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ORAL HYGIENE FOR THE ORTHODONTIC PATIENT

If you thought brushing and flossing were important before you got braces…well, you were right. But people undergoing orthodontic treatment need to be even more dedicated to good oral hygiene.

A successful orthodontic treatment depends on the health of your teeth and gums. If your teeth are fighting bacteria or inflammation, your treatment may go more slowly. It's important to follow these steps every night:

  • Floss your teeth.
  • Brush your teeth.
  • Use a mouth rinse that contains fluoride.

Bits of food tend to get trapped around braces, which leads to a build-up of dental plaque. Plaque is a mixture of bacteria, debris and bits of food. The bacteria feed on sugars and produce acids. The acids can irritate your gums, erode the enamel on your teeth and contribute to bad breath (halitosis).

It's important to remove the plaque thoroughly and often. Then, when your braces come off, the surfaces of your teeth underneath the braces will be healthy and strong and look good. Here are some tips to help you.

BRUSHING

Use a soft-bristle toothbrush. Soft bristles are better than medium or hard bristles at getting into those nooks and crannies around your braces. They also don't irritate your gums. Some companies make toothbrushes especially for people with braces. Known as bi-level brushes, they have longer bristles on the edges and shorter ones in the middle. This type of brush allows you to clean the area above and below the brackets and the brackets as well.

The most important thing is to look for a brush that's soft and approved by the American Dental Association (ADA). After that, the size of the brush, the shape of the handle and other variations are up to you.

What about an electric toothbrush? It's not necessary, but if you have one, it's safe to use it on your braces. In fact, electric toothbrushes have been shown to be more effective at removing plaque than manual brushing. The recommendation is the use of an oscillating-rotating electric toothbrush, with a specialized orthodontic brush configured to reach around the brackets. This type of electric toothbrush has been shown to be superior to the sonic type as well. Just be careful not to hit the plastic back of the brush against the brackets on your braces because it can damage them. Also, it should be used on a moderate setting so as not to break or loosen braces.

Brush at least three times a day. It is best to brush after meals to make sure there's no food trapped in or around braces. If you are not able to brush after lunch, at least rinse your mouth with water very thoroughly.

Brush for at least two to three minutes each time. It's best to use a watch or timer to make sure you are brushing long enough.

It's important to brush the braces and all the surfaces of the teeth. Make sure to pay careful attention to the areas between your brackets and your gums.

FLOSSING

Floss at least once a day. It might seem like you can't possibly floss while you have braces, but you can and you should. Special flossing products can help you get into the space between the wires and your gumline. These include floss threaders and a special kind of floss. When your braces are first put on, someone in your orthodontist's office should review flossing techniques. If you're not sure you're doing it right, ask your orthodontist during your next visit.

FLUORIDE

Use a fluoride toothpaste. It doesn't really matter which one — just make sure it has the ADA seal of approval.

Use an over-the-counter fluoride rinse. These rinses usually provide enough fluoride to help protect and strengthen teeth during orthodontic treatment. However, if you have a history of cavities or are otherwise at risk of decay, your orthodontist may prescribe a rinse that contains more fluoride.

Consider an office treatment. You can get more fluoride — usually in the form of a gel or varnish — from your dentist during a regular visit. If you have a history of decay, your dentist may suggest this type of treatment.

Fluoride treatments can also be an effective tool in helping to prevent white spot lesions as well. White spot lesions sometimes are apparent on teeth when the brackets are removed. Good oral hygiene and fluoride treatments help minimize the occurrence of white spot lesions.

During orthodontic treatment, see your family dentist for a complete examination every six months, or as directed by your dentist.

TOOLS TO HELP YOU

Rubber-tipped and end-tuft or single-tuft brushes — These are special brushes that help you to get into those nooks and crannies, as well as between your teeth. The end-tuft or single-tuft brushes look something like pipe cleaners.

Oral irrigators — These instruments shoot small streams of water onto your teeth at high pressure to remove bits of food. They are especially useful for cleaning around the brackets and wires where food can become trapped. Be sure to use a moderate setting so they don't damage your braces.

Antibacterial rinses — These rinses are fine for adults, but their high alcohol content makes them off-limits for kids. Alcohol-free rinses are available for children to use. But some are designed only to freshen breath and not to kill bacteria. Ask your orthodontist which rinses he or she recommends.

Disclosing solutions or tablets — Your dentist may have used these during an office visit to see where you tend to miss spots after brushing. Disclosing tablets and solutions use vegetable dye to highlight plaque or debris in your mouth. You can find them in a drugstore or get some from your dentist and use them at home.

If you have questions about how to use any oral hygiene product, even your toothbrush, call your orthodontist's office or talk to someone there during your next visit.

CARING FOR YOUR RETAINER

If you have a retainer or other removable orthodontic appliance, it needs to be cleaned regularly, too. After all, it spends a lot of time in your mouth. Brush the appliance daily with your soft toothbrush. Don’t use toothpaste. Ingredients in the toothpaste may create pores on the retainer. Brushing is especially important for the side that is in contact with the roof of your mouth or gums.

Brush your retainer over a wash bowl filled with a few inches of water. That way, if it slips out of your hand it will not be damaged. You also can soak it in a cleaning solution. There are several that are advertised as denture cleaners. If you want to soak your retainer, talk to your orthodontist about which solution to use. Some cleaning solutions can corrode wires or other metallic areas on orthodontic appliances.

When brushing or soaking your appliance, never use hot water. It can distort the plastic and make the appliance unusable. When your retainer is not in your mouth, keep it in the case that your orthodontist gave you. Wrapping it in a napkin is the most frequent way patients lose their retainers. Also, keep it away from your pets. Dogs and cats love the plastic and will chew it to bits if they get it.

CARING FOR FIXED LOWER LINGUAL RETAINERS

When your care is completed your orthodontist may place a wire that is attached to the back of your lower front teeth to keep them in good alignment. This type of retainer is difficult to maintain, however it is important that you use regularly use floss threaders to keep the area between the teeth and below the retainer clean to avoid accumulation of calculus (tartar) and irritation.

CARING FOR CLEAR ALIGNERS

Clear aligners are an option for some patients, particularly for minor tooth movement. Clear aligners enable most people to maintain better oral hygiene than traditional braces. Drinking liquids while wearing clear aligners should be avoided. For example, sodas are acidic and can get under the aligner and erode the teeth. Water is OK, but other liquids should be avoided when the clear aligners are in place.

EATING RIGHT

While you're wearing braces, you need to think twice about eating foods that could increase your risk of cavities. You also should avoid anything that might damage your brackets or wires. Frequently breaking your braces will add to the overall treatment time.

Stay away from hard and sticky foods. Caramel, hard candy, gum -- you get the idea. They can damage your braces and get stuck in the wires and brackets. While the food's stuck there, it provides lots of sugar for cavity-causing bacteria to munch on. Also, do not chew on ice cubes.

Cut down on all sugary and acidic foods. You can still have a limited amount of sweets and soda, but the more sugars you eat, the greater your risk of tooth decay. Always brush after eating sugary foods or candy.

It's not just what you eat, but also when you eat it. Frequent snacking on sugary foods is worse than eating those foods with a non-sugary meal. Don't eat sugary foods or candy before going to bed without brushing. The more chances you give the bacteria to turn sugars into acids, the higher your risk of decay.

DENTAL VISITS

Don't ignore your dentist just because you're visiting an orthodontist regularly. It is still important to visit your dentist for a checkup and cleaning. You should go at least twice a year, or as often as your dentist and orthodontist recommend.

 

Last updated May 7, 2021

 

References:

  • Erbe C, Jacobs C, Klukowska M, Timm H, Grender J, Wehrbein H. A randomized clinical trial to evaluate the plaque removal efficacy of an oscillating-rotating toothbrush versus a sonic toothbrush in orthodontic patients using digital imaging analysis of the anterior dentition. Angle Orthod. 2019 May;89(3):385-390. doi: 10.2319/080317-520.1. Epub 2018 Dec 5. PMID: 30516414.
  • Khoroushi M, Kachuie M. Prevention and Treatment of White Spot Lesions in Orthodontic Patients. Contemp Clin Dent. 2017 Jan-Mar;8(1):11-19. doi: 10.4103/ccd.ccd_216_17. PMID: 28566845; PMCID: PMC5426141.
  • https://www.aaoinfo.org/blog/orthodontic-treatment-with-clear-aligners/?gclid=Cj0KCQjwytOEBhD5ARIsANnRjVg1t5lykwg9DH2-JAT2b-DSJWcoBimWAiKwywtiX7X_hVQrrn9ezBsaAsqVEALw_wcB (Accessed 05-07-21)
  • Kartal Y, Kaya B. Fixed Orthodontic Retainers: A Review. Turk J Orthod. 2019 Jun;32(2):110-114. doi: 10.5152/TurkJOrthod.2019.18080. Epub 2019 Jun 1. PMID: 31294414; PMCID: PMC6605884.