Fixed Orthodontic Appliance Associated With Change in Bacterial
Diversity During First Stage of Active Orthodonotic Treatment.
Ahmed S. Al-Janabi1*, Zainab K. Al-Mahdi1, Wisam W. Alhamadi2, Qasim H.
AlWaili³
1. College of Dentistry, University of Babylon, Hilla City, Iraq.
2. Faculty of Dentistry, University of Misan /Iraq.
3. Ministry of Health/Iraq.
*Corresponding Author: Ahmed S. Al-Janabi
Abstract
Background: some researchers have noted that fixed orthodontic appliance (FOA) have stirring on oral hygiene
that lead to high cariogenic challenge. Moreover, based on the difficulty of maintaining oral hygiene, it can
also affect germs under the gums by orthodontic devices, These variables would probably lead to the
colonization of pathogenic bacteria, which are responsible for inflammation of the gingival, destruction of the
periodontal support and changes in the enamel surface. Objective: Isolation and identification of bacteria
among orthodonotic patients at progressive time during first stage of active orthodonotic treatment and
molecular identification of highly cariogenic bacteria Streptococcus mutans as well as an in vitro evaluation of
antibiotic sensitivity/resistance for bacterial isolates. Material and Methods: Sixty-five patients treated with
fixed orthodontic appliance (FOA) their age between 12-25 years. Imprint swab samples were collected
between brackets on the tooth surface monthly at zero day, 1st, 2nd and 3rd to be cultured aerobically and
anaerobically. Bacterial isolated were identified in all age groups at progressive time. Molecular detection of
S.mutans was performed using species specific primer Sm 479. The antibiotics sensitivity were done by use
Kirby- Bauer disc diffusion method for bacterial isolates, the antibiotic selected was most common antibiotic
used during orthodontic infection ( amoxicillin, amoxi-clav, cefotaxim, erythromycin and ciprofloxacin).
Results: A total 186 bacterial isolates were obtained from 65 sample of tooth swabs in zero day (immediately
after orthodontic device appliance) and 183 bacterial isolates were obtain at first month after wearing
orthodontic device, while 195 bacterial isolates were obtained at second month after wearing the device, in the
last visit (3rd month after put orthodontic device) 202 bacterial isolates were obtained, and all samples give
positive bacterial culture as shows in table (2). Also the result shows that Staphylococcus spp. was the most
bacterial isolates appear in patients with fixed orthodontic appliance (FOA). The study indicated neglected
statistically significant difference over progressive time except alpha and beta streptococci and P.aurginosa
according to Chi-square test. The bacterial isolated during this study include Staphylococcus (S. epidermidis
and S.aurus), Lactobacillus spp., Streptococcus (alpha, beta, and gamma), E.coli, Klibsilla spp., Enterobacter
spp., and P.aurginosa. Species specific primer Sm 479F/R using polymerase chain reaction (PCR) indicated
that S.mutans was detected and increased from 60% at zero day to 80% at 3rd month. The antibiotic sensitivity
test recorded that ciprofloxacin and amoxi-clav shows high effective against bacterial isolates. Conclusion: The
studies conclude that oral cavity colonized by large number of microorganisms that contribute in infection
during orthodontic treatment. Staphylococcus (aurus and epidermidis) was the most common bacteria isolated
from patients during initial stage of orthodontic treatment which appear in (81.5%) of the total isolates
followed by Lactobacillus spp. and then streptococcus spp. which appear non-statistically significant difference
(p ?0.05) among progress with treatment. The most common gram negative bacteria in zero day is E.coli (20%),
Klibsilla (18%), Enterobacter spp.(20.8) while pseudomonas aeriginosa (10.6) and also shows non-statistically
difference except P.aurginosa, The flora exists in harmony with the host but this relation may be broken due
to orthodontic device. The molecular detection of S.mutans by species specific primer shows increase in
percentage from 60% in zero days to 80% in third month. All gram positive showed high level of susceptibility
to amoxi-clav followed by ciprofloxacin and cefotaxime while gram negative show high sensitive to
erythromycin followed by ciprofloxacin and cefotaxime.