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Inside Dental Hygiene
June 2022
Volume 0, Issue 0

3 Reasons Dental Hygienists Love Clear Aligner Therapy

From one hygienist to another

Lauren Gueits, BS, RDH

As more patients seek clear aligners to achieve a straighter, beautiful, "selfie-worthy" smile, dental hygienists should also consider clear aligner therapy as a solution to many common oral health problems. Imagine if dental professionals could offer a solution to prevent occlusal wear, gingival recession, periodontal pocketing, abfractions, and cold sensitivity, and promote airway health. Good news—we can!

Clear aligner therapy offers many health benefits, which can provide patients with optimal oral health and well-being far beyond a pretty smile. This article will outline the top three benefits that are relevant to dental hygienists.

1. Improve Periodontal Health

According to Harrel and Nunn,1,2 occlusal trauma is an equal or greater risk factor for the progression of periodontal disease when compared with smoking or poor oral hygiene. If a patient presented with poor oral hygiene, would a dental hygienist not feel compelled to discuss the consequence of poor oral hygiene and review oral hygiene instructions? Similarly, if a patient was a smoker, would one not discuss the consequences of smoking on periodontal health and offer resources to help them quit? This begs the question: Why is occlusal traumatism any different? In fact, the ADHA's "Standards for Clinical Dental Hygiene Practice" includes an occlusion evaluation as part of comprehensive hard tissue evaluations,3 and the American Academy of Periodontology recommends an occlusal examination followed by recommendation of orthodontic treatment to correct tooth positioning that may contribute to the periodontal disease process.4

Simply stated, if occlusal traumatism is causing damage to both hard and soft tissues, the teeth should be taken out of trauma. Teeth should be "sliding," not "colliding." Clear aligner therapy is therefore a viable solution to prevent the onset and progression of occlusal traumatism.

Another periodontal health benefit of clear aligner therapy is the prevention and treatment of the most common malocclusion—crowded teeth. It has been shown that 2 mm or more of crowding is an independent risk factor for periodontal disease.5 Clear aligner therapy is a simple solution to help expand the arches, unravel crowding, and reduce periodontal risk factors. Just how many patients would benefit from this? One might rather ask, how many patients present with perfectly aligned teeth? Based on more than 30 years of clinical hygiene experience, I can attest that most patients have crowded teeth. In private practice, clear aligner therapy education was even more prevalent than non-surgical periodontal conversations.

2. Prevent the Trifecta: Gingival Recession, Abfractions, and Cold Sensitivity

While clear aligner therapy is already important for helping improve periodontal health, hygienists may notice that patients are more likely to be concerned about gingival recession, abfraction, and subsequent cold sensitivity than lower crowding of the teeth. This can actually be an advantage when discussing the benefits of proper tooth alignment chairside. Remember, hygienists are the detectives getting to the root cause of disease, so the recurring question is "Why?" Why are gingival recession and abfractions so common? The answer lies in the laws of physics versus dentistry.

Teeth that are lingually inclined, or what may be described to patients as "tipped in toward the tongue," cause horizontal (non-axial) forces on the teeth. These forces are not absorbed by the periodontal ligament as they would have been back in ancestral days when the teeth connected via vertical force (axial forces).6 These forces cause flexure of the weakest part of the tooth, the cementoenamel junction (CEJ), causing breakdown of the enamel rods, which may lead to notching or wedge-shaped abfractions.7,8 If the horizontal (oblique) forces are causing damage to the hard and soft tissues, then one would assume that uprighting the teeth buccally, and thus converting the forces to a vertical load, would fix the problem. And this is in fact the case. Creating vertical (axial) forces is paramount to tooth longevity, and can be easily achieved with an expansive orthodontic technique utilizing clear aligners.

Clear aligner therapy is a viable long-term solution to prevent and stop the progression of hard- and soft-tissue damage versus popular shorter-term solutions such as Class V buccal composites or waiting and watching for the conditions to worsen.9 Knowing this, perhaps dental clinicians should consider clear aligner therapy as the new gold standard of care.

3. Improve Airway Health

When patients present with narrow dental arches, they typically present with crowding, lingual inclination of the teeth, and reduced oral cavity volume. In these cases, hygienists may notice that scalloped tongue is also prevalent. What one may not realize is that scalloped tongue is an independent risk factor for obstructive sleep apnea (OSA).10 Scalloped tongue results when there is not enough room (oral cavity volume) for the tongue to properly rest in the palate. The upper and lower teeth act as a compactor when lingually inclined. Scalloped tongue is indicated by the indentations of the teeth on the lateral borders of the tongue, which is a result of the tongue being squeezed or compacted in the oral cavity. Now add a deep bite to the mix and the tongue is also compacted vertically.

So how does clear aligner therapy help? In deep bite cases, uprighting the posterior teeth increases the vertical dimension, providing more room for the tongue.11 A useful analogy to present to the patient is that of pitching a tent. By uprighting the poles of the tent, you increase the dimension of the room inside the tent. The same goes for uprighting the teeth. The oral cavity volume is increased, creating more real estate for the tongue.

According to Ben Miraglia, DDS, a faculty member of Airway Health Solutions, a helpful patient education strategy is to turn the study model to show the back view, demonstrating the patient's tongue space. If there is a deep bite coupled with lingual inclination, the tongue space can be observed to be collapsed.

Oral cavity volume can also be increased transversely in order to widen the arches. By utilizing clear aligner therapy with an expansive technique, proper aligner wear time, and minimal to no interproximal reduction (IPR), healthy changes can be promoted in the dentoalveolar complex. Increasing the oral cavity volume via widening of the arches also provides more room for the tongue. This in turn allows for proper tongue placement where the tongue is given the space to create a suction in the palate rather than falling back and down, blocking the airway. This proper tongue placement is a critical component to avoid symptoms of sleep-disordered breathing, which can range from snoring to full OSA.

Conclusion

As these three examples demonstrate, clear aligner therapy has become a true treatment solution rather than just an aesthetic option. Patients trust hygienists to help them "keep their teeth for life," and teeth that fit together properly last longer. Proper tooth alignment and dentoalveolar expansion can contribute to a hygienist's armamentarium against periodontal/dental disease and help promote healthy breathing. Fortunately, clear aligner therapy is already a sought-after option providing patients with the "3 C's" of a clear, comfortable, and convenient orthodontic option. Don't wait for patients to ask about "tooth straightening." Engage them by demonstrating all the health benefits that clear aligner therapy provides.

Video Resources:

Clear Aligners as an Expansion Tool- No IPR
Periodontal Improvements with Clear Aligners

About the Author

Lauren Gueits, BS, RDH
Founder and President Airway Health Solutions
Guest Faculty
New York University

References

1. Nunn ME, Harrel SK. The effect of occlusal discrepancies on periodontitis. I. Relationship of initial occlusal discrepancies to initial clinical parameters. J Periodontol.2001;72(4):485-494.

2. Harrel SK, Nunn ME. The effect of occlusal discrepancies on periodontitis. II. Relationship of occlusal treatment to the progression of periodontal disease. J Periodontol.2001;72(4):495-505.

3. American Dental Hygienists' Association. Standards for clinical dental hygiene practice. ADHA website. https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf. Revised June 2016. Accessed April 21, 2022.

4. The American Academy of Periodontology. Comprehensive periodontal therapy: a statement by the American Academy of Periodontology. J Periodontol. 2011;82(7):943-949.

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.

6. Lee WC, Eakle WS. Possible role of tensile stress in the etiology of cervical erosive lesions of teeth. J Prosthet Dent. 1984;52(3):374-380.

7. Rees J. The effect of variation in occlusal loading on the development of abfraction lesions: a finite element study. J Oral Rehabil. 2002;29(2):188-193.

8. Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134(2):220-225.

9. Micheal JA, Townsend GC, Greenwood LF, Kaidonis JA. Abfraction: separating fact from fiction. Aust Dent J. 2009;54(1):2-8.

10. Weiss TM, Atanasov S, Calhoun KH. The association of tongue scalloping with obstructive sleep apnea and related sleep pathology. Otolaryngol Head Neck Surg. 2005;133(6):966-971.

11. Banabilh SM, Suzina AH, Dinsuhaimi S,et al. Dental arch morphology in south-east Asian adults with obstructive sleep apnea: geometric morphometrics. J Oral Rehabil. 2009;36(3):184-192.

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