Plaque, a sticky film of bacteria constantly forming on tooth surfaces, poses a significant threat to oral health, especially for those undergoing orthodontic treatment. Brackets and wires introduce numerous new surfaces and tight spaces that complicate cleaning. This complexity means that a standard brushing and flossing routine is insufficient for preventing plaque accumulation. Successfully removing plaque requires a dedicated, modified approach using specialized tools and techniques. This extra effort prevents decay and ensures a healthy, straight smile once the orthodontic hardware is removed.
Why Braces Create Unique Plaque Challenges
Orthodontic appliances increase the total surface area within the mouth, creating new sheltered niches where plaque can thrive. Brackets bonded to the tooth surface and the archwire connecting them act as physical barriers. These barriers shield bacteria from the normal cleansing action of saliva and traditional toothbrush bristles. Food particles and sugary debris easily become trapped around the hardware, fueling the bacteria in the plaque.
The resulting acidic environment accelerates the demineralization of enamel, particularly around the brackets. Unchecked plaque accumulation leads to the formation of white spot lesions, which are areas of chalky, opaque enamel signaling the early stages of decay. These spots are permanent scars that become visibly apparent only after the braces are removed. The appliances necessitate a more thorough and time-consuming cleaning regimen to prevent this damage.
Specialized Tools and Equipment
Effectively managing plaque with braces requires specialized implements designed to navigate the orthodontic hardware.
Orthodontic Toothbrush
The primary tool is often an orthodontic toothbrush, which features a V-shaped trim where the middle bristles are shorter than the outer ones. This design allows the brush head to fit over the brackets and clean both the appliance and the tooth simultaneously. An alternative is a soft-bristled toothbrush, which can be angled to clean above and below the wires.
Interdental Tools
- Interdental brushes, also known as proxabrushes, are small, cone-shaped brushes designed to clean the tight spaces underneath the archwire and between the brackets.
- Floss threaders are flexible plastic loops used to manually guide dental floss under the main archwire for interproximal cleaning. This makes it possible to clean the sides of the teeth blocked by the wire.
- A water flosser, or oral irrigator, uses a pressurized stream of water to flush out food particles and loose plaque from hard-to-reach areas around the hardware.
Mastering the Brushing and Flossing Techniques
Thorough brushing with braces requires a methodical, three-part technique for each tooth to ensure all surfaces are cleaned.
Brushing Technique
- Hold the toothbrush bristles at a 45-degree angle pointing downward toward the chewing surface, gently brushing the area of the tooth above the bracket and near the gum line.
- Angle the toothbrush at 45 degrees upward, cleaning the surface of the tooth below the bracket and closest to the biting edge.
- Brush the bracket itself with a circular motion to dislodge any trapped debris and fully clean the hardware.
This entire process should be repeated on the back, or lingual, surfaces of the teeth. The two-minute minimum for brushing should be seen as a starting point.
Flossing Technique
Flossing demands a slow, deliberate approach using a floss threader or Superfloss, which has a stiff end. The threader is used to pass the floss underneath the archwire between two teeth, similar to threading a needle. Once the floss is under the wire, carefully wrap it around each adjacent tooth and slide it up and down to clean the interproximal space and below the gum line. This must be done for every space between the teeth, and the floss must be removed gently to avoid damaging the archwire.
Ongoing Prevention and Professional Care
Beyond the daily mechanical removal of plaque, dietary choices significantly influence the environment around the brackets. Foods that are hard, sticky, or excessively sugary should be avoided because they increase the risk of plaque accumulation and bracket damage. Hard foods, such as nuts or ice, can break the hardware, while sticky items like caramel adhere to the brackets and provide bacteria with prolonged access to sugar. Limiting consumption of highly acidic drinks, such as sodas and sports drinks, also protects the enamel from erosion.
To strengthen the enamel against the acid produced by plaque, the use of fluoride products is recommended. While daily use of fluoride toothpaste is necessary, many orthodontists recommend a prescription-strength fluoride rinse or gel to be used nightly. Fluoride helps remineralize the enamel, reversing the early stages of demineralization that lead to white spots. Even with a thorough at-home routine, professional dental cleanings are necessary to remove calcified plaque, known as calculus or tartar. Patients with braces are advised to schedule professional cleanings every three to four months, rather than the standard six months, to ensure optimal oral health throughout treatment.