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Antimicrobial effect of fluoride toothpaste on salivary Streptococcus mutans and Lactobacillus spp. in children treated with fixed orthodontic appliances

Introduction: Placement of fixed orthodontic appliances changes the oral environment and favour colonisation of aciduric cariogenic bacteria such as Streptococcus mutans and Lactobacillus spp. It has been previously reported that Streptococcus mutans levels can increase up to fivefold during orthodontic treatment. Some findings suggest that, while orthodontic treatment results in increases of salivary Streptococcus mutans levels in some individuals, the use of antimicrobials, such as chlorhexidine, may not have warranted efficacy in all orthodontic patients. Clinical studies evaluating the effectiveness of fluoride programmes in orthodontic patients have shown conflicting results. During orthodontic treatment, fluoride can be administered to the teeth in various ways, including topical (fluoridated toothpaste, mouthrinse, gel and varnish) and adhesive (fluoride-releasing cements and elastomeric modules and chains) methods. The aim of this study was to evaluate antimicrobial effect of fluoride toothpaste with different brushing frequency on salivary Streptococcus mutans and Lactobacillus spp. in children treated with fixed orthodontic appliances. Subjects and Methods: The study included 22 patients (age 14.04±1.56) scheduled for fixed orthodontic therapy. All subjects received equal braces, 4 rings and 20 brackets from the same manufacturer, bonded with the same material. Subjects were distributed among two groups: Group 1 brushed their teeth twice a day with sodium fluoride toothpaste containing 1450 ppm F-, and Group 2 used the same tooth paste and brushed their teeth after every meal (more than 3 times a day). None of them used supplementary fluoride. Stimulated saliva samples were taken before placement of the appliance, and at week 6, 12 and 18 during the therapy. Saliva samples were cultivated on selective microbial agar, for microorganism detection. Results: Salivary Streptococcus mutans were suppressed significantly during the whole experimental period in the group which used fluoride toothpaste more than 3 times a day, but not in the group which brushed their teeth twice a day. In the twice a day group salivary Streptococcus mutans number of colony forming units significantly increased during the whole experimental period and was highest in week 12. Salivary Lactobacillus spp. were not significantly affected by frequency of use of sodium fluoride toothpaste containing 1450 ppm F-. In both groups salivary Lactobacillus spp. number of colony forming units significantly increased during the whole experimental period and was highest in week 12. Conclusion: The use of the sodium fluoride toothpaste containing 1450 ppm F- more than 3 times a day, in children with fixed orthodontic appliances has effective antimicrobial activity on salivary Streptococcus mutans but not on salivary Lactobacillus spp.

fluoride; S. mutans; Lactobacillus spp; orthodontic

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