You can get braces, but only after your gum disease is managed and stabilized by a dental professional. Gum disease is an inflammation or infection of the gums and the underlying bone that supports the teeth, posing a serious risk to orthodontic treatment. Orthodontics, the process of moving teeth, relies entirely on the health of the surrounding structures. Therefore, achieving and maintaining periodontal health is a requirement for anyone considering braces.
How Gum Disease Affects Tooth Movement
Gum disease exists on a spectrum, beginning with gingivitis and potentially progressing to periodontitis. Gingivitis is the milder, reversible form, characterized by red, swollen gums that may bleed easily, but it does not involve bone loss. Periodontitis is a more serious infection that leads to irreversible destruction of the alveolar bone and the ligaments anchoring the teeth.
The biological process of orthodontic tooth movement involves controlled remodeling of the bone around the tooth root. When active periodontitis is present, the supporting bone is already being rapidly broken down due to the chronic infection. Applying orthodontic forces to a tooth with compromised and inflamed bone support can dramatically accelerate this existing bone loss. This increased rate of tissue degradation can lead to rapid tooth mobility, worsening gum recession, and premature loss of teeth.
For a person with periodontitis, the tissue is already in an inflammatory state driven by bacteria and their byproducts. The mechanical stress from orthodontic appliances introduces additional inflammation, which can act synergistically with the existing infection to speed up the disease’s progression. This is why orthodontists are cautious about placing braces on a patient with active gum disease. If the gums are healthy, even if there is a history of bone loss, the teeth can still be moved safely using light, controlled forces.
Required Periodontal Stabilization Before Braces
Before an orthodontist will consider starting treatment, a thorough periodontal evaluation is mandatory to assess the health of the supporting tissues. This evaluation involves using a specialized probe to measure the depth of the gum pockets around each tooth and taking X-rays to check the existing level of alveolar bone.
If active periodontitis is diagnosed, treatment must begin with non-surgical deep cleaning procedures like scaling and root planing. This process removes bacterial plaque and hardened calculus (tartar) from below the gumline on the root surfaces. In more advanced cases, stabilization may require surgical interventions to reduce deep pockets or perform gum grafting. The disease must be eliminated, and the inflammation must subside before any orthodontic forces are applied.
Only once the inflammation is resolved and the gums are healthy will the periodontist provide “periodontal clearance” to the orthodontist. This clearance confirms that the disease is in remission, and the teeth can be safely moved with minimal risk of relapse or further bone loss. The patient is often required to demonstrate a consistently high level of at-home oral hygiene before clearance is granted.
Specialized Oral Hygiene During Orthodontic Treatment
Once the mouth is stable and braces are placed, the risk of gum disease relapse increases substantially. The brackets and wires of fixed appliances create numerous new retention areas for plaque and food debris, making effective cleaning significantly more challenging. Therefore, a rigorous and specialized hygiene protocol is required to maintain the stabilized periodontal health.
Patients must commit to brushing after every meal and snack, using a soft-bristled toothbrush designed to navigate around the brackets. Flossing is made easier with specialized tools, such as floss threaders or orthodontic floss, which allow the material to be passed under the main archwire. Many periodontists and orthodontists recommend incorporating a water flosser, which can effectively flush out debris and bacteria from hard-to-reach areas around the appliances and gumline.
The frequency of professional dental cleanings and periodontal maintenance visits must also be increased for individuals with a history of gum disease. While a person without a history of periodontitis might visit every six months, a stabilized patient undergoing orthodontics may be required to have professional care every three to four months. This heightened professional surveillance is necessary to quickly address any sign of inflammation or disease recurrence.