Dental plaque is a colorless, sticky film of bacteria that constantly forms on teeth and along the gum line. Braces introduce numerous new surfaces and tight crevices where food particles become trapped, allowing plaque to rapidly accumulate. If not consistently removed, the acids produced by the bacteria demineralize the enamel, leading to decalcification (white spots) when braces are removed. Uncontrolled plaque also irritates the gums, often causing gingivitis, characterized by swelling and bleeding.
Essential Tools and Equipment
Effective plaque removal requires specialized tools beyond a standard toothbrush. A soft-bristled toothbrush is recommended, either a manual one designed with a “V” cut trim to contour around brackets or an electric toothbrush with an orthodontic brush head. The soft bristles are gentle on the gums and braces while still disrupting the plaque.
Interdental brushes, sometimes called proxabrushes, are small, cone-shaped brushes designed to clean the tight spaces between the archwire and the tooth surface. Specialized flossing products are also necessary, such as floss threaders or pre-cut orthodontic floss like Superfloss, which features a stiff end to guide the floss under the main wire.
A water flosser, or oral irrigator, uses a pressurized stream of water to flush out loose food particles and bacteria. While not a substitute for mechanical brushing and flossing, the water flosser is efficient at cleaning around brackets and reaching the back surfaces of the teeth.
Targeted Brushing Techniques
To manage the rapid plaque accumulation caused by braces, brush after every meal or snack to remove trapped food debris. A thorough brushing session should last for a minimum of two minutes, ensuring every tooth surface is addressed.
The most effective method involves a two-part approach to clean both above and below the archwire and brackets. First, angle the toothbrush bristles at a 45-degree angle toward the gum line, cleaning the area where the tooth meets the gum and the top edge of the bracket. Use gentle, short, circular motions across the entire surface.
Next, reposition the brush head to clean the area beneath the wire. Angle the bristles at a 45-degree angle pointing toward the biting surface of the tooth, cleaning the bottom edge of the bracket and the tooth surface below it. This technique ensures the bristles contact the enamel immediately surrounding the bracket, a common site for plaque buildup. Remember to brush the chewing surfaces and the inside surfaces of all your teeth using the same gentle motions.
Removing Plaque Between Teeth and Wires
Plaque that collects between the teeth requires specialized tools because the archwire blocks conventional floss. To clean these spaces, thread the floss under the main archwire using a floss threader or the stiff end of orthodontic floss. Once the floss is under the wire, gently slide it down between the teeth to the gum line.
Curve the floss into a “C” shape against one tooth and slide it into the sulcus (the space between the tooth and gum). Move the floss up and down five to six times, then repeat this process on the adjacent tooth. This mechanical scraping action physically removes sticky plaque from the sides of the teeth.
Interdental brushes are essential for cleaning the small spaces immediately around each bracket and under the archwire. Insert the brush gently from the top or bottom of the wire, using a small back-and-forth motion to scrub plaque off the bracket and the tooth surface beneath it. A water flosser can be used as a final step to flush away any remaining loosened debris and bacteria.
Long-Term Prevention and Maintenance
Maintaining a modified diet plays a role in reducing plaque accumulation and protecting orthodontic hardware. Avoiding hard, sticky, or chewy foods minimizes the risk of breaking brackets and wires, which can create new traps for plaque. Limiting sugary and acidic foods and drinks reduces the fuel source for plaque bacteria, decreasing the production of enamel-eroding acids.
Daily use of a fluoride-containing toothpaste is important because fluoride ions help remineralize the enamel, strengthening it against acid attacks. Your orthodontist or dentist may also prescribe a higher-concentration fluoride rinse or gel to be used nightly. This targeted fluoride application helps harden the enamel in areas most vulnerable to plaque buildup around the brackets.
Professional dental care is adjusted during orthodontic treatment, with cleanings often recommended every three to four months instead of the standard six-month interval. These frequent visits allow the hygienist to remove hardened plaque, known as calculus or tartar, which cannot be removed at home. Regular professional maintenance ensures the daily home-care routine remains effective.