Wearing braces is a major commitment, but patients often worry if a cavity is discovered during treatment. Dental decay remains a possibility, leading to concerns about whether the braces must be removed to address the problem. In the vast majority of cases, cavities can be successfully filled and treated without requiring the premature removal of the orthodontic appliance. This scenario requires careful coordination between the general dentist and the orthodontist to keep both the filling and the tooth-straightening process on track.
Addressing the Cavity While Braces Are Present
When a cavity is identified, the general dentist first assesses its location and the extent of the decay. Small or newly formed lesions, especially those on the tooth’s chewing surface or side away from the bracket, can often be treated minimally without disrupting the existing orthodontic setup. The dentist uses diagnostic tools like X-rays to determine how deep the decay has progressed into the dentin layer of the tooth.
Decay that is confined to an easily accessible area allows the general dentist to proceed with the filling using standard procedures. If the decay is located directly underneath a bracket, or in a tight spot near the archwire, the procedure becomes more complex, requiring temporary removal of some hardware. This initial decision-making process prioritizes the swift removal of the decayed material to prevent the infection from worsening.
While rare, a severe, deep infection that has reached the pulp of the tooth may require more extensive intervention, such as a root canal, even with braces present. The presence of braces does not preclude any necessary restorative treatment, though it adds logistical planning. The feasibility and timing of the treatment are determined by the decay’s severity and its proximity to the orthodontic apparatus.
Coordinating Hardware Removal for the Filling Procedure
Addressing a cavity obscured by braces requires coordination between the general dentist and orthodontist. The orthodontist temporarily disassembles the necessary hardware to grant the dentist clear access to the decayed tooth surface. This process typically begins with the careful removal of the flexible archwire that connects the brackets.
If the cavity is located on the tooth surface where the bracket is bonded, the bracket must be gently debonded from the enamel. The general dentist then proceeds with the standard filling procedure, which involves drilling away the decayed tooth structure and preparing the area for the filling material. Composite resin is the most frequently used material, as it bonds directly to the tooth structure and can be cured quickly with a specialized light.
After the filling is placed, shaped, and cured, the tooth surface is cleaned and prepared for the reattachment of the bracket, if it was removed. The orthodontist re-bonds the bracket in the original position to maintain the integrity of the ongoing tooth movement plan. Finally, the archwire is re-inserted and secured, ensuring the orthodontic treatment continues immediately after the restorative work is completed.
Preventing Future Decay During Orthodontic Treatment
The presence of brackets and wires introduces numerous new surfaces and tight spaces where food particles and plaque can easily become trapped. This significantly increases the risk of decay because these areas are difficult to clean with a standard toothbrush and floss. Plaque buildup around the brackets can lead to demineralization, which often appears as white spots on the enamel when the braces are removed.
Patients undergoing treatment must adopt a modified and rigorous oral hygiene regimen. Specialized cleaning tools are necessary to effectively navigate the hardware. Interdental brushes, also known as proxy brushes, clean under the archwire and around the brackets. Floss threaders or water flossers are recommended to remove debris and plaque from between the teeth and along the gum line, areas difficult to reach with traditional string floss.
In addition to diligent at-home care, the routine use of a fluoride mouth rinse can help strengthen the tooth enamel and provide an extra layer of defense against acid erosion. Regular check-ups and professional cleanings with the general dentist must continue throughout the entire orthodontic period, typically every six months. These appointments allow the dental team to monitor for any early signs of decay and remove hardened plaque, or calculus, that a toothbrush cannot reach.