The presence of orthodontic brackets and wires fundamentally alters the landscape of the mouth, creating numerous new surfaces and tight spaces where food debris and plaque can easily become trapped. This environment makes the standard twice-daily brushing routine insufficient for maintaining a healthy smile during treatment. The metalwork acts as an ideal anchor for bacteria, requiring a significant adjustment to daily oral hygiene habits to prevent complications. Maintaining oral hygiene throughout the orthodontic process is necessary to ensure the best possible outcome when the appliances are eventually removed.
Recommended Brushing Frequency
The consensus among orthodontists is that patients should brush their teeth after every single meal and snack. This strict protocol ensures that trapped food particles are swiftly removed before they can be metabolized by oral bacteria. Since most people consume three meals a day plus occasional snacks, this routine generally translates to brushing a minimum of four times daily.
The traditional morning and evening brushing is insufficient because plaque begins to form on tooth surfaces within hours of eating. Acids generated by bacteria start to demineralize enamel almost immediately, a process accelerated by the food traps created by the braces. Immediate brushing removes the fuel source for these bacteria, neutralizing the acid attack that follows eating.
Essential Brushing Technique
Achieving a thorough clean requires a strategic approach to navigate around the brackets and wires with a soft-bristled toothbrush. The process begins by removing any removable elastics or bands and rinsing the mouth with water to dislodge larger food particles. This initial step makes the subsequent brushing more effective by clearing the most obvious debris.
The actual brushing should be divided into two distinct phases for each tooth surface. First, position the brush at a 45-degree angle, aiming the bristles downward to clean the area above the bracket and toward the gumline. Next, reposition the brush to angle upward, cleaning the surface below the bracket and the wire, using short, gentle circular motions.
This technique ensures the bristles reach the margins of the bracket and the tooth surface beneath the wire. Finally, the biting surfaces and the entire back side of the teeth must be thoroughly brushed, as these areas can still harbor plaque.
Specialized Tools and Aids
While a standard soft-bristled toothbrush is the foundation, specialized tools are necessary to clean areas a manual brush cannot reach. Interdental brushes, sometimes called proxabrushes, feature small, cone-shaped bristles designed to clean beneath the archwire and in the tight spaces between brackets. These brushes are useful for dislodging trapped food and plaque.
Flossing remains a necessary part of the routine, but it requires assistance from a floss threader or specialized orthodontic floss. A floss threader is a stiff loop used to pull the floss under the archwire so the space between the teeth can be properly cleaned. A water flosser uses a pressurized stream of water to flush out debris and plaque from around the brackets and under the gumline. Using a therapeutic mouthwash, such as one containing fluoride, provides extra protection by helping to remineralize enamel and reduce bacterial load.
Risks of Poor Oral Care
Failing to maintain a rigorous hygiene schedule significantly increases the risk of permanent damage to the teeth and gums. The most visible consequence of poor cleaning is decalcification, which presents as chalky white spots on the enamel after the braces are removed. These spots are permanent scars caused by the loss of minerals and are highly susceptible to developing into cavities.
Plaque accumulation along the gumline leads to gingivitis, causing the gums to become inflamed, red, and prone to bleeding. Untreated gingivitis can progress to more serious periodontal disease, which damages the bone supporting the teeth. Furthermore, severe gum inflammation and tooth decay can compromise oral health, potentially requiring the orthodontist to temporarily remove the braces and prolonging the overall treatment time.