Gingivitis, a common form of gum inflammation, affects many people considering orthodontic treatment. This mild gum disease is caused by bacterial plaque buildup along the gum line, leading to redness, swelling, and bleeding. While the goal is to have healthy gums before starting tooth movement, gingivitis is typically reversible and is not a permanent barrier to getting braces. Braces can make thorough cleaning much harder, potentially worsening existing inflammation if not addressed beforehand.
Gingivitis: Definition and Impact on Orthodontic Treatment
Gingivitis is the initial and mildest form of periodontal disease, characterized by inflammation of the soft tissue surrounding the teeth. This inflammation is an immune response to bacteria accumulating in plaque that adheres to tooth surfaces. Symptoms are limited to the gum tissue, presenting as puffy gums that may bleed easily during routine hygiene.
Braces work by applying continuous, controlled pressure to the teeth, which requires the supporting structures, including the gums and bone, to be stable and healthy. When gingivitis is present, the gums are already in an inflammatory state, and the addition of orthodontic appliances can exacerbate this condition. Swollen gum tissue can sometimes obstruct the brackets and wires, physically interfering with the proper movement of the teeth and potentially slowing down the treatment plan.
If the inflammation is successfully managed and reversed, the gum tissue returns to a healthy state, allowing the orthodontic process to proceed efficiently. Addressing gingivitis is necessary because the brackets and wires create more surfaces where plaque can accumulate, making meticulous oral hygiene challenging. While gingivitis is not an automatic deal-breaker, it must be resolved to ensure a successful and complication-free treatment.
Required Dental Clearance Before Braces
Orthodontists require patients to obtain dental clearance before installing fixed appliances. This clearance confirms that the mouth is free of active decay and that the supporting gum tissues are in a stable, healthy condition. The process involves a thorough examination and cleaning by a general dentist or periodontist.
If gingivitis is found, the dentist will perform professional cleaning, often including scaling, to remove hardened plaque, known as calculus or tartar, from above and below the gum line. The patient must then demonstrate improved home care to allow the gum inflammation to resolve. Orthodontic treatment generally cannot begin until the swelling has subsided and the gums no longer bleed upon gentle probing. This minimizes the risk of complications once the braces are placed.
Maintaining Gum Health During Orthodontic Treatment
Maintaining gum health with braces requires significantly more effort and specific tools. The brackets and wires create numerous small spaces where food particles and bacterial plaque can become trapped. Brushing should be performed after every meal or snack using a soft-bristled or orthodontic-specific toothbrush.
A modified brushing technique is necessary, angling the brush at 45 degrees to clean around the brackets and wires, focusing on both the top and bottom edges. Flossing daily is non-negotiable, requiring specialized tools like floss threaders or interdental brushes to navigate the wires and clean between the teeth. Water flossers are also helpful, using pressurized water to dislodge debris from hard-to-reach areas around the brackets.
The increased difficulty in cleaning means that patients undergoing orthodontic treatment often need more frequent professional dental cleanings. While a six-month interval is standard, those with braces may benefit from check-ups and cleanings every three to four months. These appointments allow the dental hygienist to remove plaque and calculus that cannot be reached at home, ensuring the gums remain healthy throughout treatment.
When Gingivitis Becomes a Serious Barrier (Periodontitis)
The line between reversible gingivitis and a serious barrier to treatment is the progression to periodontitis. Periodontitis is an advanced form of gum disease where inflammation affects the underlying bone and ligaments supporting the teeth. This results in the formation of deep pockets around the teeth and irreversible bone loss.
Moving teeth through bone that is already compromised by periodontitis is extremely risky. The forces exerted by the braces can accelerate bone loss, potentially leading to tooth instability or even loss. For this reason, active, uncontrolled periodontitis is a contraindication for orthodontic treatment. A periodontist must first manage and stabilize the condition, often through deep cleaning procedures, before an orthodontist can safely begin treatment.