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I believe the April JADA cover story article by Dr. Anne-Marie Bollen and colleagues, "The Effects of Orthodontic Therapy on Periodontal Health: A Systematic Review of Controlled Evidence" (JADA 2008;139[4]:413–422), is both confusing and misleading. The authors failed to recognize that frequently orthodontic treatment is of great benefit to periodontal health.¹

First, the authors did not separate children from adults. Children tend not to brush and floss and to eat large amounts of simple carbohydrates. Nevertheless, they have a low prevalence of periodontal disease. Straightening their teeth would not necessarily make a low prevalence of periodontal disease even lower. Adults, who might gain the most from orthodontic treatment, were under-represented.

Second, no attempt was made to classify what the malocclusion condition was. While there is little evidence to support that class II malocclusions, deep bites or spacing contribute to periodontal disease, there is overwhelming evidence that crowding does contribute to periodontal disease. Crowding interferes with oral hygiene, traps food particles and changes microflora ecology.^2–5 To group all of these orthodontic conditions together conceals the underlying importance of correcting crowding.

The main cohort who might reap periodontal benefits through orthodontic treatment is adults with crowded teeth. They can be treated effectively with the Invisalign system (Align Technology, Santa Clara, Calif.) without any of the drawbacks of conventional braces, such as plaque trapping and barriers to using dental floss.

It is unfortunate that many students and researchers of the future will find this article on MEDLINE or PubMed and read only the misleading conclusion in the online abstract.

This study, which fails to disclose the entire truth, should not have been the cover article in an otherwise fascinating issue of JADA.

	REFERENCES

TOP REFERENCES

1. Ngom PI, Diagne F, Benoist HM, Thiam F. Intraarch and interarch relationships of the anterior teeth and periodontal conditions. Angle Orthod 2006;76(2):236–242.[Medline]
   
   
2. Glans R, Larsson E, Øgaard B. Longitudinal changes in gingival condition in crowded and noncrowded dentitions subjected to fixed orthodontic treatment. Am J Orthod Dentofacial Orthop 2003;124(6):679–682.[Medline]
   
   
3. Ashley FP, Usiskin LA, Wilson RF, Wagiayu E. The relationship between irregularity of the incisor teeth, plaque, and gingivitis: a study in a group of schoolchildren aged 11–14 years. Eur J Orthod 1998;20(1):65–72.[Abstract/Free Full Text]
   
   
4. Chung CH, Vanarsdall RL, Cavalcanti EA, Baldinger JS, Lai CH. Comparison of microbial composition in the subgingival plaque of adult crowded versus non-crowded dental regions. Int J Adult Orthodon Orthognath Surg 2000;15(4):321–330.[Medline]
   
   
5. Staufer K, Landmesser H. Effects of crowding in the lower anterior segment: a risk evaluation depending upon the degree of crowding. J Orofac Orthop 2004;65(1):13–25.[Medline]
   
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ostreicher, D. S. Search for Related Content PubMed PubMed Citation Articles by Ostreicher, D. S.