Orthodontic treatment with fixed appliances and biofilm formation-a potential public health threat?

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. 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. 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. Improved preventive measures and antimicrobial materials are urgently required to prevent biofilm-related complications of orthodontic treatment from overshadowing its functional and esthetic advantages. High treatment demand and occurrence of biofilm-related complications requiring professional care make orthodontic treatment a potential public health threat.