Plaque is a sticky biofilm composed of bacteria that constantly forms on the surfaces of teeth. If not removed regularly, plaque hardens into calculus, contributing to gum inflammation and tooth decay. Fixed orthodontic appliances, such as braces, introduce numerous small surfaces, brackets, and wires that act as mechanical traps for food debris and bacterial accumulation. These hiding spots significantly increase the difficulty of maintaining a clean environment. Removing this plaque requires specialized methods and tools beyond standard oral hygiene routines.
Brushing Techniques for Fixed Appliances
Effective plaque removal requires adapting brushing techniques to the complex structure of braces. Many orthodontists recommend using an orthodontic toothbrush, which features a “V-trim” or concave bristle design shaped to accommodate the brackets. This specialized brush head allows for simultaneous contact with both the tooth surface and the bracket during cleaning.
The physical brushing motion requires a multi-step approach. First, position the brush head at a 45-degree angle downward toward the gumline to clean the area above the bracket and the wire. Use gentle, short, circular strokes, thoroughly brushing each tooth individually and ensuring the bristles sweep under the bracket.
Next, reverse the brush angle, positioning it 45 degrees upward toward the chewing surface to clean the area below the bracket. This technique dislodges plaque accumulating on the gingival side of the bracket and the underlying tooth enamel. This combination effectively cleans the entire front surface of the tooth.
After cleaning around the brackets, address the chewing surfaces of the back teeth with a standard back-and-forth scrubbing motion. Dedicate sufficient time to the removal process, spending approximately 10 seconds on each tooth.
Both manual and electric toothbrushes are effective if the proper technique is consistently used. Electric toothbrushes with small, oscillating-rotating heads can offer superior plaque disruption, especially when specialized orthodontic brush heads are utilized. The small movements and deliberate angling are more important than the speed or force applied.
Specialized Tools for Interdental Cleaning
Specialized manual tools are necessary to remove plaque trapped between the teeth and beneath the archwire, areas the toothbrush cannot reach. Traditional flossing is impossible with fixed braces because the wire prevents the thread from passing down from the top. Therefore, a floss threader or specialized orthodontic floss with a stiff end is required to pass the filament under the main archwire.
The stiff end of the threader or floss is carefully guided beneath the archwire between two adjacent teeth. Once threaded, the floss is positioned against the side of one tooth and gently moved up and down the tooth surface, reaching slightly beneath the gumline to disrupt the biofilm. This process must be repeated for every space between all teeth, cleaning the side of both teeth bordering the gap. This deliberate process mechanically separates the sticky plaque film.
Interdental brushes, sometimes called Proxabrushes, clean the areas immediately surrounding the brackets. These small, cone-shaped brushes have bristles arranged around a thin wire core, making them ideal for navigating tight spaces. The brush is inserted gently underneath the archwire and around the sides of the bracket itself.
The small bristles physically scrape away plaque and food particles that accumulate on the bracket surfaces and adjacent tooth enamel. Using the interdental brush requires a gentle back-and-forth motion without forcing the brush, which could damage the appliance.
Supplemental Cleaning Methods
Supplemental methods enhance overall cleanliness after brushing and flossing. Water flossers, or oral irrigators, use a pressurized stream of water to flush out loose debris and remaining particles from hard-to-reach areas. The pulsed water jet effectively cleans around brackets and wires where food may be lodged.
Water irrigation is excellent for rinsing and dislodging food, but it does not have the mechanical scraping action necessary to remove adherent plaque biofilm from the tooth surface. Therefore, the water flosser should be used as an adjunct to, not a replacement for, traditional brushing and interdental cleaning.
Therapeutic mouth rinses provide further benefits. Fluoride rinses are recommended as they help remineralize enamel surfaces, making teeth more resistant to acid erosion caused by bacteria. This is valuable because orthodontic treatment often increases the risk of decalcification, which appears as white spots.
Antimicrobial rinses, such as those containing chlorhexidine, are sometimes prescribed for short-term use to control high levels of gum inflammation. These chemical agents reduce the overall bacterial load in the mouth. Rinses work best when applied to surfaces that have already been cleaned of physical plaque structure.
The Daily Cleaning Schedule and Verification
Maintaining an effective cleaning schedule requires consistency and frequency. Teeth should ideally be cleaned after every meal or snack to prevent food debris from settling and fueling plaque formation around the brackets. A thorough session combining brushing and specialized interdental tools typically requires five to ten minutes.
Since thoroughness is more important than speed, patients must verify the effectiveness of their efforts. Plaque disclosing tablets or solutions contain a vegetable dye that stains remaining plaque bright colors, making the biofilm visible. Using these periodically allows the patient to identify and focus on areas they consistently miss.
In addition to the daily home care, regular appointments with a dental hygienist are necessary to monitor long-term plaque control. Professional cleanings allow for the removal of hardened calculus that cannot be removed by brushing alone. Orthodontic checks also help monitor the overall health of the gums and the enamel surrounding the fixed appliances.