A common question for people considering a straighter smile is whether existing dental decay, or cavities, will prevent them from getting braces. Orthodontic treatment, which involves applying controlled forces to move teeth, requires a foundation of healthy teeth and gums to proceed safely and effectively. The presence of active tooth decay introduces complications that can undermine the entire process. Therefore, foundational dental health is a prerequisite for tooth alignment.
Addressing Existing Tooth Decay Before Orthodontic Treatment
The definitive answer is that any active tooth decay must be fully treated and eliminated before beginning the process of tooth movement with braces or aligners. This requirement is non-negotiable because the teeth need to be structurally sound to withstand the consistent forces applied by the orthodontic appliances. The first step in the orthodontic journey is typically a comprehensive dental examination, including X-rays, to identify any existing decay, infections, or other issues.
This initial assessment often involves a close collaboration between the general dentist and the orthodontist. The dentist’s role is to ensure the mouth is “decay-free,” treating any areas of active decay, which could range from small fillings to more extensive restorations like crowns. Superficial issues, like minor staining or early enamel demineralization, may sometimes be monitored, but any lesion that has created a cavity must be restored. Only once the restorative work is complete and the teeth are stable can the orthodontist proceed with the placement of brackets or the provision of aligners.
Risks of Starting Braces with Untreated Decay
Attempting to start orthodontic treatment with untreated tooth decay is highly discouraged because it increases the risk of serious complications and significantly prolongs the overall treatment time. Brackets and wires inherently create numerous small spaces and traps where food particles and plaque can accumulate, making oral hygiene more difficult than usual. This environment accelerates the progression of existing decay, quickly turning small cavities into much larger problems.
Teeth weakened by active decay are structurally compromised and may not be able to endure the mechanical stress of orthodontic forces. The constant pressure applied to move a tooth can cause a decayed tooth to fracture, or in severe cases, lead to the eventual loss of the tooth. Furthermore, the bonding material used to attach brackets cannot adhere effectively to a decayed or unstable tooth surface, resulting in bracket failure and a compromised treatment plan.
If a cavity is discovered and requires treatment while the braces are already on, the procedure becomes more complicated. The dentist may need the archwire or even the bracket itself removed by the orthodontist to access the decayed area for a proper filling. This interruption requires additional appointments, temporarily halts the planned tooth movement, and can add months to the total treatment duration.
Preventing New Decay While Wearing Braces
Maintaining excellent oral hygiene is paramount during orthodontic treatment because the appliances increase the surfaces where plaque can hide, multiplying the risk of new decay. The cleaning routine must become more diligent and frequent, ideally involving brushing after every meal and snack to remove trapped food debris immediately.
Specialized tools are highly recommended to effectively clean around the hardware and prevent the formation of white spot lesions, which are early signs of decay. Interdental brushes are designed to clean beneath the archwires and around the individual brackets where a standard toothbrush cannot reach. Since traditional flossing is challenging, aids like floss threaders or orthodontic floss are necessary to navigate the wire and clean between the teeth and gums daily.
Many orthodontists also strongly recommend the use of a water flosser, which uses a pressurized stream of water to dislodge food and plaque from hard-to-reach areas. The frequent use of fluoride products is another protective measure, as fluoride helps to strengthen the tooth enamel and enhance remineralization. This might include using a fluoride toothpaste and a prescribed fluoride mouthwash, or receiving professional fluoride treatments at the dental office. Regular check-ups and cleanings with the general dentist, typically every three to six months, are necessary alongside scheduled orthodontic adjustments.