The presence of orthodontic hardware, such as brackets and wires, creates numerous surfaces and crevices where bacterial plaque easily accumulates. Plaque is a sticky, colorless film composed of bacteria and sugars that constantly forms on teeth. If this film is not thoroughly removed, the bacteria produce acids that can lead to enamel demineralization, causing permanent white spots or cavities, especially around the edges of the brackets. Maintaining meticulous oral hygiene during orthodontic treatment is essential to ensure tooth health and achieve the best possible result when the braces are removed.
Essential Brushing Techniques and Tools
The foundation of plaque removal begins with proper brushing, which must be performed at least twice daily for a minimum of two minutes, and ideally after every meal. A soft-bristled toothbrush is recommended, as its flexibility allows it to navigate around the hardware without damaging the brackets or irritating the gums. Orthodontic toothbrushes feature a specialized V-shaped bristle pattern designed to contour over the archwire and brackets, enhancing cleaning efficiency.
The technique requires a two-part approach to clean both the bracket surface and the gumline effectively. First, angle the toothbrush downward at 45 degrees to clean the area above the brackets and the archwire, pushing debris toward the biting surface. Next, reverse the angle to 45 degrees upward, cleaning the area below the brackets and the gumline, gently pushing the bristles under the wire. This method ensures the entire tooth surface and hardware are systematically cleaned using small, gentle circular motions on each tooth. Electric toothbrushes can also be effective, especially those with small, oscillating heads or specialized orthodontic brush heads designed to clean consistently around the brackets and wires.
Cleaning Tight Spaces: Flossing and Interdental Aids
Brushing alone cannot reach the plaque that collects beneath the archwire and between the teeth, making daily interdental cleaning necessary. Traditional dental floss requires a floss threader, a small, rigid plastic loop that guides the floss underneath the main archwire. Once threaded, the floss is gently worked up and down the sides of each tooth to clean the interproximal spaces and the gumline.
Specialized orthodontic floss, often called Superfloss, has a stiffened end that eliminates the need for a separate threader. This floss typically includes a spongy section to clean around the hardware and a regular section for the gumline. Interdental brushes, also known as proxabrushes, are small, tapered brush heads used with a gentle in-and-out motion to dislodge trapped food and plaque from the spaces between the wire and the bracket.
An oral irrigator, or water flosser, provides a supplementary method for dislodging debris and loosely attached plaque. This device uses a pressurized stream of water to flush out food particles trapped around the brackets and under the archwire. While it does not fully replace the mechanical removal achieved by floss, the water flosser is effective for reaching the entire perimeter of the hardware and reducing the bacterial load.
Supplementary Plaque Control Measures
Beyond mechanical cleaning, certain non-mechanical steps reinforce plaque control and protect the underlying enamel. Fluoride mouth rinses are beneficial because the fluoride ion helps remineralize the enamel surface, making it resistant to acid attacks produced by plaque bacteria. Using a fluoride rinse after brushing and flossing provides a final coating of protection, especially in areas where the brackets are bonded.
Antimicrobial mouth rinses may also be recommended by a dental professional to reduce plaque-forming bacteria and manage gingivitis, or gum inflammation, which is common with braces. When using a therapeutic rinse, avoid eating or drinking for at least 30 minutes afterward to allow the active ingredients to remain on the tooth surface.
Dietary modifications also play a role in limiting plaque formation and subsequent enamel damage. Highly acidic or sugary foods and drinks provide fuel for the bacteria. Sticky or hard foods should be limited or avoided entirely, as they can damage the appliance and complicate hygiene.