Braces are highly effective for straightening teeth, but they introduce unique challenges to maintaining oral hygiene. The brackets and wires create numerous crevices that easily trap food particles and encourage the rapid accumulation of plaque. If this plaque is not meticulously removed, it can lead to gingivitis, tooth decay, and decalcification, which presents as permanent white spots on the enamel once the braces are removed. A dedicated cleaning regimen is necessary to ensure the health of the teeth and gums throughout the treatment period, requiring specialized tools and techniques.
Essential Tools for Braces Hygiene
The standard toothbrush alone is insufficient for navigating the intricate structure of brackets and archwires. Orthodontic toothbrushes often feature a “V-trim” bristle pattern, where the center bristles are shorter to accommodate the bracket, allowing the outer bristles to clean the tooth surface above and below the hardware. An interdental brush, sometimes called a proxabrush, is a small, cylindrical brush designed to slide beneath the archwire and clean the spaces between the teeth and around the brackets.
Specialized flossing aids are mandatory to clean between the teeth and bypass the archwire. Floss threaders are flexible plastic loops that allow traditional dental floss to be pulled under the wire. Alternatively, Superfloss offers a three-part strand with a stiff end for threading, a spongy middle for cleaning, and a regular floss section. A water flosser uses a pressurized stream of water to flush out trapped debris and plaque from hard-to-reach areas around the braces.
Daily Brushing and Rinsing Techniques
Effective brushing requires a methodical approach that addresses the multiple surfaces created by the hardware, ideally performed after every meal or snack. The technique begins by positioning a soft-bristled toothbrush at a 45-degree angle toward the gum line, using short, gentle, circular strokes to clean the area where the tooth meets the gum. This angle allows the bristles to gently clean just beneath the gum margin, where plaque tends to accumulate.
Next, the brush must be angled to clean both above and below the brackets, ensuring the entire surface of the tooth is covered. Use a downward angle to clean the top side of the brackets and the tooth surface beneath them, and an upward angle to clean the bottom side and the tooth above. This process should be executed gently, focusing on one or two teeth at a time, which typically requires a total brushing time of at least two to three minutes.
The chewing surfaces and the inside surfaces of all teeth must also be thoroughly brushed. After the mechanical cleaning, rinse the mouth with water or a fluoride mouthwash to dislodge any remaining food particles and provide protection against decay. The appearance of shiny metal and clearly defined bracket edges is a visual indicator of successful plaque removal.
Strategies for Effective Orthodontic Flossing
Flossing with fixed braces is necessary for removing plaque from the interdental spaces and beneath the gum line, though it is the most time-consuming part of the hygiene routine. Using a floss threader involves guiding the stiff end under the archwire, between two adjacent teeth. Once the floss is threaded through, it is carefully pulled to bring the main section of the floss into the space.
With the floss in place, it should be wrapped into a “C” shape against one tooth and gently slid up and down to clean the side of the tooth and slightly below the gum line. This action must be repeated for the adjacent tooth before the floss is carefully removed from beneath the wire. The water flosser offers an efficient alternative or supplement to string floss, especially for those who find manual threading difficult.
The device’s tip should be angled at 90 degrees to the teeth and gum line, tracing the entire archwire and gum margin to flush out debris and bacteria. While the water flosser is excellent for general debris removal, traditional flossing may still be recommended for the deepest interdental cleaning.
Long-Term Care and Troubleshooting Braces Issues
Beyond the daily cleaning routine, long-term success with braces depends on dietary modification to protect the hardware from damage. Hard, crunchy, and sticky foods are the main culprits for causing loose brackets or bent wires, which can prolong treatment time. Items like nuts, popcorn kernels, ice, and chewy candies should be avoided completely.
If a wire or bracket becomes loose, contact the orthodontist promptly, as a damaged component can stop the proper movement of teeth. For a poking wire, a small piece of orthodontic wax can be placed over the sharp end as a temporary measure to prevent irritation.
Decalcification, or the formation of white spots, is a permanent concern caused by plaque acids drawing minerals out of the enamel around the edges of the brackets. This is prevented by diligent plaque removal and by minimizing the consumption of sugary and acidic beverages, which increase the bacteria’s acid production.