Research Corner - Interest in orthodontic tooth alignment in adult patients affected by periodontitis
Mr Alex Pollard, our Honorary Editor, has kindly written a precis of a really thought-provoking article that was recently published.
This was an exploratory study, to gain understanding of the attitude of patients towards orthodontic treatment and any clinical factors that may be related to their interest. The authors performed periodontal and orthodontic measurements/indices on 115 adult patients with moderate to severe periodontitis. 60% were females, with an mean age of 56 +/- 9.3 years. Participants also completed a questionnaire that collected demographics, quality of life data and their interests in undergoing orthodontic treatment.
The authors note that pathological tooth migration, characterised by drifting, flaring and elongation of the dentition, affects around 30-56% of patients with periodontitis. This can result in occlusal and aesthetic issues. Another aesthetic issue is the black triangles often seen in patients with significant loss of attachment. It is crucial to achieve periodontal stability first of all, but orthodontic treatment can help to maintain the natural dentition and restore oral function and in many cases improve aesthetics too. Common beneficial targets of orthodontic treatment are the correction of excessively tipped molars, traumatic deep bites, and flared or spaced incisors.
Some limitations of this study include the use of a questionnaire that has not been validated, although most of its questions stem from the validated OHIP-G49 (the German version of OHIP-49). The study was conducted in Germany, so the values of individuals may differ as well as the way that healthcare is delivered, compared to the UK. In addition, there was not a periodontally healthy comparison group so it is not possible to determine whether the desire for orthodontic treatment is higher in people with periodontitis or simply ubiquitous.
With these potential limitations in mind, the study found that two-thirds of included individuals with moderate to severe periodontitis had a desire for orthodontic therapy. However, there were no correlations with severity of periodontitis, tooth alignment or gender. Older patients were significantly more interested in orthodontic treatment and most participants had never been provided with information about orthodontic treatment in adults.
My take - there is no doubt that undertaking orthodontic treatment in patients with moderate to severe periodontitis is more complex and anyone without significant experience in delivering orthodontic treatment should proceed with caution. For instance, the fulcrum of the tooth moves apically when there is clinical attachment loss, meaning that orthodontic forces need to be adjusted to compensate. This study shows a great desire amongst individuals with periodontitis to receive information about adult orthodontic treatment. For those of us working in the field of periodontology, it may be prudent to undertake relevant CPD so that we can have these conversations more effectively with our orthodontic colleagues. Also, establishing a strong working relationship with someone who can deliver the orthodontic treatment would be useful, so that a sensible multidisciplinary treatment plan can be developed with patients stabilised pre-treatment and kept stable throughout. Overall, I thought the paper was a good reminder to consider our patients holistically and not to presume what they may or may not want to achieve from their treatment.
Click on the link below to access the full article;