As the goals of orthodontics evolve and treatment modalities expand, we find ourselves offering orthodontic therapy to patients in every age group. The American Association of Orthodontics recommends every patient be seen by an orthodontist for an evaluation by age 7.¹ Some orthodontists interceptively treat patients with growth aberrations as early as 3 years of age.² Early evaluation and treatment provides an enhanced opportunity for successful outcomes in the management of growth and development, space preservation and facial balance. Newer research demonstrates that orthodontic expansion may play a role in the elimination of nocturnal enuresis (bed-wetting)³, ADD, ADHD4 as well as the elimination of snoring and sleep apnea.⁵ As we observe the profession moving toward earlier referral, we must recognize the value a dental hygienist has in assisting these younger patients with oral hygiene instruction, patient education and behavioral modification.

Periodontal considerations of the orthodontic patient are a top priority. The association between malocclusion and periodontal challenge is well established.⁷ It is also well documented that periodontal health is a necessity for safe, efficient and effective tooth movement.⁸ Early in my career, circa 1985-ish, I was faced with patients who wore orthodontic appliances and struggled with periodontal compromise. I referred these patients to general dentists and their hygienist for tissue management and therapy. Often times, I met resistance as I was repeatedly advised, “We will handle the tissue when the appliances are removed.” Extremely frustrated (as I was confident the active infection required immediate attention), I referred these same periodontally-challenged orthodontic patients to the periodontist. When I encountered a similar disinterest in managing the soft tissue infection (while the brackets/appliances were in place), I knew I had to take matters into my own hands.

Don’t let old boundaries prevent you from delivering the care your patients need. Every orthodontic patient is a perio patient.

So what’s the best advice to offer a dental hygienist treating the orthodontic patient? Embrace the paradigm that the orthodontic patient is a perio patient! Once you transcend that barrier, you will intuitively know how to treat these patients’ unique but comprehensive needs. Remember, fixed appliances don’t eliminate the need to take routine x-rays. Consider recommending sealants on all molars and bicuspids because of increased caries risk. Assume the ortho/perio patient will require a more frequent recare interval due to the bacterial challenge. Address gingival inflammation as it occurs, while the appliances are in place. If scaling and root planing is indicated, do it. Jump all over your remineralization protocols, before, during and after orthodontic treatment.

As the role of the dental hygienist expands, it is important to remember the responsibility we have to provide comprehensive care to each of our patients. The orthodontic patient presents hard and soft tissue challenges that should be managed by the trained professional. Time and consideration must be given to these necessities so optimum oral health is the final outcome. As dental hygienists, we have a wonderful opportunity yet critical responsibility to counsel our patients about the importance of living healthier lives through meticulous oral healthcare. No patient is more deserving of our effort than the orthodontically-challenged patient.