Braces themselves do not directly create cavities, but they significantly alter the oral environment, which increases the risk of tooth decay if diligent hygiene is neglected. A cavity represents permanent damage to the tooth structure, while the process begins with demineralization, the loss of minerals from the tooth enamel. This initial stage of mineral loss is reversible with proper care, whereas a true cavity requires a dental filling. The concern is not the hardware itself, but the way it complicates the daily removal of plaque, setting the stage for decay.
How Braces Change the Oral Environment
The brackets, wires, and bands of fixed orthodontic appliances introduce physical obstructions that make the teeth harder to clean. These components create sheltered, complex surfaces, often called plaque traps, where food particles and sticky bacterial film easily accumulate. Standard brushing and the natural rinsing action of saliva struggle to reach the areas surrounding the brackets and under the archwires.
When plaque remains, the bacteria consume sugars and starches from the diet, producing acidic byproducts. These acids attack the tooth enamel, causing the outer layer to lose calcium and phosphate minerals in a process known as demineralization. The composition of the plaque can change after braces are placed, often showing higher numbers of acid-producing bacteria like Streptococcus mutans.
This constant acid exposure creates an imbalance, tipping the scale toward decay. Since the orthodontic hardware blocks the free flow of saliva and mechanical brushing, the enamel around the brackets becomes highly susceptible to mineral loss. If this demineralization continues unchecked, the enamel structure will eventually break down, leading to a cavity.
Specialized Cleaning Techniques and Tools
Achieving effective oral hygiene with braces requires specialized techniques and the use of targeted tools. Brushing should be performed at least twice a day, ideally after every meal, using a soft-bristled toothbrush and fluoride toothpaste. The proper technique involves angling the brush both above the brackets, toward the gumline, and below the brackets, toward the chewing surface, to clean all exposed enamel surfaces.
Flossing is significantly more challenging but remains necessary for removing plaque from between the teeth. Tools such as floss threaders or specialized orthodontic floss with stiff ends can be used to navigate the dental floss under the archwire. Interdental brushes, also known as proxy brushes, are small, tapered tools designed to fit into the tight spaces under the archwire and around the brackets.
Water flossers, which use a pressurized stream of water, serve as a supplementary tool to dislodge food debris and loose plaque from around the hardware. While effective for rinsing, they are not a substitute for the physical removal of sticky plaque achieved by brushing and traditional flossing. Integrating fluoride into the routine is also important, often through a fluoride mouthwash or a high-concentration prescription toothpaste to aid in remineralization.
Dietary choices directly influence the decay risk, as bacteria feed on leftover sugars and carbohydrates. Avoiding hard, sticky, or overly sugary foods and drinks minimizes the fuel available to the acid-producing bacteria and prevents damage to the brackets. Rinsing the mouth with water immediately after eating or drinking helps clear away food particles and neutralize acids until a full cleaning can be performed.
Identifying and Reversing Early Damage
The earliest sign of damage is the appearance of white spot lesions (WSLs), which are areas of demineralized enamel that appear chalky, opaque white, or dull. These spots most often form around the edges of the brackets where plaque has accumulated. WSLs are not yet true cavities, but they indicate a significant weakening of the enamel structure.
If caught early, white spot lesions are often reversible because the surface layer of the enamel may still be intact. Improved oral hygiene is the first step, as removing the plaque allows the minerals in saliva and fluoride to begin the repair process, called remineralization. The orthodontist or dentist will monitor these areas and may recommend professional intervention.
Treatment can include concentrated topical fluoride applications, such as prescription-strength toothpaste or fluoride varnishes applied in the office. Products containing calcium and phosphate, sometimes referred to as remineralizing pastes, can also be applied to help replenish lost minerals. For spots that do not fully resolve after the braces are removed, cosmetic treatments like microabrasion or resin infiltration can be used to reduce their appearance.