Debunking the Myth of Superior Oral Hygiene
with Invisalign.
With
the advent of direct advertising to the public, one item that has continuously been
claimed is that Clear Aligners such as Invisalign, Clear Correct, ClearPath or
a dozen other brands provide better oral hygiene for orthodontic patients. This mantra has been echoed by dentists
working to compete against their specialist colleagues offering true
traditional orthodontics with braces and other appliances. But is this based in truth or just another
hollow advertising promise by the companies and dentists providing these other
products? Let’s look at one such ad from
an aligner company:
First,
no one is doubting the esthetics of clear aligners; and they can move teeth into better alignment,
just not as quickly, not as efficient and certainly not to the same degree in
many, many cases. Additionally the idea/myth of
minimal appointments and few visits should be a red flag pointing to the fact
that they are used as a mail-order type of appliance with little oversight by
dental assistants (often trained in a few minutes to place aligners) and even
less from the doctors themselves.
And
teeth, believe it or not, will not move faster because of an aligner, ever. That is because aligners are removable and
they get loose from function in the mouth and constant removal and replacement.
In
fact, there are many studies that debunk much of the advertising concerning
aligners (see previous Blog article Does
Invisalign work?) so these companies have skipped the Orthodontists and advertise directly to General Dentists and the public through TV ads and radio.
Putting
that aside, I want to focus on the advertisement claim of “No Effect on Oral
Hygiene” and the most current research to address this myth.
In the
February 2018 issue of the American Journal of Orthodontics and Dentofacial
Orthopedics (AJODO), this very question has been answered with a prospective,
randomized clinical trial comparing not only clear aligners with traditional
braces, but also traditional braces with self-ligating braces (also a company
that has claimed better oral hygiene). (1)
“No evidence of differences in oral hygiene levels among clear
aligners, self-ligating brackets, and traditional elastomeric ligated brackets
after 18 months of active orthodontic treatment.”(1)
“The observations made in this study contradict popular beliefs that removable appliances have a minimal effect on
periodontal health”
This
study was set up using 71 patients (41 boys, 30 girls with a mean age of 15.6
years old). 27 patients were treated
with Invisalign aligners, 22 patients were treated with self-ligating braces
and the last 22 patients were treated with traditional braces.
Oral
hygiene was studied before treatment, at 9mo into treatment, and 18mo after
treatment.
Results
revealed “No evidence of differences in oral hygiene levels among clear
aligners, self-ligating brackets, and traditional elastomeric ligated brackets
after 18 months of active orthodontic treatment.”
In fact, the
researches point out that “The
observations made in this study contradict popular beliefs that removable
appliances have a minimal effect on periodontal health”
In discussion, the authors point out that
this confirms previous research that covering the teeth with aligners prevents
self-cleaning effects of tongue and saliva (below).
“The
continuous coverage of all surfaces of the teeth including 1 to 2 mm of
gingiva by aligners has been shown to prevent the flushing effect of saliva on
dental tissues” (2)
It is also mentioned from other previous
studies that, “insufficient saliva
secretion reduces the self-cleansing mechanisms of the oral cavity and limits
the antimicrobial effects of the residual saliva. This can
potentially lead to greater accumulation of dental plaque. Furthermore, the
margins of aligners are almost never perfectly smooth. This can irritate the
marginal gingiva.” (3, 4)
So
once again, even though you may hear it and see it in advertisements, online
resources or even word of mouth, true research shows that oral hygiene concerns
should not be a factor in choosing aligners v. traditional true Orthodontics
(i.e. Braces).
* https://doi.org/10.1016/j.ajodo.2017.10.009
1. Aditya Chhibber,a
Sachin Agarwal,b Sumit Yadav,c Chia-Ling Kuo,d and Madhur Upadhyayc
Norwalk,
Ohio, Melbourne, Australia, and Farmington, Conn, Which orthodontic appliance is best for oral hygiene? A randomized
clinical trial, (Am J Orthod Dentofacial Orthop
2018;153:175-83)
2. Addy, M., Shaw, W.C., Hansford, P., and Hopkins, M. The effect of orthodontic appliances on the
distribution of Candida and plaque in adolescents. Br J Orthod. 1982; 9: 158–163
3. Lara-Carrillo, E., Montiel-Bastida, N.M., Sánchez-Pérez,
L., and Alanís-Tavira, J. Effect of orthodontic treatment on saliva, plaque and the
levels of Streptococcus mutans and Lactobacillus. Med Oral Patol Oral Cir Bucal. 2010; 15: e924–e929
4. Türköz, C., Canigür Bavbek, N., Kale Varlik, S., and
Akça, G. Influence of thermoplastic retainers on Streptococcus mutans and
Lactobacillus adhesion. Am J Orthod Dentofacial Orthop. 2012; 141: 598–603
If you have questions or comments concerning this or any
orthodontic question, please feel free to make a complimentary new-patient
appointment at either my Steiner Ranch location or my North-central Austin
location on West 35th street and MoPac.
Dr. James R. Waters is
a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of
Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian
graduate from the prestigious Saint Louis University Orthodontic Program
receiving the J.P. Marshall award for clinical excellence in 2001. He holds a Bachelor’s Degree in Science,
Doctorate in Dental Surgery, a post-doctorate certificate in Advanced
Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics
and a Master of Science Degree in Orthodontics and is a Diplomate of the
American Board of Orthodontics. Dr.
Waters and his wife of 20 years live in Austin, TX with their 4 children where
he has a thriving, multi-faceted Specialist practice with locations in Steiner
Ranch and North-Central Austin. You can
learn more about Dr. Waters at BracesAustin.com.
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