Oral Hygiene, Brushing, and Flossing with Braces
The objective of orthodontic treatment is straightening of the teeth and correcting the bite. If the health of the teeth is ignored along the way, the treatment result can be significantly compromised. Therefore, effective brushing and flossing is one of the most critical actions needed from patients during braces. Regular visits to the general dentist for examination and cleaning are also essential.
The results of inadequate oral hygiene include decalcification (white spots/marks), gingivitis (inflammation of the gums), and periodontal disease (inflammation leading to bone loss).
A common misconception is that the braces themselves cause marks on the teeth. The reality is that the plaque left around the braces causes decalcification, otherwise decalcification would occur in everyone that had braces. Fortunately, decalcification is preventable by thorough brushing and flossing, along with regular visits to the general dentist/hygienist.
In order to counter the process leading to decalcification, consistent and effective brushing techniques are required. An illustration of a technique that can be used to effectively clean around the braces is shown below. Notice that only a couple of teeth at a time are brushed. This helps concentrate on specific areas around the braces and along the gum line. The angle of the brush is important in order to properly clean all sides of the teeth and under the wire.
Using floss between the teeth is also very important during braces. The space between the teeth is unreachable by a brush, so regular flossing will help to prevent plaque buildup in these areas. With braces, the wires will prevent the usual technique for flossing. Therefore, the floss can first be thread underneath the wire by hand or with a flossing aid (i.e. a floss threader). Then the floss can pass in between the teeth up to the gum line as usual.
Following are additional brushing instructions to keep in mind. First, frequent visits with a general dentist for examination and cleaning are critical to prevention. Most people see their dentist every 6 months. Some patients may need more frequent visits. Talk to the orthodontist and dentist about their recommendations.
Second, it is important that the teeth are brushed after every meal. Food can collect very easily around the braces and therefore needs to be removed on a regular basis.
Third, avoid trying to brush all the teeth at once. It helps to limit brushing to a couple of teeth at a time. This way, areas on certain teeth will not be missed.
Fourth, effective brushing requires time. Avoid rushing and make sure any areas that may have been missed are checked and re-brushed. A good technique would be to use a timer (some electric toothbrushes have timers built in).
Lastly, brush from the top, bottom, and middle towards and between the braces and wire. Also remember to brush towards the gums gently, since overaggressive brushing can damage the gum tissue.
The effectiveness of topical fluoride during orthodontic treatment is widely accepted in the scientific literature as providing significant protection against decalcification. Therefore, in addition to proper brushing and flossing, daily use of a fluoride rinse will help to reduce the chance of developing cavities and white spots on the teeth. Available rinses include Phos-Flur® (Colgate), Act® (Johnson & Johnson), and many more. The best way to decide on a product is to look for the American Dental Association (ADA) seal of acceptance. Products that have the ADA Seal of Acceptance have undergone testing to prove their effectiveness. Further information of accepted products can be found on the ADA web site (www.ada.org).
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