It is common for patients undergoing orthodontic treatment to require a dental filling. Braces, consisting of brackets and wires, straighten teeth and correct bite issues over an extended period. During this time, the development of a cavity—a damaged area on the tooth surface caused by decay—remains a possibility. Receiving a filling while wearing braces is a routine and possible procedure in dental care.
Is Getting a Filling Possible With Braces
The ease of restoring a tooth while braces are present is determined by the location and extent of the decay. A cavity located on the biting surface of the back teeth or on the tongue-side (lingual) or cheek-side (buccal) surfaces, away from the bonded brackets, is straightforward to treat. The dentist can typically access and fill this decay without needing to change the orthodontic hardware.
Decay that develops directly beneath or immediately next to an orthodontic bracket presents a more complicated challenge. Braces create small areas where plaque accumulates, leading to mineral loss in the enamel, called decalcification, which can progress into a cavity. The bracket and its adhesive physically obstruct the dentist’s view and prevent tools from reaching the decayed area.
Gaining Access to the Cavity
Treating a cavity with braces requires careful coordination between the general dentist, who performs the filling, and the orthodontist, who manages the braces. The first step often involves the temporary removal of the archwire, the thin metal wire connecting all the brackets, along with the elastic ties or ligatures holding it in place. This removal provides the dentist with a clearer path to the tooth surface.
If the cavity is located on the front surface of the tooth, directly under the bracket, the bracket must be temporarily detached. The orthodontist or dental staff will carefully “de-bond” the bracket using specialized tools to prevent damage to the enamel or the bracket itself. Once the bracket is off, the general dentist can proceed with removing the decay and placing the dental filling unhindered.
After the restorative work is completed, the tooth surface is thoroughly cleaned and prepared for re-attachment. The orthodontist then re-bonds the temporarily removed bracket in its correct position. This two-part process ensures the cavity is properly treated without compromising the ongoing tooth movement and alignment plan.
Special Dental Considerations During Treatment
The environment created by braces introduces unique factors that must be addressed during restorative procedures. Brackets and wires make effective brushing and flossing more difficult, increasing the risk of decalcification, which often appears as chalky white spots on the enamel around the bracket edges. These spots indicate early mineral loss and require the dentist to distinguish them from a true cavity when planning treatment.
The choice of filling material is influenced by the presence of braces and future orthodontic adjustments. Composite resin fillings, which are tooth-colored, are preferred because they bond well to the tooth structure and offer an aesthetic solution. In some cases, an existing filling might need slight reshaping after placement to ensure correct bracket positioning and proper tooth movement.
Meticulous post-filling oral hygiene is important for patients with braces to prevent new decay or damage to the restoration. The patient must be diligent in cleaning around the new filling and all existing brackets, often using specialized brushes and floss threaders. Regular professional cleanings and the application of fluoride varnishes are part of the treatment plan to remineralize weakened enamel and protect the teeth from further acid erosion.