Fixed orthodontic appliances (braces) increase the difficulty of maintaining a clean mouth. Brackets, bands, and wires introduce numerous surfaces and tight spaces where food particles and plaque easily become trapped. This environment makes effective oral hygiene challenging, leading to an elevated risk of dental issues during treatment. Unremoved plaque, a sticky film of bacteria, allows microorganisms to produce acids that demineralize tooth enamel. This process results in decalcification (permanent white spots on the teeth) and a higher incidence of gingivitis, or gum inflammation.
Essential Tools for Cleaning Around Brackets
Cleaning fixed appliances requires specialized equipment. An orthodontic toothbrush is a foundational tool, often featuring V-trim bristles, where the center bristles are shorter than the outer ones. This V-shape allows the brush head to cradle the bracket and archwire, cleaning the metal and the surrounding tooth surface simultaneously. Interdental brushes (Proxabrushes) resemble miniature pipe cleaners manufactured in various sizes. These small, tapered brushes slide underneath the archwire to clean tight spaces between brackets and the tooth surface.
Flossing with traditional string floss is nearly impossible due to the archwire, necessitating aids like floss threaders or Superfloss. A floss threader is a stiff, needle-like device with a loop that allows regular floss to be pulled through the narrow gap between the wire and the gumline. Superfloss is a pre-cut strand combining a stiff end for threading, a spongy section for cleaning around the appliance, and a regular floss section. A water flosser, or oral irrigator, delivers a pressurized stream of water to flush out food debris and loose plaque from inaccessible areas.
Mastering Brushing and Flossing Techniques
The modified brushing technique for braces requires a two-step approach to ensure all tooth surfaces are reached. First, hold the toothbrush at an upward angle, positioning the bristles above the brackets and directed toward the gumline. Use small, gentle circular motions to clean this area, focusing on each tooth individually to remove plaque accumulation. Next, angle the toothbrush downward, placing the bristles below the brackets and directed toward the biting surface of the tooth. This ensures the underside of the bracket and the remaining tooth surface are cleaned, requiring a minimum of two minutes of brushing time, ideally after every meal.
Flossing must be performed daily, as brushing alone cannot clean between the teeth. To navigate the archwire, thread the floss through a floss threader loop or use the stiff end of a Superfloss strand. Gently guide the floss beneath the archwire and between the two teeth, taking care not to snap the floss down onto the gums. Once through, wrap the floss around the side of one tooth and move it up and down in a C-shape motion, reaching just under the gumline, then repeat the process on the adjacent tooth.
The mechanical action of the interdental brush targets the area directly beneath the archwire and the bracket wings. Carefully slide the brush under the main wire and move it back and forth to dislodge trapped food and plaque. This supplemental cleaning helps disrupt biofilm in areas prone to staining and decay. Consistent application of these techniques maximizes plaque removal and minimizes the risk of complications.
Dietary Adjustments and Managing Minor Irritations
Protecting the orthodontic appliance requires specific dietary limitations. Hard, crunchy, sticky, and chewy foods must be avoided because they can bend wires, dislodge brackets, or break the appliance. Examples include nuts, popcorn, hard candies, caramel, and chewing gum. To enjoy hard foods like apples or raw carrots, cut them into small, bite-sized pieces and chew with the back teeth, preventing biting with the front teeth.
Minor irritations are common, especially in the first weeks or following an adjustment. The lips, cheeks, and tongue may rub against the brackets and wires, leading to temporary mouth sores. Orthodontic wax provides a simple physical barrier; a small, softened piece is pressed directly onto the bracket or wire causing irritation, smoothing the surface. Rinsing the mouth with warm salt water helps soothe irritated gum tissue and expedite the healing of small sores. Regular appointments are necessary for adjustments, monitoring overall health, and professionally cleaning difficult-to-reach areas.