Wearing dental braces is a common and effective way to achieve a straighter smile and improve overall oral health. Many individuals wonder if braces can lead to tooth decay, a concern arising from the presence of brackets and wires. While braces do not directly cause tooth decay, they can create conditions that increase the risk of plaque accumulation and cavities if proper oral hygiene is not maintained.
How Braces Create Conditions for Decay
Braces introduce new surfaces and intricate spaces where food particles and plaque can easily become trapped. The brackets, wires, and bands of fixed braces create nooks challenging to clean with standard brushing and flossing. This increased difficulty in maintaining oral hygiene leads to greater plaque accumulation, a sticky film of bacteria that forms on teeth.
Bacteria within plaque feed on sugars from food and drinks, producing acids. These acids attack the tooth enamel, which is the hard outer layer protecting the teeth. This process, known as demineralization, causes the enamel to lose essential minerals, leading to small, chalky white spots on the tooth surface, often around the brackets. These “white spot lesions” are an early sign of enamel weakening and can progress into cavities if left unaddressed. Demineralization can begin as early as four weeks after braces are placed.
Preventing Decay While Wearing Braces
Preventing tooth decay with braces relies on consistent oral hygiene and mindful dietary choices. Brushing after every meal removes food particles and plaque caught in the braces. Use a soft-bristled or electric toothbrush, angling it at 45 degrees to the gumline, then brush above and below the brackets and along chewing surfaces. Clean each tooth carefully, ensuring all surfaces are reached.
Flossing daily removes plaque from between teeth and under wires. Specialized tools like floss threaders, orthodontic flossers, or interdental brushes help navigate around wires and brackets. Water flossers are effective for dislodging food particles and plaque from hard-to-reach areas. Rinsing with water after meals, especially when brushing is not immediately possible, dislodges loose debris.
Dietary adjustments also prevent decay. Avoid sugary and sticky foods like candy, caramel, chewing gum, and dried fruits, as they easily get trapped in braces and contribute to plaque buildup. Hard or crunchy foods such as nuts, hard candies, popcorn, and ice should also be avoided, as they can damage braces and increase decay risk. Acidic foods and drinks, including sodas and sports drinks, erode enamel, making teeth more susceptible to decay; limit consumption and rinse with water afterward.
Fluoride is a preventative measure. Fluoride toothpaste and mouthwashes strengthen tooth enamel, making it more resistant to acid attacks. Orthodontists may recommend professional fluoride applications or fluoride-containing bonding materials to protect teeth. Regular dental check-ups and cleanings with both a general dentist and orthodontist are recommended throughout treatment. These visits allow for professional cleaning, oral health monitoring, and early issue detection.
Identifying and Treating Decay
Recognizing signs of tooth decay or white spot lesions while wearing braces allows for timely intervention. Early signs include increased tooth sensitivity, particularly to hot, cold, or sweet foods. Visible changes on the tooth surface, such as white, chalky spots or discoloration around the brackets, indicate early demineralization. As decay progresses, pits or holes may become visible, and the tooth might appear dull or chalky. Persistent pain, pain while chewing, or bad breath can also signal decay.
Dentists and orthodontists can identify subtle signs of demineralization or developing cavities through visual inspection and X-rays. If decay is detected early, it can often be managed with non-invasive treatments. For white spot lesions, fluoride treatments, such as high-concentration fluoride varnishes or gels, can help remineralize affected enamel, replenishing lost minerals and potentially reducing their visibility. Products containing calcium and phosphate, like MI Paste, also support remineralization.
If decay has progressed beyond early demineralization, traditional dental fillings may be necessary. While possible to fill a cavity with braces on, the process can be more complex, sometimes requiring the orthodontist to remove wires or brackets for dentist access. In some cases, advanced treatments like Icon resin infiltration (blending white spots with surrounding enamel) or dental bonding and veneers may be considered after braces are removed. Effective management and treatment of decay during orthodontic treatment requires consistent communication between the patient, orthodontist, and general dentist.