Fixed orthodontic appliances, commonly known as braces, are utilized to gradually shift teeth into proper alignment. The success of this treatment hinges not only on the mechanics of the hardware but also on consistent, meticulous home care by the patient. Proper maintenance is necessary to prevent common dental complications, such as tooth decay, gum inflammation (gingivitis), and white spots on the teeth. This requires a shift in daily habits, specifically focusing on how to clean around the appliances, what foods to consume, and how to manage minor hardware issues that may arise.
Essential Daily Cleaning Techniques
Maintaining oral hygiene with braces requires specialized tools and a more time-intensive technique. Food particles and plaque easily become trapped in the small spaces created by the brackets and wires, making a standard brushing routine insufficient. Patients should aim to brush after every meal and snack, not just twice daily, to remove debris before it can cause damage to the tooth surface.
The correct brushing method involves cleaning the teeth and hardware from multiple angles. First, brush the chewing surfaces and the inside of the teeth with a soft-bristled toothbrush. Next, position the brush head at a 45-degree angle downward to clean the area above the brackets and the archwire, sweeping toward the chewing surface. Then, angle the brush head 45-degrees upward to clean the area below the brackets and wire, again sweeping toward the chewing surface.
This process must be gentle but thorough, with an approximate duration of three minutes per session to ensure all surfaces are reached. Interdental brushes are highly effective for cleaning the tight spaces directly underneath the archwire and between the brackets. These supplementary tools help dislodge trapped food that the primary toothbrush may miss.
Flossing remains a necessary step for removing plaque from between the teeth. Traditional dental floss must be threaded beneath the archwire using a stiff-tipped specialized floss or a reusable floss threader. Once beneath the wire, the floss can be gently manipulated in a C-shape around each tooth.
Many orthodontists now recommend a water flosser as a highly effective alternative to string floss. A water flosser uses a pressurized, pulsating stream of water to flush out food particles and bacterial biofilm from around the brackets and under the wires. Clinical studies suggest that, particularly with an orthodontic tip, this method can be significantly more effective at reducing plaque and gingivitis in braces wearers than traditional flossing.
Protecting Your Braces Through Diet
The physical integrity of the orthodontic hardware is delicate and can be compromised by certain foods. Foods that are excessively hard or crunchy must be strictly avoided because the force required to chew them can snap the adhesive bond holding a bracket to the tooth. Examples include hard candies, ice, nuts, hard pretzels, and popcorn kernels, which are notorious for lodging in and around the appliances.
Similarly, sticky foods pose a high risk because they can physically pull the wire out of the bracket slots. Items like caramels, taffy, licorice, and chewing gum can adhere aggressively to the metal components, making removal difficult and potentially causing damage during the process. These foods also tend to leave sugary residue that is difficult to clean, increasing the risk of cavities.
Even some otherwise healthy foods require modification to be consumed safely. Raw vegetables, such as carrots, and whole fruits, like apples, should not be bitten into directly with the front teeth. Instead, they must be cut into small, bite-sized pieces and chewed with the back teeth to minimize the stress placed on the front brackets and wires.
Preventative care also extends beyond food to include certain oral habits. Patients should avoid chewing on non-food items, such as pen caps, pencils, or fingernails, as these habits introduce concentrated forces onto the braces. Repetitive stress from these actions can lead to hardware failure that requires an unscheduled repair appointment.
Handling Common Issues and Hardware Damage
Temporary discomfort is common, especially after the braces are placed or adjusted. The gentle pressure applied to the teeth can cause a dull ache, which can usually be managed with over-the-counter pain relievers such as acetaminophen. Rinsing the mouth with a warm salt water solution can also help soothe irritated gums and any minor sores that develop as the soft tissues adjust to the hardware.
Irritation caused by the braces rubbing against the cheeks, lips, or tongue is often resolved with orthodontic wax. This non-toxic wax creates a smooth, protective barrier over the sharp or rough edges of a bracket or wire. To apply the wax, the patient must first ensure the area is clean and dry, as the wax adheres better to a moisture-free surface.
A small, pea-sized piece of wax should be rolled into a ball to soften it and then gently pressed directly over the part of the appliance causing irritation. The wax is designed to be a temporary solution and should be removed before eating or brushing, then replaced with a fresh piece if needed. If a wire shifts or breaks, creating a sharp end that pokes the cheek, the wax should be applied over the tip immediately to prevent injury.
For a poking wire, a clean pencil eraser can sometimes be used to gently push the wire back toward the tooth. If the archwire has slipped out of a bracket on the back tooth, sterilized tweezers can sometimes be used to carefully slide the wire back into the tube. These are temporary measures, and the orthodontist should be contacted immediately for a professional repair to ensure the treatment remains on schedule.