Braces themselves do not cause infections, but they significantly increase the risk by complicating the process of maintaining oral hygiene. The hardware creates numerous new surfaces and tight spaces where food debris and plaque—a sticky film of bacteria—can accumulate rapidly, making effective cleaning extremely challenging. If this bacterial buildup is not thoroughly removed, the risk of localized infections in the mouth rises considerably. This article explores the mechanical reasons for this increased risk and details the common infections and conditions that can arise during orthodontic treatment.
The Environment Braces Create
Orthodontic appliances transform the mouth into a complex environment that actively promotes bacterial retention. The brackets, wires, bands, and elastics are all obstacles that impede the natural sweeping action of saliva and the mechanical action of a toothbrush. These components create hundreds of microscopic “plaque traps” that are difficult for traditional brushing and flossing to reach.
Food particles and bacterial plaque accumulate particularly around the edges of the brackets and beneath the archwire, establishing a protective niche for microorganisms. When plaque is left undisturbed, the bacteria multiply and produce acids that erode the tooth enamel and irritate the soft tissues of the gums. This retained plaque is the direct precursor to inflammation and the development of infection-related oral health problems.
Common Oral Health Issues
The presence of braces, coupled with inadequate cleaning, frequently leads to specific oral health problems. The most common issue is gingivitis, the initial stage of gum disease caused by plaque accumulation along the gumline. Symptoms include gums that appear red, swollen, or bleed easily when brushing or flossing. If gingivitis is not reversed through meticulous hygiene, the inflammation can progress to periodontitis, a deeper infection that damages the soft tissue and the bone supporting the teeth.
Another significant concern is the development of dental caries, or tooth decay, which is often visible as demineralization. This early stage of decay appears as chalky white spots on the enamel, typically forming right around the area where the bracket is bonded. These white spots indicate a loss of minerals from the tooth surface due to prolonged acid exposure.
If a cavity progresses, it can cause tooth sensitivity to hot or cold temperatures, pain while chewing, or a visible pit or dark spot on the tooth. In some cases, a persistent bad taste or chronic bad breath can signal a deeper infection or abscess resulting from untreated decay. The continuous irritation from the appliance can also increase the susceptibility to oral thrush, a fungal infection.
Maintaining Oral Cleanliness
Minimizing the infection risk requires a significantly intensified and modified oral hygiene routine. Patients should brush after every meal and snack to remove trapped food and debris immediately. Specialized tools like soft-bristled or orthodontic toothbrushes are necessary, and the technique must involve angling the brush to clean both above and below the brackets.
Interdental brushes are small, cone-shaped tools designed to clean the tight spaces between the archwire and the teeth, which a standard brush cannot reach. Flossing becomes more complex but remains an absolute necessity for cleaning between the teeth. A floss threader or specialized rigid-tipped orthodontic floss must be used to carefully guide the floss underneath the main archwire before cleaning the sides of each tooth.
Many find a water flosser, which uses a pressurized stream of water, to be a highly effective adjunct for dislodging plaque and food particles around the hardware. Rinsing with an antimicrobial or fluoride mouthwash can provide additional protection against bacteria and help strengthen the enamel. Regular professional cleanings, often recommended every three to four months, are also essential to remove hardened plaque and tartar that home care cannot eliminate.