It is possible to get a cavity while wearing braces, and the presence of orthodontic hardware often increases the likelihood of tooth decay. A cavity is a hole that forms in a tooth as a result of decay, a progressive disease that destroys dental tissues. This decay process begins when oral bacteria consume sugars and starches left on the teeth, producing acids that slowly wear away the protective enamel layer. The brackets and wires of braces create a complex environment where these cavity-causing conditions can flourish.
How Braces Increase Cavity Risk
The fixed nature of orthodontic appliances introduces numerous new surfaces, nooks, and crannies that are prone to trapping food particles and plaque. Brackets, wires, and bands create retention areas where the sticky film of bacteria, known as plaque, can easily accumulate and adhere. This mechanical obstruction makes it significantly harder to clean the entire tooth surface thoroughly compared to an unobstructed tooth. When plaque is not removed, the acid it produces remains in prolonged contact with the tooth enamel, causing demineralization. Difficulty accessing areas beneath the archwires and surrounding the brackets leads to higher acid exposure, accelerating the decay process.
Common Sites for Decay
Decay is most frequently observed in specific, hard-to-reach locations when a patient wears braces. One of the earliest and most common signs of decay is the appearance of white spot lesions, or decalcification, which typically form on the enamel surface immediately around the brackets. These opaque, chalky spots are the visible result of mineral loss from the enamel where plaque has lingered. Food debris and plaque also readily collect in the spaces between teeth, which become especially challenging to clean with a wire running across them. Decay is also common directly beneath the archwire and underneath the molar bands that wrap around the back teeth.
Essential Brushing and Flossing Techniques
A specialized hygiene routine is necessary to prevent decay and clean effectively around the hardware. Brushing should occur after every meal and snack, using a soft-bristled toothbrush and fluoride toothpaste. A common technique involves a three-step method for each tooth: brushing above the bracket, brushing below the bracket, and then brushing directly on the bracket to dislodge trapped debris. The toothbrush should be angled toward the gumline and then angled toward the biting surface to ensure the bristles clean both the top and bottom edges of the brackets. Interdental brushes, sometimes called proxy brushes, are tiny, cone-shaped brushes used to scrub the tight spaces between the archwire and the bracket.
Flossing remains a daily task, even though the wires pose a barrier. Traditional floss requires a floss threader, a small plastic loop used to guide the floss under the archwire before it can be used between the teeth. Alternatively, specialized orthodontic floss has a stiffened end that can be threaded under the wire, eliminating the need for a separate tool. Water flossers are also highly effective, using a stream of water to blast away plaque and food particles from all the hard-to-reach areas around the brackets and wires.
Treating Cavities During Orthodontic Treatment
When decay is detected, the remedial action depends on the extent and location of the damage. Minor decay, such as early white spot lesions, can often be managed with enhanced oral hygiene, dietary changes, and professional application of fluoride treatments. These treatments work to remineralize the enamel, sometimes reversing the early stages of decay. For a larger cavity that requires a filling, the general dentist and the orthodontist must coordinate the treatment. If the decay is hard to reach, the orthodontist may need to temporarily remove the archwire to allow the dentist clear access to perform the filling, or in rare cases, remove and re-bond the bracket itself.