Braces are complex oral appliances that fundamentally change the landscape of the mouth, creating numerous new surfaces and tight spaces where food particles and plaque can accumulate. This architectural change means that the standard twice-daily brushing routine is no longer sufficient for maintaining oral health. Since orthodontic treatment involves cementing brackets directly to the tooth enamel, maintaining excellent hygiene is required throughout the process. This commitment helps prevent complications and ensures the best possible outcome when the appliances are removed.
The Recommended Brushing Frequency
The minimum recommendation for brushing when wearing braces is typically four times a day, a significant increase over a normal routine. This schedule involves brushing after the three main meals—breakfast, lunch, and dinner—and a final cleaning before going to bed. This frequency is necessary because brackets and wires immediately trap food debris upon eating.
Immediate removal of food and plaque is necessary because these substances quickly produce acid, starting the demineralization process on the tooth surface. Brushing after every meal ensures that damaging substances are removed before they cause harm. Some orthodontists may even suggest brushing after any snack for constant cleanliness.
Specialized Brushing Techniques
Cleaning around the wires and brackets requires a specific approach that differs from regular brushing. It is recommended to use a soft-bristled toothbrush or an electric toothbrush with a head designed for orthodontic appliances. The first step involves cleaning the chewing surfaces and the inside surfaces of the teeth using small, gentle circular motions.
The specialized technique focuses on the front surfaces and the hardware, requiring a dual-angle approach to clean above and below the archwire. To clean the area above the brackets, angle the brush downward at 45 degrees, sweeping toward the wire to dislodge debris. To clean below the brackets, angle the brush upward at 45 degrees, sweeping toward the wire and along the gumline. This two-part process ensures the bristles reach the margins where the brackets meet the tooth, a common site for plaque accumulation.
Addressing Risks of Poor Oral Hygiene
Failing to adhere to a frequent cleaning schedule can lead to negative outcomes that compromise the final result of the orthodontic treatment. One common risk is enamel decalcification, which occurs when plaque sits on the enamel surrounding the brackets. The acid erodes the minerals in the tooth, leading to the formation of permanent white spots or scars on the tooth surface when the appliances are removed.
Another complication is the development of gingivitis due to persistent plaque accumulation along the gumline. Plaque buildup irritates the gum tissue, causing inflammation, swelling, and bleeding. If gingivitis is left unaddressed, it can progress to periodontal disease, which can damage the bone supporting the teeth. The presence of braces makes the teeth more susceptible to these issues.
Essential Interdental Cleaning
Brushing alone cannot completely remove all food particles and plaque because the wires and brackets block access needed to clean between the teeth. Therefore, interdental cleaning is a mandatory supplementary step to ensure complete plaque removal.
Flossing Tools
A traditional floss strand requires the use of a floss threader, a small, flexible loop used to guide the floss under the archwire. Once threaded, the floss can be moved between the teeth and along the gumline.
Specialized Brushes and Irrigators
Other effective tools include specialized brushes and water flossers.
- The interdental brush (proxabrush) is a tiny brush designed to clean small spaces under the archwire and around the bracket components.
- These brushes are useful for dislodging larger food particles that a toothbrush might miss.
- A water flosser (oral irrigator) uses a pressurized stream of water to flush out debris from hard-to-reach areas.
- Water flossers are generally recommended as an addition to, rather than a replacement for, manual flossing methods.