Effect of professional flossing with chlorhexidine gel on approximal caries in 12- to 15-year-old schoolchildren

The aim of the investigation was to evaluate the effect of chlorhexidine gel treatment on caries development of approximal tooth surfaces and on salivary counts of Streptococcus mutans. 220 12-year-old schoolchildren, divided into three groups, participated: (1) chlorhexidine gel group (n = 72), (2) placebo gel group (n = 77), and (3) control group (n = 71). The study was carried out double blind with respect to the two gel groups. Group 1 was treated 4 times/year with 1% chlorhexidine gel and group 2 with a placebo gel. Approximately 1 ml of gel was applied interdentally by means of a flat dental floss. The control group did not receive any gel treatment or flossing. Number of S. mutans in the saliva was estimated on five occasions during the study with the spatula method. After 3 years, the mean approximal caries increment, expressed as new DFS, was 2.50 in the chlorhexidine gel group and 4.30 in the placebo gel group (p less than 0.05). The corresponding figure in the control group was 5.25 (p less than 0.001 when compared to group 1). 44% of the children in the chlorhexidine gel group and 32% in the placebo gel group did not develop any new approximal caries lesion during the 3-year observation period compared to 18% in the control group (group 1-3 p less than 0.001; group 2-3 p less than 0.05). The number of new approximal fillings (FS) was 0.24 in the chlorhexidine gel group, 0.75 in the placebo gel group and 0.82 in the control group (group 1-3 p less than 0.01; group 2-3 p less than 0.05). There was no statistically significant difference between the groups with respect to numbers of S. mutans in saliva. However, there were more individuals with low numbers of S. mutans in the chlorhexidine gel group at the final examination compared to the baseline level (p less than 0.05).     

Microbial aspects of preventive regimes in patients with overdentures

The aim of this study was to test effects of preventive regimes using fluoride and chlorhexidine to prevent caries and periodontal diseases in 34 patients with overdentures. The patients, who were treated with immediate overdentures, were distributed at random into three experimental groups. In these groups, different gels--a placebo, a fluoride, and a chlorhexidine-fluoride gel--were tested by daily application. Supragingival plaque samples from selected surfaces of two abutment teeth were taken at one week, and at one, three, and six months after initial insertion of the overdenture. The placebo and fluoride gel influenced neither total CFU nor S. sanguis and A. viscosus/naeslundii counts. In the placebo group, but not in the fluoride group, S. mutans levels increased significantly, indicating the caries risk involved in overdentures. The use of chlorhexidine-fluoride gel resulted in a long-term suppression of total CFU. Further, S. mutans was found to be selectively suppressed to below detection level. A. viscosus/naeslundii was initially strongly suppressed, but after three months a partial return of the population was noticed. S. sanguis was relatively insensitive to the chlorhexidine-fluoride gel. It is concluded that a daily application of a chlorhexidine-fluoride gel is effective against plaque formation and S. mutans on abutment teeth in overdentures.     

Effect of toothbrushing with chlorhexidine gel on salivary microflora, oral hygiene, and caries

abstract – The effect of daily toothbrushing with 0.5 % chlorhexidine-containing gel for 12 months was evaluated in a double-blind study in 37 dental students. The active gel did not markedly influence plaque formation, gingival conditions, or caries as compared with placebo gel treatment. Salivary bacterial counts were performed on subgroups of six subjects using chlorhexidine gel and on six using placebo gel. No differences in the effect of treatment on the microorganisms studied in the two subgroups could be detected except for S. sanguis . The percentage of this species decreased in the placebo group and increased in the chlorhexidine group. The difference became significant after 2 weeks. A tendency to a greater reduction of S. mutans noted in the chlorhexidine group was most marked in individuals who had high initial counts of this species. The proportion of S. sanguis , which could grow on chlorhexidine-containing mitis salivarius medium, increased and after 12 months of chlorhexidine treatment averaged 34 % of cultivable S. sanguis compared with 0.002 % prior to treatment. The number of less sensitive S. sanguis decreased in the 12 months following termination of treatment. There was no observed tendency for the selection or proliferation of other streptococci, gram-negative rods, yeasts, or staphylococci.     

Lack of effect of chlorhexidine varnish on Streptococcus mutans transmission and caries in mothers and children

In a randomized clinical trial, we evaluated the effect of a 10% chlorhexidine varnish (Chlorzoin) on the mother-child transmission of Streptococcus mutans and on subsequent caries experience. Chlorhexidine (n = 38) or a placebo varnish (n = 37) was applied to the dentitions of 75 mothers at a time when their first babies were about 6 months old (approximate time of first tooth emergence). Three more applications at weekly intervals and subsequent applications at 6-month intervals followed the initial application. The mother-child pairs were followed up until the child's fourth birthday. Maternal salivary S. mutans levels in the treatment group remained significantly lower (p < 0.05) compared to the control group up to 12 months after the initial application. However, this intervention did not significantly alter the S. mutans colonization in children or the caries increment in either the mother or the child.     

A longitudinal study of 0.2% chlorhexidine gel for removal of mutans streptococci infection in preschool children

BACKGROUND: The purpose of the present longitudinal study was to determine the effectiveness of 0.2% chlorhexidine (CHX) in removing mutans streptococci (MS) in a treatment cohort of caries-free, preschool children. METHODS: Thirty-six children with mean age 38.6 +/- 15.9 months who had MS infection brushed once daily with 0.2% chlorhexidine (CHX) gel for a period of 6-12 months. The children were examined every three months to assess their oral hygiene and dietary habits and MS status using a commercial microbiological kit. RESULTS: The percentages of children who eliminated MS from their mouths increased from 28 per cent after three months to 48 per cent after six months and over 70 per cent after 12 months of gel use (p = 0.039). Compliance of brushing with CHX gel was significantly associated with MS removal after six months gel use (p < 0.02). At the three and six month recalls, sugar snacks and increased sugar frequency were associated with continued presence of MS (p = 0.03 and p = 0.007). After three months cessation of CHX use, 13 (45 per cent) remained MS free (p = 0.003). CONCLUSIONS: This pilot study involving caries-free preschoolers with MS shows the potential of chlorhexidine gel to remove MS for the limited duration of study.     

Effect of oil pulling on Streptococcus mutans count in plaque and saliva using Dentocult SM Strip mutans test: a randomized, controlled, triple-blind study

Background: Oil pulling has been used extensively for many years, without scientific evidence or proof, as a traditional Indian folk remedy to prevent teeth decay, oral malodor, bleeding gums, dryness of throat and cracked lips, and for strengthening the teeth, gums, and jaws. Aims: The aim of this study was to evaluate the effect of oil pulling with sesame oil on the count of Streptococcus mutans in plaque and saliva of children, using the Dentocult SM Strip mutans test, and to compare its efficacy with that of chlorhexidine mouthwash. Materials and Methods: Twenty age-matched adolescent boys were selected based on information obtained through a questionnaire. They were divided randomly into two groups: the control or chlorhexidine group (group I) and the study or oil pulling group (group II); there were ten subjects in each group. Plaque and saliva samples were collected from all the 20 subjects on the strips from the Dentocult SM kit and, after incubation, the presence of S. mutans was evaluated using the manufacturers' chart. The study group practiced oil pulling with sesame oil and the control group used chlorhexidine mouthwash for 10 min every day in the morning before brushing. Samples were collected from both groups after 24 h, 48 h, 1 week, and 2 weeks and the efficacy of oil pulling was compared with that of chlorhexidine mouthwash. Results: There was a reduction in the S. mutans count in the plaque and saliva samples of both the study and the control groups. The reduction in the S. mutans count in the plaque of the study group was statistically significant after 1 and 2 weeks (P = 0.01 and P = 0.008, respectively); the control group showed significant reduction at all the four time points (P = 0.01, P = 0.04, P = 0.005, and P = 0.005, respectively, at 24 h, 48 h, 1 week, and 2 weeks). In the saliva samples, significant reduction in S. mutans count was seen in the control group at 48 h, 1 week, and 2 weeks (P = 0.02, P = 0.02, P = 0.008, respectively). Conclusion: Oil pulling can be used as an effective preventive adjunct in maintaining and improving oral health.     

Prolonged oral reduction of Streptococcus mutans in humans after chlorhexidine disinfection followed by fluoride treatment

The effect of oral chlorhexidine gel treatment supplemented with fluoride applications was studied in subjects with high salivary levels of S. mutans. In two experiments short-term treatment with a 1% chlorhexidine gel was followed by applications of either a 1% NaF gel daily for 2 weeks or a 1% NaF gel daily for 6 weeks supplemented twice with topical application of an 8% SnF2 solution. The salivary numbers of S. mutans were lower in the test group than in the placebo group after 6 and 12 weeks in experiments 1 and 2, respectively, and considerably lower than the pretreatment values. The findings show that fluoride applications can be a valuable adjunct to chlorhexidine treatment for combatting S. mutans.     

Prolonged oral reduction of Streptococcus mutans in humans after chlorhexidine disinfection followed by fluoride treatment

Abstract – The effect of oral chlorhexidine gel treatment supplemented with fluoride applications was studied in subjects with high salivary levels of S. mutans. In two experiments short-term treatment with a 1% chlorhexidine gel was followed by applications of either a 1% NaF gel daily for 2 weeks or a 1% NaF gel daily for 6 weeks supplemented twice with topical application of an 8% SnF₂ solution. The salivary numbers of S. mutans were lower in the test group than in the placebo group after 6 and 12 weeks in experiments 1 and 2, respectively, and considerably lower than the pretreatment values. The findings show that fluoride applications can be a valuable adjunct to chlorhexidine treatment for combatting S. mutans.     

Effect of a chlorhexidine varnish on Streptococcus mutans in saliva

The aim of the present work was to evaluate the effect of a thymol/chlorhexidine varnish at 1% on Streptococcus mutans (S. mutans) in saliva applied after teaching and evaluating an oral hygiene technique and dressing the cavities to reduce the bacterial load. Streptococcus mutans levels in saliva samples and dental status were evaluated in 38 girls between 6 and 13 years of age with high risk of caries. The girls were then trained and assessed in oral hygiene. On day seven, oral hygiene assessment was repeated and supragingival plaque control was performed. After 15 days (day 21) another culture was performed and the level of S. mutans in saliva samples was determined. Evaluation and reinforcement of the oral hygiene technique were repeated and the cavities were dressed to reduce the bacterial load. At 36 days from the onset of the experiment, culture S. mutans counts were performed; evaluation and reinforcement of the oral hygiene technique were undertaken and the girls were divided randomly into two groups: 1 The teeth of the experimental group were painted with a varnish containing 1% chlorhexidine and thymol. 2 The teeth of the control group were painted with a placebo varnish containing only thymol. After a further 15 days (day 51), another culture and S. mutans counts were performed. The results showed a gradual reduction in the S. mutans counts in saliva in each subsequent experimental period analyzed. Significant differences between the experimental group and the control group were recorded after treatment. It can be concluded that the levels of S. mutans decreased in each subsequent experimental period and that the application of a 1% chlorhexidine varnish elicited a significant reduction in S. mutans levels.     

The effect of chlorhexidine varnish treatment on salivary mutans streptococcal levels in child orthodontic patients.

A chlorhexidine dental varnish was applied to the teeth of 26 children, ten to 17 years of age, in an attempt to limit the increase in colonization by mutans streptococci that normally accompanies the placement of fixed orthodontic appliances and to assess the acceptance of the application procedure. Despite the insertion of the appliances in the month following the varnish application, the numbers of detectable salivary mutans streptococci in the children were found to remain significantly lower than baseline values for seven months (p less than 0.01). Among the 26 children, 16 exhibited high counts (greater than 2.5 x 10(5) cfu/mL saliva) at baseline, but none exhibited such counts until three months post-treatment, when one child did. By seven months, eight children had high counts. No significant difference in effectiveness was observed between varnish formulations containing 10% or 20% chlorhexidine acetate, or between children of different ages or past caries experience. The lack of drop-outs and the results of a questionnaire indicated that acceptance of the treatment by the children was excellent. The study indicates that chlorhexidine varnish therapy was acceptable to the children and was effective in suppressing oral mutans streptococcal levels for long periods, even when used prior to the placement of fixed orthodontic appliances.     

Effects of chlorhexidine-fluoride gel treatments in mothers on the establishment of mutans streptococci in primary teeth and the development of dental caries in children.

In a longitudinal 3-year study, 151 children were followed for the colonization of the primary dentition by mutans streptococci (MS) and for the development of dental caries. At the age of 1 year, the child-mother pairs were divided into three groups on the basis of the levels of MS in maternal saliva. In the experimental group, the mothers had MS levels higher than 10(5) CFU/ml, and they were given chlorhexidine (1%)-sodium fluoride (0.2%) gel treatments twice a year for 3 years. Two control groups were formed. In control group 1, the mothers also had high levels of MS, but no gel was given. In control group 2, the mothers had low (< 10(5) CFU/ml) baseline levels of salivary MS, and no chlorhexidine-fluoride gel was used. In the total study population, 16, 42, and 54% of the children were colonized by MS by the age of 2, 3, and 4 years, respectively. Most children harbored only Streptococcus mutans, but 2 had both S. mutans and Streptococcus sobrinus, and 2 had only S. sobrinus. Twenty-eight percent of the MS-positive children developed caries by the age of 4 years, whereas 4 out of 27 children with dental caries did not have any detectable MS in their plaque samples. Both the colonization by MS and the caries incidence were highest in control group 1 and lower in the experimental group and in control group 2. These observations suggest that the reduction of maternal salivary MS at the time of tooth emergence may delay, or perhaps even prevent, the colonization of MS in the children's primary dentition with a concomitant decline in caries incidence, even in a population with an already low prevalence of dental caries.     

Preventing the transfer of Streptococcus mutans from primary molars to permanent first molars using chlorhexidine

PURPOSE: The purpose of this study was to determine if the application of 1% chlorhexidine-containing wax on primary molars during the period of eruption of the first permanent molars could prevent the transfer of certain oral flora, namely Streptococcus mutans, to the permanent molars. METHODS: Fourteen children with a mean age of 6.5 years (7 males and 7 females) were assigned into two groups: a chlorhexidine group (n=9) in which 1% chlorhexidine-containing wax was painted on primary molars on one side of the mouth; and a placebo wax group (n=5) in which a similar wax, but without chlorhexidine, was painted on primary molars on the other side of the mouth. Baseline saliva samples and pooled plaque samples from the primary molars on both sides of the dentition were obtained from the two treatment groups. Following treatment, plaque samples from the occlusal fissures of the first permanent molars on both sides of the dentition were obtained. The levels of S.mutans and other members of the oral flora on the treated sides (chlorhexidine or placebo) were compared with those on the untreated sides. RESULTS: The results showed that the proportions of S.mutans to S.sanguinis were significantly lower in the chlorhexidine-treated sides compared to the untreated (P=0.04) and in the chlorhexidine-treated patients compared to placebo (P=0.029). CONCLUSIONS: Since lower mutans to sanguinis ratios have been associated with lower caries experience, treating primary molars with 1% chlorhexidine wax during eruption of permanent first molars may be a simple means for shifting the fissure flora of the permanent molars towards a more favorable balance.     

Effects of highly concentrated stannous fluoride and chlorhexidine regimes on human dental plaque flora

The aim of this study was to determine the effect of an intensive antimicrobial treatment on the number of Streptococcus mutans, Streptococcus sanguis, Actinomyces viscosus/Actinomyces naeslundii, and the total Colony-forming Units (CFU) in plaque. The dentition of human volunteers was treated in a dental office with either chlorhexidine (5%) or stannous fluoride (8%). Following the office treatment with chlorhexidine, selected volunteers rinsed daily at home for seven or 49 days with chlorhexidine solution (0.2%), while another group flossed daily at home for seven days with dental floss impregnated with chlorhexidine. On days one, seven, 21, 35, and 49 after the local applications, we took saliva samples and plaque samples from fissures, smooth surfaces, and approximal areas. Chlorhexidine and stannous fluoride suppressed S. mutans and the Actinomyces species on all surfaces and in saliva. S. mutans on tooth surfaces was suppressed for approximately seven days and returned to the baseline level at day 21. A. viscosus/naeslundii was suppressed for more than seven days on the teeth. S. sanguis and the total CFU returned to the baseline level within seven days on all surfaces and in saliva. Rinsing or flossing with chlorhexidine suppressed S. mutans during the period of time that these supplements were used. Brushing for seven days with chlorhexidine gel (1%) without a preceding intensive chlorhexidine treatment had virtually no effect on S. mutans in approximal areas and in saliva, but suppressed S. mutans in fissures and on smooth surfaces.     

The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients A randomized prospective study part II: Bacteriological parameters

In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1±1.5 years) were evaluated twice over 2-day test periods. In the randomized, double-blind study the influences of a 0.2% chlorhexidine mouthrinse (Corsodyl^®, CHX) and a commercially available dentrifice supplementing fluoride (Odol-med-3^®) were compared intra- and interindividually in a crossover design with regard to the bacteriological parameters. The bacteriological parameters of vital fluorescence, bacteriological counts (BC), colony forming units (CFU), plating efficiency (PE) and mutans streptococci (MS) were related to the clinically assessed indices of plaque and gingivitis.All parameters analyzed demonstrated significant differences between the control and the test (chlorhexidine) group. Where-as the values of BC, CFU, and PE progressively increased in the control group from T0 to T2, these parameters distinctly decreased in the chlorhexidine group. All values of vital flora (VF) scored around 75% in the control group compared to values of 30% in the test group. BC, CFU und PE correlated significantly. The score of mutans streptococci persisted or increased in the controls whereas mutans streptococci approached 0 in the chlorhexidine group. Until the 5th day of washout a clear-cut carry over of the chlorhexidine rinse on mutans streptococci as well as on the gingival index was evident.     

Effect of intensive treatment with chlorhexidine on number of Streptococcus mutans in saliva

The effect of intensive treatment with chlorhexidine on the number of S. mutans in saliva was studied in 24 schoolchildren highly infected with this organism. Chlorhexidine gel in individual dental trays was applied under supervision on two consecutive days, four times the first day and three times the second day. The number of S. mutans in saliva was monitored for 6 months. Immediately after treatment, the number was greatly reduced in all of the children. Thirty days after treatment only three children had more than 2 X 10(5) S. mutans/ml saliva, and after 4 months, 11 children still had less than 2 X 10(5) S. mutans/ml saliva. After 6 months the effect of the treatment was obvious in 20% of the children. The results indicate that intensive treatment with chlorhexidine can be used to reduce the S. mutans infection. The antimicrobial treatment, however, should be individually controlled because of variations in the response of the subjects.     

Clinical and microbiological effects of chlorhexidine and arginine sustained-release varnishes in the mentally retarded

Local applications of sustained-released varnishes of chlorhexidine and arginine were used in a controlled pilot study of 34 mentally retarded patients, ages 18–45, assigned to one of these groups: chlorhexidine (C), arginine (A), or placebo (P). A professional scaling followed by four weeks of professional brushing to reach a Plaque Index (PII) and Gingival Index (GI) of 1.0 at baseline preceded eight weeks of daily varnish application to the buccaI and labial surfaces of all teeth. Clinical parameters (PII and GI) and bacterial samples from selected teeth were collected at predetermined intervals. Four and eight weeks following the baseline, the PII was significantly different among the groups, with the lowest score in the chlorhexidine group. No significant differences among the three groups were noted for the GI. The chlorhexidine and arginine groups showed significant reductions (p < 0.05 and p < 0.01, respectively) in the number of S. mutans. The arginine group showed a nonsignificant increase in the number of S. sanguis. These results suggest that the topical antimicrobial agents may have some relevance to plaque control among patients with mental retardation.     

The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients

In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1 +/- 1.5 years) were evaluated twice over 2-day test periods. In the randomized, double-blind study the influences of a 0.2% chlorhexidine mouthrinse (Corsodyl, CHX) and a commercially available dentifrice supplementing fluoride (Odol-med-3) were compared intra- and interindividually in a crossover design with regard to the bacteriological parameters. The bacteriological parameters of vital fluorescence, bacteriological counts (BC), colony forming units (CFU), plating efficiency (PE) and mutans streptococci (MS) were related to the clinically assessed indices of plaque and gingivitis. All parameters analyzed demonstrated significant differences between the control and the test (chlorhexidine) group. Where-as the values of BC, CFU, and PE progressively increased in the control group from T0 to T2, these parameters distinctly decreased in the chlorhexidine group. All values of vital flora (VF) scored around 75% in the control group compared to values of 30% in the test group. BC, CFU und PE correlated significantly. The score of mutans streptococci persisted or increased in the controls whereas mutans streptococci approached 0 in the chlorhexidine group. Until the 5th day of washout a clear-cut carry over of the chlorhexidine rinse on mutans streptococci as well as on the gingival index was evident. Since dead microorganisms remain on the tooth surface and in order to maintain oral health, chlorhexidine application might advisedly be supplemented by mechanical plaque control.     

A longitudinal controlled study of factors associated with mutans streptococci infection and caries lesion initiation in children 21 to 72 months old

PURPOSE: The purpose of this longitudinal study was to determine factors associated with mutans streptococci (MS) infection and development of caries lesions in a group of children 21 to 72 months old. METHODS: The 63 caries-free children, recruited since birth, were divided into: (1) a study group of 24 children who were colonized with MS; and (2) a control group of 39 children without MS. The children were recalled every 3 months for approximately 24 months, and their social, medical, and dental histories were updated. At each recall, the teeth were checked for presence or absence of plaque, enamel hypoplasia, and caries lesions, and their MS status was assessed using a commercial test kit. RESULTS: MS infection was associated with: (1) visible plaque (P < .01); (2) enamel hypoplasia (P < .05); (3) commencement of tooth-brushing after 12 months of age (P < .05); (4) lack of parental assistance with tooth-brushing (P < .025); and (5) increased hours of child care/school (P < .05). Four children (20%) were colonized at an age range of 21 to 36 months, 9 (45%) at 37 to 48 months, and 7 (35%) at 49 to 72 months (P < .001). Eight children who developed caries lesions: (1) had more hypoplastic teeth (P < .001); (2) ate sugar-containing snacks (P < .05); and (3) did not brush regularly with chlorhexidine gel (P < .01) compared to those who remained free of caries lesions. CONCLUSIONS: Lack of oral hygiene, consumption of sugar-containing snacks, and enamel hypoplasia are significant factors for both MS infection and caries lesion initiation.     

The comparative evaluation of the effects of tongue cleaning on salivary levels of mutans streptococci in children

To cite this article:
Int J Dent Hygiene 10 , 2012; 107–112
DOI: 10.1111/j.1601‐5037.2011.00522.x Rupesh S, Winnier JJ, Nayak UA, Rao AP, Reddy V, Peter J. The comparative evaluation of the effects of tongue cleaning on salivary levels of mutans streptococci in children. Abstract: Objectives: The study compared and evaluated the effects of tongue scraping and tongue brushing on salivary mutans streptococci levels in children. Methods: The investigation was a single‐blind, stratified comparison of three parallel groups of children who performed either tongue scraping or tongue brushing along with tooth brushing or only tooth brushing twice daily under professional supervision for a 21‐day period. A total of three saliva samples were taken from each individual, at baseline, on day 10 and on day 21, and colony counts of mutans streptococci were determined. All data were subjected to statistical analysis using Wilcoxon’s signed‐ranks sum test and Mann–Whitney U‐test. Results and conclusions: The results of the present study show that tongue scraping and tongue brushing demonstrated statistically significant reductions in salivary mutans streptococci counts after 10 days and also after 21 days. It was also noted that tongue scraping and tongue brushing were equally effective in reducing colony counts.     

Effect of sustained-release chlorhexidine varnish on Streptococcus mutans and Actinomyces viscosus in orthodontic patients.

This study evaluated the effect of sustained-release chlorhexidine varnish on orthodontic patients. Ten children, ages 10 to 16 years, participated. Bacterial levels of Streptococcus mutans and Actinomyces viscosus and total counts were evaluated in sputum samples. These counts were evaluated at 4 stages: before orthodontic treatment, at least 2 weeks after bonding of the brackets, 1 week after application of chlorhexidine varnish, and 3 weeks after application of chlorhexidine varnish. Increases in bacterial levels of S mutans and in the total bacterial count were detected after the brackets were bonded. One week after the sustained-release chlorhexidine varnish was applied, a significant decrease of total bacterial levels and S mutans was observed. This decrease persisted for 3 weeks after the first application. No significant change in A viscosus levels occurred during that period. The results provide additional evidence that sustained-release chlorhexidine varnish decreases S mutans levels in orthodontic patients with fixed appliances and therefore might be useful in preventing caries lesions.