Bacterial Adhesion on Orthodontic Bracket Surfaces: Mechanisms, Contributing Factors, and Preventive Approaches Using Nano Particles and Herbal Extract

Abstract

 Fixed orthodontic appliances are helpful in achieving optimal tooth positioning; however, their use imposes surfaces that are prone to bacterial adhesion and biofilm development. Biofilm formation can be detrimental to one’s oral hygiene as it may lead to caries, gingivitis, or decalcification of enamel. We focus on the phenomenon of bacterial colonization on orthodontic brackets and discuss how some surface features like roughness, surface energy, and hydrophobicity promote the adhesion of microorganisms. Some dominant microorganisms involved in biofilm development, which later on are reinforced by the secretion of extracellular polymeric substances (EPS), are Staphylococcus aureus and Streptococcus mutans. This paper also analyzes the bacterial attachment using different approaches like microbial culture, quantitative PCR (qPCR), or scanning electron microscopy (SEM) and discusses their pros and cons. To reduce bacterial adhesion, preventive methods such as antibacterial coatings (e.g. AgNPs and TiO₂) and mouth antiseptics (e.g. chlorhexidine and chamomile extract) are proposed. Herbal extract especially Chamomile extract is equally as effective as chlorhexidine in the reduction of S. aureus colonies making it a better option due to its low side effects. New developments such as smart brackets with nanoparticle coating, and therapies using probiotics, are proving useful in reshaping oral bacteria by targeting pathogenic bacteria. Additional work is necessary on clinical trials over extended periods, standardizing the use of probiotics, and creating multifunctional coatings designed to strategically improve oral health during orthodontics treatment. This review highlights the need for enhanced interdisciplinary efforts to address the issues of bacterial adhesion and patient care in orthodontics. 

Keywords: bacterial adhesion, orthodontic brackets, biofilm, nanoparticles, herbal extracts, oral hygiene