Clear aligners are transparent, custom-made thermoplastic trays designed to gradually shift teeth into alignment. These appliances are an increasingly popular choice for orthodontic treatment because they offer a discreet and removable alternative to traditional braces. The presence of active dental decay, commonly known as cavities, complicates the start of this therapy. Generally, you cannot begin wearing clear aligners until all existing cavities have been fully treated and resolved. The tight fit of the aligners over the teeth creates a unique environment that necessitates a healthy, stable starting point, making preparatory dental work a mandatory first step.
Treating Existing Decay Before Aligner Therapy
Active tooth decay must be eliminated by a general dentist before the orthodontic phase can begin. Aligner trays must be worn for approximately 22 hours per day, completely covering the tooth surfaces. When a clear aligner tray is placed over a tooth with an existing cavity, it essentially seals off the decay. This action traps any bacteria and acid against the lesion, preventing the natural flow of saliva from reaching and neutralizing the area. Saliva plays a crucial role in oral defense by washing away food particles and neutralizing acids, but the aligner inhibits this natural cleansing mechanism. As a result, an untreated cavity under the tray can progress and worsen into a more severe problem.
Aligners are custom-fabricated based on a precise digital scan or impression of the teeth. If a filling is placed after the aligner fabrication, the restored tooth’s shape and contour will change, causing the aligner to no longer fit accurately. This poor fit can interfere with the programmed tooth movement, necessitating new impressions and ordering a new set of trays.
How Decay Severity Impacts Your Treatment Timeline
The required treatment for existing decay directly determines the length of the waiting period before aligner therapy can commence. For minor to moderate decay, the procedure usually involves a simple filling to remove the decayed material and restore the tooth’s structure. In these cases, the delay is typically minimal, often just a brief wait for the restorative material to set. The tooth is then ready for the final orthodontic scanning or impression.
More severe decay, however, requires complex and time-consuming procedures, resulting in a longer pause in the orthodontic timeline. If the decay has reached the pulp, the patient may require a root canal, followed by the placement of a crown. If a tooth is too damaged to be saved, an extraction may be necessary, and the site must be allowed to heal completely before the aligner process can be finalized. Resolving underlying issues like gum inflammation or active infection is also mandatory to ensure a healthy foundation for tooth movement.
Preventing New Cavities During Aligner Use
Once aligner treatment begins, patients must adopt a stricter oral hygiene protocol, as the risk of new cavities is elevated. The aligners create an environment where plaque and acid are held in close contact with the enamel, reducing the protective effect of saliva. This sealing effect can accelerate the demineralization process if proper cleaning is neglected.
Brush and floss thoroughly after every single meal or snack, before reinserting the aligners. Placing the trays over teeth that have not been cleaned will trap food debris and bacteria, essentially “marinating” the teeth in decay-causing substances. It is also necessary to clean the aligners themselves daily with a soft brush and a specialized cleaner or mild soap, avoiding hot water which can warp the plastic.
Patients should limit consumption to only plain water while the aligners are worn. Sugary or acidic drinks, such as soda, juice, or flavored coffee, can seep under the trays, and the liquid will be held against the tooth surface for an extended period. Incorporating a fluoride rinse or toothpaste can also help remineralize the enamel and provide an extra layer of protection against acid attacks. Patients with a history of decay may benefit from more frequent professional cleanings, sometimes every three to four months.