Skip to main content
SpringerLink
Log in

Halitosis, Oral Health and Quality of Life during Treatment with Invisalign® and the Effect of a Low-dose Chlorhexidine Solution

Halitosis, Mundgesundheit und Lebensqualität während der Invisalign®-Therapie und der Einfluss einer Chlorhexidin-Mundspüllösung

  • Original Article
  • Published:
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Aim:

This study examined how halitosis, oral dryness and general oral health were impacted during treatment with the Invisalign® system. Furthermore, the effect of a lowdose chlorhexidine solution (CHX) was evaluated.

Patients and Methods:

Thirtyone patients with good periodontal health participated in this crossover study and were divided into two groups (group 1: CHX/no CHX, group 2: no CHX/CHX). The following parameters were recorded during the first 8 months of Invisalign® treatment: stimulated saliva flow rate, organoleptic index, tongue coating index, measurement of the oral volatile sulfur compound level (ppb), modified gingival and plaque index and bleeding on probing index. Professional oral cleaning was performed at the beginning of each period lasting 3 months. The patients received a questionnaire at the first, third, fourth, sixth and eighth control visits.

Results:

The very low volatile sulfur compound level was significantly decreased by CHX (0.06%) during the first examination period (p = 0.02), i.e. for the first group of patients only. Neither halitosis, nor oral dryness, nor high plaque or gingival index measurements were observed. Oral health-related quality of life was hardly influenced by wearing aligners and oral hygiene habits were very good.

Conclusions:

This study provides evidence that Invisalign® treatment is characterized by only minimal impairment of overall oral health and the associated quality of life. Consequently, it appears unnecessary to recommend the general adjunctive use of a low-dose chlorhexidine mouthwash during treatment with Invisalign®.

Zusammenfassung

Ziel:

Es sollte untersucht werden, ob sich während einer Behandlung mit Invisalign® das anekdotisch geschilderte subjektive Vorhandensein von Halitosis oder Mundtrockenheit objektivieren lässt und inwieweit sich die Mundgesundheit und die Lebensqualität im Therapieverlauf verändern. Zusätzlich wurde der Einfluss einer niedrig dosierten Chlorhexidin-Mundspüllösung (CHX) ermittelt.

Patienten und Methodik:

Es wurden 31 parodontal gesunde Probanden in diese Cross-Over-Studie aufgenommen und in zwei Gruppen aufgeteilt (Gruppe 1: CHX/kein CHX, Gruppe 2: kein CHX/CHX). Zu acht Untersuchungszeitpunkten während der ersten 8 Monate der Invisalign®-Behandlung erfolgte die Erhebung folgender Parameter: stimulierte Speichelfließrate, organoleptischer Index, Zungenbelagsindex, Messung der oralen flüchtigen Schwefelverbindungen (ppb), modifizierter Gingiva-Index, modifizierter Plaque-Index und Bleeding on Probing Index. Zu Beginn der beiden 3-monatigen Untersuchungsperioden erfolgte zudem eine professionelle Zahnreinigung. Die Fragebögen wurden am ersten, dritten, vierten, sechsten und achten Kontrolltermin beantwortet.

Ergebnisse:

Durch die 0,06%ige Chlorhexidin-Gabe konnte eine statistisch signifikante Reduktion der sehr niedrigen Werte der flüchtigen Schwefelverbindungen während der ersten Periode (p = 0,02), also nur bei der ersten Gruppe, festgestellt werden. Bei den untersuchten Patienten wurden weder Halitosis, noch Mundtrockenheit, noch erhöhte Plaque- oder Entzündungswerte beobachtet. Die mundgesundheitsbezogene Lebensqualität wurde durch das Tragen der Aligner kaum beeinflusst. Die Mundhygieneangewohnheiten waren sehr gut.

Schlussfolgerungen:

Die vorliegende Arbeit legt dar, dass sich die Invisalign®-Therapie durch sehr geringe Beeinträchtigungen der Mundgesundheit und der darauf bezogenen Lebensqualität auszeichnet. Eine grundsätzliche Empfehlung zur Unterstützung der häuslichen Mundhygiene durch eine Chlorhexidin-Mundspüllösung scheint für Patienten der Invisalign®-Therapie nicht notwendig.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Addy M, Moran JM. Clinical indications for the use of chemical adjuncts to plaque control: chlorhexidine formulations. Periodontol 2000 1997;15:53–4.

    Google Scholar 

  2. Addy M, Moran JM, Newcombe R, et al. The comparative tea staining potential of phenolic, chlorhexidine and anti-adhesive mouthrinses. J Clin Periodontol 1995;22:923–8.

    Article  PubMed  Google Scholar 

  3. Arweiler NB, Ilse A. Niedrig dosierte Chlorhexidinpräparate. Oralproph Kinderzahnheilk 2007;29:16–21.

    Google Scholar 

  4. Bauer W, Diedrich P. Motivation und Erfolgbeurteilung erwachsener Patienten zur kieferorthopädischen Behandlung — Interpretation einer Befragung. Fortschr Kieferorthop 1990;51:180–8.

    Article  PubMed  Google Scholar 

  5. Berg R. Motivation als ausschlaggebender Faktor bei Erwachsenenbehandlung. Fortschr Kieferorthop 1986;47:287–94.

    Article  PubMed  Google Scholar 

  6. De Boever EH, Loesche WJ. Assessing the contribution of anaerobic microflora of the tongue to oral malodor. J Am Dent Assoc 1995;126:1384–93.

    PubMed  Google Scholar 

  7. Filippi A. Halitosis. Patienten mit Mundgeruch in der zahnärztlichen Praxis. Quintessenz Verlag, 2006:5:53–6.

    Google Scholar 

  8. Fritz U, Diedrich P, Wiechmann D. Lingual technique — patients’ characteristics, motivation and acceptance. J Orofac Orthop 2002;63:228–33.

    Article  Google Scholar 

  9. Hoffmann T, Bruhn G, Richter S, et al. Clinical controlled study on plaque and gingivitis reduction under long-term use of low-dose chlorhexidine solutions in a population exhibiting good oral hygiene. Clin Oral Invest 2001;5:89–95.

    Article  Google Scholar 

  10. Hothorn LA, Hauschke D, Senn SJ, et al. Pro’s and Con’s of cross-over trials. In: Vollmar J, Hothorn LA, eds. Biometrics in the Pharmaceutical Industry. Stuttgart: G. Fischer, 1997:97.

    Google Scholar 

  11. Hummel T, Sekinger B, Wolf S, et al. ’sniffin’ Sticks’: Olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold. Chem Senses 1997;22:39–52.

    Article  PubMed  Google Scholar 

  12. Jenkins S, Addy M, Newcombe RG. Dose response of chlorhexidine against plaque and comparison with triclosan. J Clin Periodontol 1994;21:250–5.

    Article  PubMed  Google Scholar 

  13. Kaza S. Scanning Process and Stereolithography. In: Tuncay OC, ed. The Invisalign® system. Surrey, UK: Quintessence Publishing, 2006:47–54.

    Google Scholar 

  14. Khan RS, Horrocks EN. A study of adult orthodontic patients and their treatment. Br J Orthod 1991;18:183–94.

    PubMed  Google Scholar 

  15. Kesling HD. The philosophy of the tooth positioning appliances. Am J Orthod 1945;31:297–304.

    Google Scholar 

  16. Kleinberg I, Wolff MS, Codipilly DM. Role of saliva in oral dryness, oral feel and oral malodour. Int Dent J 2002;52:236–40.

    PubMed  Google Scholar 

  17. Lang NP, Adler R, Joss A, et al. Absence of bleeding on probing — an indicator of periodontal stability. J Clin Periodontol 1990;17:714–21.

    Article  PubMed  Google Scholar 

  18. Lang NP, Brecx M. Chlorhexidine digluconate: an agent for chemical plaque control and prevention. J Periodontol Res 1986;21:74–89.

    Article  Google Scholar 

  19. Lehmacher W. Analysis of the crossover design in the presence of residual effects. Stat Med 1991;10:891–9.

    Article  PubMed  Google Scholar 

  20. Lehmacher W. Residual effects in cross-over trials. In: Vollmar J, ed. Biometrics in the Pharmaceutical Industry. Stuttgart: G. Fischer, 1997:41–65.

    Google Scholar 

  21. Löe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533–51.

    Article  PubMed  Google Scholar 

  22. McKiernan E, McKiernan F, Jones ML. Psychological profiles and motivation of adults who seek orthodontic treatment. Int J Adult Orthod Orthognath Surg 1992;7:187–98.

    Google Scholar 

  23. Meier B, Wiemer KB, Miethke R-R. Invisalign® — patient profiling. J Orofac Orthop 2003;64:352–8.

    Article  PubMed  Google Scholar 

  24. Micheelis W, Schiffner U (Gesamtbearbeitung). Vierte Deutsche Mundgesundheitsstudie (DMS IV). Neue Ergebnisse zu oralen Erkrankungsprävalenzen, Risikogruppen und zum zahnärztlichen Versorgungsgrad in Deutschland 2005. Köln: Deutscher Zahnärzte Verlag (DäV), 2006.

    Google Scholar 

  25. Miethke R-R, Brauner K. A Comparison of the periodontal health of patients during treatment with the Invisalign® system and with fixed lingual appliances. J Orofac Orthop 2007;68:223–31.

    Article  PubMed  Google Scholar 

  26. Miethke R-R, Vogt S. A comparison of the periodontal health of patients during treatment with the Invisalign® system and with fixed orthodontic appliances. J Orofac Orthop 2005;66:219–29.

    Article  PubMed  Google Scholar 

  27. Miyazaki H, Sakao S, Katoh Y, et al. Correlation between oral sulphur compounds and certain oral health measurements in the general population. J Periodontol 1995;66:679–84.

    PubMed  Google Scholar 

  28. Nachnani S. The effects of oral rinses on halitosis. J Calif Dent Assoc 1997;25:145–50.

    PubMed  Google Scholar 

  29. Nattrass C, Sandy JR. Adult orthodontics — a review. Br J Orthod 1995;22:331–7.

    PubMed  Google Scholar 

  30. Nedwed V, Miethke R-R. Motivation, acceptance and problems of Invisalign® patients. J Orofac Orthop 2005;66:162–73.

    Article  PubMed  Google Scholar 

  31. Quirynen M, Avontroodt P, Soers C, et al. The efficacy of amine fluoride/stannous fluoride in the suppression of morning breath odour. J Clin Periodontol 2002;29:944–54.

    Article  PubMed  Google Scholar 

  32. Quirynen M, Zhao H, van Steenberghe D. Review of the treatment strategies for oral malodour. Clin Oral Invest 2002;6:1–10.

    Google Scholar 

  33. Roldán S, Winkel EG, Herrera D, et al. The effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc lactate on the microflora of oral halitosis patients: a dual-centre, double-blind placebo-controlled study. J Clin Periodontol 2003;30:427–34.

    Article  PubMed  Google Scholar 

  34. Rosenberg M, Gelernter I, Barki M, et al. Day-long reduction of oral malodor by a two-phase oil: water mouthrinse as compared to chlorhexidine and placebo rinses. J Periodontol 1992;63:39–43.

    PubMed  Google Scholar 

  35. Rosenberg M, Kulkarni GV, Bosy A, et al. Reproducibility and sensitivity of oral malodor measurements with a portable sulphide monitor. J Dent Res 1991;70:1436–40.

    PubMed  Google Scholar 

  36. Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964;22:121–35.

    Article  PubMed  Google Scholar 

  37. Tayer BH, Burek MJ. A survey of adults’ attitudes toward orthodontic therapy. Am J Orthod 1981;79:305–15.

    Article  PubMed  Google Scholar 

  38. van Steenberghe D, Avontroodt P, Peeters W, et al. Effect of different mouthrinses on morning breath. J Periodontol 2001;72:1183–91.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthodontics, University of Cologne, Cologne, Germany

    Isabelle Schaefer & Bert Braumann

  2. Department of Orthodontics, University of Cologne, Kerpener Straße 32, 50931, Cologne, Germany

    Isabelle Schaefer

Authors
  1. Isabelle Schaefer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bert Braumann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Isabelle Schaefer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schaefer, ., Braumann, B. Halitosis, Oral Health and Quality of Life during Treatment with Invisalign® and the Effect of a Low-dose Chlorhexidine Solution. J Orofac Orthop 71, 430–441 (2010). https://doi.org/10.1007/s00056-010-1040-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00056-010-1040-6

Key Words:

Schlüsselwörter:

Search

Navigation