Permanent brace, loose brace or better no one at all?

Question

Hello,
I am a dentist and I am working in an orthodontist's office. We are treating at the moment a patient with CF (12-years old). Oral hygiene is not optimal but she wants absolutely to have her teeth done. Our question would be if we would do harm to the patient with a loose or permanent brace respectively which one would be better because of the germs that we have in the office in general as well as the germs which occur in the oral cavity respectively can multiply in the oral cavity during usage of a brace.
Many thanks in advance

Answer

Dear collegue,
an increased risk of caries in case of an orhtodontic treatment with permanent brackets and ligaments is existent due to the more complicated possibilities of cleaning and to a lesser extent due to the illness of CF.
An increased risk would occur if your patient had few or very viscous saliva, which you could clarify possibly with a determination of the saliva flow rate.
In case of an only moderate oral hygiene and a reduced, viscous saliva a permanent orthodontic therapy would be problematic and then for sure a loose brace would be more suitable. These are also well suitable for CF patients. However, hereby a rigorous cleaning and maintentance of the devices is of course equally important. It is recommendable to give the instruction to store the device dryly in case of non-usage due to the risk of multiplication of germs respectively formation of algae in case of storage in humid environment.
CF patients can be treated at the dentist or orthodonist as all other patients; a problem is however the water, that can be contaminated in our treating units and be a source of Pseudomonas, these are dangerous for the CF patients. There is a guideline in process on this topic. I try to do it like this in my office:
a) Running of a disinfection system in the treating chairs
b) Regular microbiological controls of the water
c) Before treatment, flushing of all water containing systems for 1-2 minutes
d) Not filling the cup for rinsing the mouth at the treatment unit but at the tap of the sink
e) Usage of sterile sodium chloride solution during treatment e.g. preparation ("drilling"); this works only with a "surgical motor"
f) Removal of dental calculus and deposits preferably with manual instruments; ultrasound only if necessary
g) Instead of multifunctional syringe, single-use syringe and wide canule with sodium chloride solution or fresh water from the tap

Many greetings
Michael Sies

19.04.2013