Orthodontic hardware, including brackets and wires, creates numerous new surfaces where plaque and food particles accumulate. This environment significantly increases the risk of enamel demineralization, often resulting in white spot lesions (WSLs) visible once the braces are removed. Fixed appliances lead to higher biofilm deposition, emphasizing the necessity of precise cleaning to prevent these early signs of tooth decay. Because WSLs affect a large percentage of orthodontic patients, a meticulous daily hygiene routine is vital for successful treatment.
Essential Tools for Braces Hygiene
Effective cleaning with braces requires specialized equipment designed to reach around the fixed appliances. A soft-bristled toothbrush, manual or electric, is recommended because it is gentle on the gums and the brackets. Orthodontic toothbrushes, sometimes called V-trim brushes, feature a specialized bristle pattern with a recessed middle section that contours around the brackets. This design allows the outer bristles to clean the gumline and the tooth surface simultaneously.
Fluoride toothpaste is necessary for all patients with braces, as it strengthens the enamel and promotes remineralization against acid attacks. For reaching tight spaces between the wire and the tooth, small interdental brushes, also known as proxabrushes, are highly effective. These tiny, cone-shaped brushes mechanically sweep away debris that a regular toothbrush cannot access, reducing the risk of localized decay.
The Step-by-Step Brushing Technique
The mechanical process of brushing must be adapted to thoroughly clean the tooth surfaces and the orthodontic hardware. Before applying toothpaste, rinse with water to help dislodge any large food particles trapped in the brackets and wires. The entire brushing session should last for a minimum of two minutes to ensure every surface is adequately cleaned.
Begin by focusing on the tooth surface covered by the braces (facing the cheek and lips). Position the toothbrush bristles at a 45-degree angle pointing down toward the wire, covering the top edge of the brackets and the tooth surface beneath them. Use a gentle, small circular or back-and-forth scrubbing motion to clean each tooth, concentrating on only one or two teeth at a time.
Next, reposition the brush so the bristles are angled at 45 degrees pointing up toward the gumline, cleaning the lower edge of the brackets and the tooth surface above the wire. This dual-angle technique cleans the entire bracket surface and the surrounding enamel, which are high-risk areas for plaque accumulation. The motion should be consistently gentle, as applying too much pressure can damage the braces or irritate the gums.
After cleaning the front surfaces, brush the inner surfaces of all teeth, from the molars to the front, using the same small, gentle motions. Finally, clean the chewing surfaces of the back teeth with a straight-on scrubbing motion. This systematic approach guarantees that all parts of the mouth are addressed within the two-minute window.
Advanced Cleaning: Flossing and Interdental Care
Following the main brushing, supplementary cleaning is required to reach tight spots inaccessible to the toothbrush head. Flossing remains necessary to remove bacterial biofilm and debris from between the teeth and beneath the gumline. Because the archwire blocks the path, standard floss must be threaded under the wire to reach the contact point between teeth.
Floss threaders, which are small, flexible loops of plastic, can pull regular floss beneath the archwire, similar to threading a needle. Specialized orthodontic floss, like Superfloss, is also available, featuring a stiffened end that guides directly under the wire without a separate threader. Once positioned, wrap the floss into a “C” shape around the side of one tooth and slide it gently up and down, reaching slightly below the gumline.
After flossing, use the small interdental brushes (proxabrushes) to clean meticulously around the brackets themselves. Insert the proxabrush gently into the space between the wire and the bracket, moving it back and forth to clear out trapped food and plaque. This tool is useful for cleaning the sides of the brackets and the small gaps next to the gums. Complete the routine with a final rinse, using plain water or an antimicrobial mouthwash, to flush away loosened particles.