It is understandable to wonder if complex dental procedures are possible when wearing fixed orthodontic appliances. Yes, a deep cleaning, known as Scaling and Root Planing (SRP), can be performed while you have braces. This procedure is necessary when gum disease has progressed beyond simple gingivitis, which is common for patients with braces due to challenges in maintaining optimal oral hygiene. The presence of brackets and wires necessitates certain adjustments to the cleaning process, but they do not prevent the necessary treatment from taking place.
What is a Deep Cleaning Procedure?
A deep cleaning, or Scaling and Root Planing (SRP), is a non-surgical procedure designed to treat active periodontal disease, which is an infection affecting the gums and surrounding bone structure. It is significantly different from a standard prophylactic cleaning, which focuses only on removing plaque and tartar from above the gumline. SRP is necessary when periodontal measurements reveal pocket depths greater than three millimeters, indicating that the gum tissue has detached from the tooth surface, creating a space for bacteria to thrive.
The procedure is divided into two distinct parts: scaling and root planing. Scaling involves the careful removal of hardened bacterial deposits, known as calculus or tartar, from the tooth surface and deep within the periodontal pockets below the gumline. Specialized instruments, including ultrasonic scalers and manual hand scalers, are used to access these subgingival areas.
Root planing follows scaling and involves meticulously smoothing the surface of the tooth roots. This smoothing step is carried out to eliminate microscopic irregularities where bacteria can easily adhere and colonize. Creating a clean, smooth root surface helps the gum tissue heal and potentially reattach to the tooth, which reduces the depth of the periodontal pockets. Local anesthesia is often administered to ensure patient comfort, as this process involves working below the gumline on sensitive root surfaces.
Performing Deep Cleaning While Wearing Braces
Fixed orthodontic appliances introduce mechanical challenges to SRP that require modifications to the standard technique. The brackets and archwires obstruct direct access to certain areas of the tooth surface, particularly near the gumline and between the teeth. Dental professionals must navigate around the hardware using specialized, smaller instruments to effectively reach the entire root surface.
Ultrasonic tips and hand instruments must be angled and manipulated with extra care to avoid damaging the orthodontic cement, brackets, or wires. The archwire, which runs across the front of the teeth, can specifically complicate the process of scaling and planing the roots of the front teeth. However, the procedure can typically be completed without requiring the temporary removal of the archwire or brackets.
The decision to proceed with SRP is often made with close coordination between the general dentist or periodontist and the orthodontist managing the case. In rare instances, if an area is completely inaccessible and severely diseased, the orthodontist may need to temporarily remove a wire or bracket to allow for thorough treatment. After the deep cleaning is completed, the periodontium is given time to heal, and a follow-up visit is scheduled to re-measure the pocket depths. The goal is to treat the underlying infection and restore gum health without disrupting the alignment process.
Why Orthodontic Hardware Increases Periodontal Risk
Fixed orthodontic hardware significantly increases a patient’s risk of developing the periodontal conditions that necessitate a deep cleaning. The brackets, bands, and archwires create numerous small, complex surfaces that act as retention sites for dental plaque, essentially forming “plaque traps.” This makes the mechanical removal of bacterial biofilm much more difficult than in a mouth without braces.
The resulting buildup of plaque, if not meticulously cleaned, leads to inflammation of the gums, a condition known as gingivitis. This is characterized by red, swollen gums that bleed easily during brushing and flossing. Studies frequently show a rise in plaque accumulation and gingivitis within the first few months after fixed appliances are placed.
If this chronic inflammation continues, the bacterial toxins begin to break down the fibers that hold the gum tissue to the tooth, causing the gum to pull away and form deeper pockets. This progression from gingivitis to periodontitis ultimately makes SRP necessary. To mitigate this risk, patients with braces must adopt an enhanced oral hygiene regimen.
Preventative measures include using specialized tools to clean thoroughly around all parts of the appliance:
- Orthodontic toothbrushes.
- Interdental brushes.
- Floss threaders.
- Water flossers.
Consistent, diligent plaque control is the most effective way to prevent the chronic inflammation that leads to the need for a deep cleaning. Maintaining excellent home care helps ensure that the periodontium remains healthy enough to support tooth movement throughout the entire treatment.