A cavity is a small hole that develops in a tooth due to decay, which occurs when bacteria in the mouth produce acids that erode the tooth’s hard outer layer, the enamel. When planning for orthodontic treatment, an active cavity presents a barrier to getting braces installed. The general rule is that any existing tooth decay must be completely treated and resolved before the placement of brackets and wires. Moving forward with braces over untreated decay can introduce complications. This requirement ensures that the foundation for your smile correction is strong and healthy before the process of tooth movement begins.
The Requirement for Pre-Orthodontic Treatment
It is mandatory to address any existing decay because the process of orthodontics significantly increases the risk of the decay worsening. Braces introduce numerous small surfaces and tight spaces where food particles and plaque can easily become trapped, creating a highly acidic environment that accelerates the decay process. If a cavity is already present, the orthodontic hardware makes it much harder to clean the area thoroughly, virtually guaranteeing the decay will progress rapidly.
Placing a bracket over an area with compromised enamel is also problematic because the bonding agent needs a healthy, intact surface to adhere effectively. A decayed tooth surface may not hold the bracket securely, leading to bonding failure and treatment delays. If a cavity grows significantly while the braces are on, the wires and brackets often obstruct the general dentist’s access to the decay.
Treating a progressed cavity with braces in place can require the orthodontist to remove or partially disassemble the appliance, which is time-consuming and inconvenient. The greatest risk is that an untreated cavity could progress deep enough to reach the tooth’s pulp, causing a painful infection and potentially requiring an emergency root canal or even tooth extraction. The tooth must be strong enough to withstand the continuous, gentle pressure exerted by the braces.
Steps for Filling Decay Before Braces
Once a need for orthodontic treatment is established, the general dentist and the orthodontist will coordinate to ensure all decay is addressed first. The first step involves a thorough dental examination, often including X-rays, to accurately diagnose the location and extent of all cavities. A treatment plan is then developed, outlining the necessary procedures, which can range from simple fillings to more complex treatments like root canals or extractions.
For standard cavities, the procedure involves the dentist numbing the area with a local anesthetic before using specialized tools to remove all the decayed and infected tooth material. The cavity is then cleaned and disinfected. The final step is restoring the tooth by placing a filling material, often a composite resin that is bonded to the tooth surface and cured with a special light.
Composite resins are frequently preferred because they are tooth-colored and bond directly to the enamel, which is a stable surface for subsequent bracket placement. It is imperative that the filling procedure is completed and the tooth has fully recovered before the orthodontist bonds the braces to the teeth. This sequenced approach ensures that the tooth is structurally sound and prepared to endure the mechanical forces of orthodontic movement.
Maintaining a Healthy Mouth While Wearing Braces
Preventing new cavities once braces are installed requires a diligent oral hygiene routine, as the hardware makes cleaning more challenging. Patients should brush after every meal or snack using a soft-bristled toothbrush to clean above and below the brackets and along the gumline. An electric toothbrush with an orthodontic head can also be beneficial for reaching complex surfaces.
Flossing requires specialized tools to navigate the wires, such as floss threaders or orthodontic floss, which has a stiff end that can be guided under the archwire. Water flossers are highly effective at flushing out food debris and plaque from around the brackets and between teeth. Regular use of fluoride toothpaste and sometimes a prescription fluoride rinse is recommended to help re-mineralize the enamel and protect against acid erosion.
Patients should avoid foods that are hard, sticky, or chewy, as these can damage the brackets or wires and lead to plaque accumulation. Maintaining regular appointments with both the orthodontist and the general dentist for checkups and professional cleanings every six months is essential.