In vivo investigation of gingival health and oxidative stress changes in patients undergoing orthodontic treatment with and without fluoride use

Abstract

Background and Aims: We aimed to investigate gingival index changes and oxidative stress in orthodontic patients with and without the use of fluoridated agents over a 6-month period. Materials and Methods: Ninety subjects divided into three groups (30 untreated controls, 30 with fixed appliances using nonfluoridated toothpaste, and 30 with fixed appliances using fluoridated toothpastes and mouthwashes) comprised the sample. The Loe gingival index was used to rank gingival health at four specific time periods in the groups to determine differences (before, at 7 days, 30 days, and 6 months). Gingival crevicular fluid was evaluated for cytokines (interleukin [IL]-1ß and tumor necrosis factor [TNF]-a) to determine differences in oxidative status between the groups. Results: Controls showed no changes in gingival index throughout the 6-month observation period. There was a deterioration in gingival health in both the fluoridated and nonfluoridated groups till 6 months. IL-1ß levels in the fluoridated group increased from the 7 th day, reached a peak at 30 days, and remained slightly elevated at 6 months. The nonfluoridated group also showed elevated levels at all tested time periods, but levels were lower as compared to fluoridated samples. The differences in IL-1ß values between the fluoridated and nonfluoridated treated groups were significant. TNF-a levels in the three groups also showed a similar pattern with elevated levels seen in both the treated groups at the 7 th, 30-day, and 6-month periods. The fluoridated group showed the highest levels at three time periods which was statistically significant. Conclusions: Gingival health of subjects treated with fixed orthodontic appliances deteriorated from appliance placement till a 6-month time period. Cytokines such as IL-1ß and TNF-a associated with oxidative stress during orthodontic treatment increased in both the treated groups, with higher levels in fluoridated subjects. Long-Term consequences of oxidative stress changes need further investigation.