Orthodontic Appliance Associated Oral Lesions: A Systematic Review and Meta-Analysis of Clinical Prevalence, Onset, and Contributing Factors.

OBJECTIVES

To investigate the prevalence, onset, and contributing factors of oral mucosal lesions associated with orthodontic treatment.

METHODS

A comprehensive database search (PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar) was conducted according to PRISMA. Random-effects meta-analyses were conducted to estimate pooled prevalence and subgroup analyses of associations, where appropriate.

RESULTS

A total of 18 studies met inclusion criteria, revealing a pooled prevalence of 58% for orthodontic appliance-associated oral lesions (95% CI: 50%-66%; I2 = 73.9%). Traumatic lesions showed significant variation by lesion type (p = 0.0093), with ulceration/erosion being the most prevalent. Allergic stomatitis and lichenoid reactions had a prevalence of 18% (95% CI: 13%-25%; I2 = 78%), while gingival overgrowth was at 54% (95% CI: 34%-73%; I2 = 96.8%). The strongest association with oral lesions was treatment duration (pooled effect estimate = 4.61; 95% CI: 3.15-6.75), followed by lifestyle and appliance-related factors. Findings should be interpreted cautiously.

CONCLUSION

Oral mucosal lesions are commonly reported among patients undergoing orthodontic treatment, with considerable variability in lesion type, timing, and associated risk factors. These findings highlight the importance of preventive strategies, regular monitoring, and individualized patient management during orthodontic care.

SYSTEMATIC REVIEW AND META- ANALYSIS PROTOCOL REGISTRATION: PROSPERO-CRD: 420251078164.