Braces create many small areas where food particles and plaque can easily become trapped. This difficulty in maintaining oral hygiene means developing a cavity during orthodontic treatment is a common concern. The thought of needing a dental procedure while wearing hardware can be anxiety-inducing, leading many to wonder how a general dentist can repair a tooth when the surface is partially covered. Addressing tooth decay quickly is important to maintain tooth integrity and prevent delays in the overall treatment plan.
Can a Cavity Be Filled While Wearing Braces?
The answer to whether a cavity can be filled while wearing braces is yes; in most situations, a general dentist can perform the necessary restorative procedure. Modern dentistry is well-equipped to handle the minor complications posed by orthodontic hardware. The goal is always to treat the decay without disrupting the alignment process, which is why the dentist and orthodontist often communicate directly. The feasibility of working around the braces depends on the exact location and the extent of the decay on the tooth surface. Cavities on the chewing surfaces or those easily accessible from the side of the tooth usually present no problem at all.
Logistics of the Dental Procedure
When a cavity is accessible, the dentist can proceed with the filling procedure by working carefully around the existing hardware. The presence of brackets and wires requires the use of smaller, specialized instruments to reach the decayed area. The dentist uses a high-speed drill with a modified angle to remove the damaged enamel and underlying dentin without touching the bracket itself. Maintaining a clean and dry field is often the biggest challenge, as the hardware can interfere with the placement of cotton rolls or other moisture control devices.
Once the decay is removed, different types of filling materials may be used. Composite resin, which is a tooth-colored plastic mixture, is commonly selected for its strong bonding properties and aesthetic results. In some cases, a glass ionomer cement may be chosen, particularly for smaller lesions, because it releases fluoride which can help strengthen the surrounding enamel. The dentist must ensure the filling material is cured and bonded securely to the tooth structure while keeping it completely isolated from the orthodontic adhesive used to attach the bracket.
When Orthodontic Hardware Must Be Temporarily Removed
While most fillings can be done with the braces intact, certain circumstances demand the temporary removal of the orthodontic hardware. If the cavity is located directly beneath the bracket base, or if the decay is on the side of the tooth where the archwire completely obstructs the dentist’s access, removal becomes necessary. Deep cavities or those that extend to the area between two teeth (interproximal decay) often require a clear line of sight and instrument access that the wire prevents.
The orthodontist, or sometimes the dentist with specific instruction, will carefully detach the necessary bracket and remove the archwire from the tooth. Once the hardware is removed, the general dentist has unimpeded access to clean out the decay and place the filling. After the restoration is complete, the bracket is re-bonded to the tooth, and the archwire is reinserted to continue the teeth-straightening treatment. This ensures the cavity is treated thoroughly without compromising the long-term success of the orthodontic correction.
Preventing Tooth Decay During Treatment
The hardware of the braces creates many retention sites for plaque, making meticulous oral hygiene paramount to preventing new cavities. Patients should brush for at least two minutes after every meal and snack to remove food debris trapped around the brackets and wires. Using a soft-bristled toothbrush or an electric toothbrush with an orthodontic head is beneficial for cleaning all surfaces effectively. The “two-step” brushing technique, which involves cleaning above the brackets and then below them, helps ensure all tooth surfaces are addressed.
Flossing is significantly more challenging but remains absolutely necessary to clean between the teeth and under the archwire. Specialized aids like floss threaders or pre-cut orthodontic floss are designed to be guided under the wire to reach the interproximal spaces. Water flossers are also highly effective tools that use a stream of pulsating water to dislodge plaque and food particles from hard-to-reach areas around the hardware.
Incorporating a daily fluoride rinse or a prescription-strength fluoride toothpaste, if recommended by the dental professional, can provide an extra layer of protection by strengthening the tooth enamel against acid attacks. Limiting sugary and sticky foods, which easily get trapped and feed the acid-producing bacteria, is also an important part of a preventive diet. Regular dental checkups and professional cleanings are likewise important to monitor oral health throughout the duration of the orthodontic treatment.