Management of dental plaque with air-polishing in patients with orthodontic braces

INTERVENTION: Air‐polishing with EMS Air‐Flow Two quadrants of the mouth will receive the Air‐Flow cleaning during their monthly orthodontic visits. The treatment protocol will be set according to the manufacturer’s recommendations; that is the distance of the air‐polishing tip to the surface of the enamel will be between 3 to 5 mm. The angulation of the central beam will be between 30 to 60 degrees. A set cleaning time of five seconds only for each tooth in each quadrant to be treated will be enforced with a stopwatch. The system used is the Air‐Flow Handy 3.0 Plus handpiece (Electro Medical Systems, Nyon, Switzerland). The Powder used is Air‐Flow Sub+Supragingival Plus Powder with a particle size of 14µm granules. The device settings will standardised at an air pressure of 5 bar with a water flow rate of 20mL/min. The Air‐Flow intervention will be conducted by only one person, the investigator. The Air‐Flow will be conducted by a single dentist of five years experience. The intervention will be monitored by a digital clinic note placed on the patient's file using the patient management software Titanium. Participants will receive one treatment followed by another (in a random order), but both will be conducted at the start of the same monthly orthodontic adjustment appointment. CONDITION: Dental plaque;Gingivitis;Enamel demineralisation; ; Dental plaque ; Gingivitis ; Enamel demineralisation Oral and Gastrointestinal ‐ Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon PRIMARY OUTCOME: Primary outcome 1: Silness and Löe Gingival Index; ; To assess the clinical severity of gingival inflammation as well as its location for each patient.; Recorded using a blunt periodontal probe.; Four locations around each tooth (buccal, mesial, distal and lingual) are given a score according to the index.[Timepoint: Every monthly adjustment appointment (pre intervention) for 6 months] Primary Outcome 2: Modified Silness and Löe Plaque Index; ; Plaque will be disclosed to allow accurate assessment of accumulation. The modified Silness and Löe index as described by Williams will be used. The tooth will be divided into mesial, distal, gingival, and incisal (occlusal) regions in relation to the bracket.; Plaque is then scored in each area based on four codes used in the original Silness and Löe index and values summed to obtain a total score, which can range between 0 and 16 for each tooth.[Timepoint: Monthly adjustment appointments (pre and post intervention) for 6 months] Primary outcome 3: Mean percentage fluorescence loss ; ; Using Inskeptor systems Q‐Ray Pen Quantitative Light‐induced Fluorescence and Q‐Ray software.; To measure changes in enamel mineral content.[Timepoint: Baseline, 6 months after intervention] SECONDARY OUTCOME: Secondary outcome 1: Plaque pixel coverage change in R30 (red autofluorescence of bacteria porphyrins) ; ; Using Inskeptor systems Q‐Ray Pen Quantitative Light‐induced Fluorescence and Q‐Ray software. ; [Timepoint: Every monthly adjustment appointment (pre intervention) for 6 months] INCLUSION CRITERIA: • Poor oral hygiene and plaque control (defined by patients currently under treatment who have attended at least two consecutive adjustment appointments where poor oral hygiene has been noted in their clinical record) • Permanent dentition • Minimum of 20 natural teeth • Full upper and lower fixed appliances, with conventional buccal stainless‐steel metal brackets (RMO Mini‐Taurus, Alexander prescription)