Orthodontic appliances induce both quantitative and qualitative changes in oral microbiome, which, combined with the weakening of periodontal tissue integrity and functional overload on teeth caused by applied forces, contribute to the development of inflammation in periodontal tissues. The purpose of this review was to assess the impact of orthodontic appliances on periodontal tissues and oral microflora. Specifically, we explored the role of orthodontic treatment in triggering inflammatory processes, gingival enlargement, and compromised oral hygiene. Moreover, we emphasized the significance of preventive and prophylactic measures to mitigate these effects and preserve oral health during orthodontic treatment. We used the Google Scholar, PubMed, and ScienceDirect databases to gather articles for our review. Articles addressing the significance of preventive measures in orthodontic patients were also included. In total, 80 articles were reviewd, with 33 of them selected for in-depth analysis. The review revealed both removable and fixed orthodontic appliances significantly influence the oral environment and significantly alter oral status. These changes impact the qualitative and quantitative variables of the oral microbiome and may result into the onset of inflammatory processes. Due to the deteriorated oral hygiene contributed by the presence of these appliances Inflammatory processes were initiated in the periodontal tissues, manifesting as teeth-gingival junction disorders, bleeding, and gingival overgrowth.
Our findings highlight that it is essential to assess the status of the oral cavity and the health of the periodontal tissues before initiating orthodontic treatment. The quality of oral hygiene must be of utter importance. An individualized protocol should be established, with prophylactic and preventive measures implemented throughout the treatment process. This approach helps maintain a healthy oral microflora and prevents both qualitative and quantitative changes that can lead to inflammatory processes of the periodontal tissues and gingival overgrowth.