Periodontal diseases are a diverse family of inflammatory conditions that affect the periodontium and negatively impact our oral health. Orthodontic appliances, such as traditional brackets and wires can create numerous plaque retention sites, increasing the patients' risk of developing periodontal disease and dental caries. The periodontal tissue reaction to the orthodontic appliance depends on a multitude of factors, including host resistance, presence or absence of systemic conditions, type of appliance and material used, as well as the amount and composition of dental plaque. Additionally, lifestyle choices, such as smoking, can also adversely affect the periodontal health. The evaluation of these factors has gained significant attention as well as considerations on how to reduce these risks. There have been numerous documented reports of significant increases in the number of oral bacteria during orthodontic treatment. Current evidence supports an association between the increase in plaque indices and the decrease in overall oral health of orthodontic patients, especially in cases where fixed appliances are used. Regardless of the nature of the orthodontic appliance, whether they are removable, thermoplastic, contoured wires, or brackets and arch wires, they inhibit the stimulation of the gingival papilla and the mucosa by the tongue, lips, cheeks, and saliva.
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