Yes, a cavity can and must be filled while braces are in place. Tooth decay is a common concern during orthodontic treatment because the brackets and wires create numerous new surfaces and tight spaces where food particles and plaque can easily become trapped. This increased surface area makes thorough cleaning more difficult, raising the risk of cavity formation. Addressing decay promptly is necessary to prevent the issue from worsening and interfering with the alignment process.
The Answer: Repairing Cavities While Braces Are On
The restorative procedure is performed by a general dentist, not the orthodontist, but the presence of the hardware introduces a logistical challenge for tool access. Most cavities, particularly those on the chewing surfaces or accessible sides of the teeth, can often be filled without modifying the braces. For decay located on the sides of the tooth near the bracket, the dentist requires a clear path to effectively prepare and restore the area.
To gain this necessary access, the orthodontist or a trained dental assistant will temporarily remove the flexible archwire that connects the brackets. This procedure involves untying the wire from the bracket slots. In rare instances, if the decay is in an extremely hard-to-reach location or directly under a bracket, that specific bracket may also need to be removed.
Once the wire is removed, the general dentist proceeds with the standard filling procedure, which involves drilling away the decayed enamel and dentin, cleaning the area, and placing the filling material. After the filling is completed and set, the archwire is reinserted and secured, sometimes in the same appointment or a follow-up appointment. This temporary removal ensures the dentist can complete the restoration without damaging the hardware or compromising the filling.
How Dental Professionals Coordinate Treatment
Successfully treating a cavity with braces requires direct and timely communication between the general dentist and the orthodontist. The patient or parent typically initiates this coordination by informing both offices immediately after a cavity is diagnosed. The two specialists then determine the necessary steps, which usually involves the orthodontist giving instructions on which parts of the hardware need to be temporarily disabled.
The general dentist, who performs the cavity filling, typically does not replace the orthodontic hardware, as this is the orthodontist’s specialized task. Therefore, the filling appointment is often scheduled immediately before or very close to an existing or newly scheduled orthodontic adjustment appointment. This ensures the tooth is restored and the orthodontic treatment can resume quickly, minimizing any delay in the tooth movement schedule.
This coordinated scheduling prevents the teeth from shifting out of alignment during the time the wire is removed. The orthodontist’s role is to ensure the integrity of the appliances and the continuity of the treatment plan, while the dentist focuses on the health and restoration of the tooth structure.
Preventing Tooth Decay During Orthodontic Treatment
The presence of brackets and wires increases the difficulty of maintaining a clean mouth, making meticulous oral hygiene necessary for preventing decay. Brushing should be performed after every meal and snack, rather than just twice daily, to remove food debris that easily lodges around the appliance components. A soft-bristled or orthodontic-specific toothbrush should be used to clean both above and below the brackets, angled toward the gum line and then toward the biting surface.
Flossing is non-negotiable for cleaning between teeth where a toothbrush cannot reach. Specialized tools such as floss threaders or orthodontic floss picks are necessary to pass the floss underneath the archwire. Many patients find a water flosser highly effective, as it uses a pressurized stream of water to dislodge plaque and food particles from around the brackets and wires.
Dietary and Appliance Protection
Dietary modifications are a significant part of prevention, as certain foods can damage the hardware or fuel bacterial growth. Avoid sticky, chewy, or hard foods like caramels, taffy, or hard candies that can pull off brackets or bend wires. Limiting the intake of sugary and acidic beverages reduces the energy source for decay-causing bacteria and protects the enamel from acid erosion.
Using a fluoride mouth rinse daily can provide an extra layer of protection. Fluoride helps remineralize and strengthen the tooth enamel, making it more resistant to decay.