Title	In Pediatric Patients, Use of Removable Orthodontic Appliances May Lead to an Increased Risk of Dental Caries
Clinical Question	In pediatric patients, does use of a removable orthodontic appliance increase the risk of dental caries?
Clinical Bottom Line	The use of removable appliances is another variable to consider when determining the caries risk status of patients, as these patients have been found to harbor a higher frequency of the caries-promoting bacteria Streptococcus mutans.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 11767275 Batoni/2001 147 patients aged 8-10 years Cross Sectional Study Key results S. mutans, which is associated with the onset of dental caries, was isolated in more children who had been using removable appliances for at least 6 months (n=53) (60.4%) compared to the control group of children who have never undergone orthodontic therapies (n=94) (47.8%), but not at statistically significant levels (P > 0.05). However, S. mutans was isolated at a statistically significant (P<0.01) higher frequency on the occlusal surfaces of teeth in currently caries-free pediatric patients that use removable orthodontic appliances (83.3%) compared to the control group (34.1%). This increased frequency of caries causing bacteria could put those patients who use removable orthodontic appliances at higher risk for developing dental caries.
Evidence Search	"Orthodontic Appliances, Removable"[Mesh] AND "Dental Caries"[Mesh]
Comments on The Evidence	Validity: The study above has a reasonable expectation of good validity, as patient groups were similar at the start of the study, and patient groups were treated the same. However, it is not stated if the study’s investigators were blinded to the patient’s orthodontic appliance status or if there were competing interests. Completion rate of the participants, patient follow-up, compliance, and recall bias did not play a role in this study, based on the study design. Perspective: Long-term studies are needed to determine the caries incidence in patients wearing removable orthodontic appliances, as opposed to simply their S. mutans frequency. However, orthodontic patients who use removable appliances should still be carefully monitored for caries development.
Applicability	This study used subjects that would be a good representation of pediatric patients who are old enough for removable orthodontic appliance use, as the 147 patients included in the study were 8-10 years old. Adding in use of a removable orthodontic appliance as an additional factor to consider in patients caries risk status should be feasible in any dental office setting, as pediatric patients caries risk status and caries development is closely monitored at each appointment anyway.
Specialty	(Orthodontics) (Pediatric Dentistry)
Keywords	Caries risk, Orthodontics
ID#	2816
Date of submission	03/30/2015
E-mail	fortanely@livemail.uthscsa.edu
Author	Beatriz E. Fortanely
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kelly C. Lemke, DDS
Faculty mentor e-mail	LemkeK@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available