Orthodontic appliances transform the mouth into an environment where plaque, a sticky bacterial biofilm, accumulates rapidly. Brackets and wires create numerous retention sites, making plaque removal significantly more challenging than on smooth tooth surfaces. If this bacterial plaque is not consistently removed, the acid it produces will cause demineralization, commonly appearing as white spots, or decalcification, on the enamel once the braces are removed. Furthermore, untreated plaque accumulation leads to gingivitis, characterized by swollen and bleeding gums, and ultimately increases the risk of developing cavities. Specialized cleaning routines are necessary to maintain a healthy smile throughout the entire orthodontic treatment.
Essential Brushing Techniques for Braces
Effective plaque control begins with adjusting the mechanical technique of toothbrushing to navigate the hardware. A soft-bristled toothbrush is preferred to prevent damage to the gums and appliances; V-trimmed brushes, specifically designed for braces, can also be helpful. The standard approach requires a two-part brushing method for each tooth surface: one motion cleans above the archwire and bracket, and the other cleans below.
When cleaning the upper half of the tooth, the brush should be angled downward, with the bristles pointing toward the gumline to sweep away plaque that collects near the brackets. For the lower half of the tooth, the brush angle is reversed, pointing the bristles upward toward the chewing surface to clean under the wire. This angled, gentle motion should be applied to each tooth individually, ensuring that the bristles reach the gumline and the exposed enamel surfaces.
To directly clean the brackets and the narrow space between the wire and the tooth, interdental brushes, also known as proxabrushes, are highly effective. These small, tapered brushes can be carefully inserted under the archwire to mechanically scrub the plaque off the hardware itself. Electric toothbrushes with specialized orthodontic heads can also be used, often requiring only that the user holds the brush at the correct angle for a few seconds per tooth.
Targeted Cleaning for Hard-to-Reach Areas
Even with careful brushing, the small contact points between teeth, known as interproximal spaces, are not fully accessible due to the archwire passing through them. Cleaning these areas requires specialized tools to prevent plaque from calcifying into tartar, which cannot be removed at home. Floss threaders are flexible plastic loops that act like a needle to carry traditional dental floss under the archwire.
The user threads a section of floss through the threader, guides the stiff end under the main wire, and then pulls the floss through to access the space between two teeth. Once the floss is positioned, it must be gently moved up and down the side of each tooth, curving it into a “C” shape to reach slightly below the gumline and scrape the plaque off the enamel. This process must be repeated for every single space between the teeth, as the floss cannot simply be pulled out and moved to the next space. Specialty products like Superfloss simplify this by featuring a stiffened end that eliminates the need for a separate threader.
In addition to traditional string flossing, oral irrigators, commonly called water flossers, offer a complementary method for removing loose debris and plaque. These devices use a pressurized, pulsing stream of water to flush out food particles and dislodge bacteria from around brackets, under archwires, and along the gumline. While a water flosser is highly efficient for rinsing away loose material in difficult areas, it does not replace the mechanical scraping action of string floss, which is necessary for fully removing the sticky biofilm from the tight contacts between the teeth.
Adjunctive Care and Professional Maintenance
Beyond the physical action of brushing and flossing, supplementary products and routine professional care reinforce plaque control. The use of therapeutic mouthwashes, particularly those containing fluoride, helps to strengthen the enamel against acid attacks. These alcohol-free fluoride rinses can be swished after brushing and flossing to provide an extra layer of protection, which is particularly beneficial in preventing decalcification around the brackets.
Dietary choices play a significant role in reducing the fuel source for plaque-forming bacteria. Avoiding excessively sticky, hard, or sugary foods is recommended because they cling to the brackets and wires, creating an ideal environment for rapid bacterial growth. If immediate brushing is not possible after a meal or snack, rinsing the mouth vigorously with water can help dislodge some of the food debris until a full cleaning can be performed.
Regular professional maintenance appointments remain a necessary part of the oral hygiene regimen during orthodontic treatment. Even the most diligent home care cannot prevent the slow accumulation of calcified plaque, or tartar, especially in hard-to-reach areas near the gums. Dental cleanings and check-ups, often scheduled more frequently than the standard six months, allow a professional to remove hardened deposits and monitor for early signs of decalcification or gingivitis.