A permanent, or bonded, retainer is a thin wire cemented to the backside of the front teeth, typically on the lower arch. This device holds the teeth in their final position following orthodontic treatment, preventing them from shifting back toward their original alignment. While effective, this fixed wire poses a significant challenge for daily oral hygiene because it obstructs the normal path of dental floss. This obstruction creates an area where plaque and food debris can easily accumulate. Consistent cleaning is required to navigate the wire and ensure the tooth surfaces and gums remain healthy.
Essential Manual Techniques Using Floss
The most direct and effective way to remove sticky bacterial plaque, or biofilm, from the surfaces beneath the retainer is using dental floss. Since the retainer wire prevents traditional flossing, specialized tools are required to thread the floss into the space between the teeth and under the wire. Floss threaders act like a needle, featuring a stiff, nylon loop through which regular floss is passed. The stiff end of the threader is then guided between two teeth and under the retainer wire, pulling the attached length of floss through.
Once the floss is successfully under the wire, wrap it around the side of one tooth in a “C” shape. Gently move the floss up and down to clean the surface, extending slightly below the gumline. This process must be repeated for the adjacent tooth before the floss is pulled out and re-threaded for the next space. If the retainer is bonded to every tooth, this threading action must be performed for each space. If the retainer is only bonded to the teeth at the ends, the floss can often be slid along the wire to clean multiple spaces after being threaded once.
An alternative is specialized or tufted floss, such as Superfloss. This product is pre-cut and features a stiffened end that functions as its own threader, eliminating the need for a separate tool. The stiff end is guided under the retainer wire, followed by a thick, spongy section designed to efficiently clean the surface area around the wire and the gumline. The cleaning is completed with a standard section of floss on the opposite end.
Advanced Tools for Supplementing Cleaning
While manual flossing is the gold standard for removing tenacious plaque, supplementary devices can enhance the overall cleaning regimen by flushing out loose debris. Water flossers, or oral irrigators, use a pressurized, pulsating stream of water to dislodge food particles and plaque from around the wire and between the teeth. To use a water flosser effectively, lean over the sink and direct the stream perpendicular to the retainer wire, starting with a low pressure setting.
The water flosser is effective for rinsing away loose material and reaching difficult areas, but it is insufficient as a complete replacement for manual flossing, which physically scrapes away the sticky biofilm. For a more precise mechanical clean around the bonding sites, interdental brushes are another beneficial tool. These miniature brushes resemble tiny pipe cleaners and can be gently inserted into the spaces between the teeth and around the wire to scrub the surfaces.
Interdental brushes come in a variety of sizes and shapes. Selecting the correct diameter is important to ensure a snug fit without forcing the brush into the space, which could damage the gums or the retainer itself. These brushes are particularly useful for cleaning the tiny gaps where the bonding agent connects the wire to the tooth surface.
Recognizing and Preventing Dental Complications
Failure to consistently clean beneath a permanent retainer creates an environment where oral health complications are likely. The retainer wire acts as a physical barrier that encourages the accumulation of bacterial plaque. This plaque rapidly hardens into calculus, or tartar, a calcified deposit that cannot be removed by brushing or flossing. This accumulation leads to localized inflammation of the gum tissue, known as gingivitis, characterized by redness, swelling, and bleeding during cleaning.
If gingivitis is left unaddressed, the chronic inflammation can progress to periodontitis, which involves the destruction of the bone and supporting structures around the teeth. Furthermore, the constant presence of plaque around the bonding sites and on the back surface of the teeth elevates the risk of tooth decay, or cavities. These areas are difficult for saliva to reach and neutralize acids, leading to demineralization of the tooth enamel.
Preventing these complications requires a commitment to the detailed cleaning methods described, performed at least once daily. It is also important to maintain a schedule of regular professional dental checkups and cleanings, typically every six months. During these appointments, the dental hygienist removes any hardened tartar and inspects the retainer for damage, ensuring the device functions without compromising the health of the teeth and gums.