI). A questionnaire was used to collect patient's information, including gender, age, treatment motivation, and frequency of tooth brushing.
  
  
  RESULTS
  Gingival (PI score = 0.9 ± 0.7), mesial (0.8 ± 0.6), and distal (0.8 ± 0.5) areas accumulated more biofilm than occlusal areas (0.3 ± 0.3) (P < 0.038). The maxillary lateral incisors (1.1 ± 0.8) and maxillary canines (1.0 ± 0.8) had more biofilm than other teeth (P < 0.05). The maxillary arch (0.8 ± 0.7) had significantly more biofilm than mandibular arch (0.6 ± 0.6) (P = 0.042). No significant difference was found between the right side (0.7 ± 0.7) and left side (0.7 ± 0.6) (P = 0.627). Less biofilm was found in females (0.6 ± 0.5), adults (0.3 ± 0.3), and "self-motivated" patients (0.3 ± 0.3), compared with males (0.9 ± 0.5), children (0.8 ± 0.6), and "family-motivated" patients (1.1 ± 0.5) (P < 0.001). The amount of biofilm was associated with self-report of the frequency of daily tooth brushing (P < 0.001).
  
  
  CONCLUSIONS
  Patients wearing fixed orthodontic appliances have the highest biofilm accumulation on the maxillary lateral incisors and maxillary canines, particularly in the gingival area and areas behind arch wires. Less biofilm was observed in female and adult patients and in those who were self-motivated and brushed their teeth more often.
authors.affiliation: Discipline of Orthodontics, Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand. li.mei@otago.ac.nz.
authors.forename: Li
authors.initials: L
authors.lastname: Mei
authors.affiliation: Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
authors.forename: Joyce
authors.initials: J
authors.lastname: Chieng
authors.affiliation: Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
authors.forename: Connie
authors.initials: C
authors.lastname: Wong
authors.affiliation: Discipline of Orthodontics, Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
authors.forename: Gareth
authors.initials: G
authors.lastname: Benic
authors.affiliation: Discipline of Orthodontics, Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
authors.forename: Mauro
authors.initials: M
authors.lastname: Farella
mesh_terms: D000293:Adolescent; D000367:Age Factors; D018441:Biofilms / Q000254:growth & development*; D003481:Cuspid / Q000382:microbiology; D003774:Dental Plaque Index; D005260:Female; D005881:Gingiva / Q000382:microbiology; D006801:Humans; D007180:Incisor / Q000382:microbiology; D008297:Male; D009042:Motivation; D009967:Orthodontic Appliances / Q000009:adverse effects / Q000382:microbiology*; D012307:Risk Factors; D012737:Sex Factors; D014099:Toothbrushing
keywords: Biofilm; Dental plaque; Oral hygiene; Orthodontics; White spot lesions