Braces are fixed orthodontic appliances composed of brackets, wires, and bands, bonded to the teeth to guide movement and correct alignment. While straightening teeth, this hardware fundamentally complicates maintaining a clean mouth. The components create numerous spaces where food debris and bacterial plaque easily become trapped. This accumulation of biofilm makes it challenging to remove bacteria effectively with a standard brushing routine, setting the stage for negative consequences if hygiene is neglected.
Localized Damage Around Brackets
The most common and earliest consequence of poor hygiene with braces is enamel decalcification, or demineralization, occurring specifically around the bracket edges. Plaque accumulation adjacent to the brackets creates a localized environment where bacteria produce acids that attack the tooth enamel. This acid dissolves minerals, primarily calcium, from the enamel surface, leading to a loss of density.
This mineral loss results in a chalky, opaque appearance on the tooth surface, referred to as a “white spot lesion” (WSL). These white spots become obvious once the braces are removed, as the enamel beneath the bracket adhesive remains pristine. WSLs are the earliest form of tooth decay and represent vulnerable areas on the tooth surface. Studies indicate that a high percentage of patients develop some degree of decalcification during fixed orthodontic treatment when oral hygiene is insufficient.
Impact on Gum Tissue and Tooth Structure
Ignoring plaque buildup allows damage to progress beyond localized white spots, affecting gum tissue and the entire tooth structure. Plaque not meticulously removed from the gumline and around the brackets irritates the soft tissues, leading to gingivitis. Gingivitis is characterized by gums that are red, swollen, and prone to bleeding during brushing or flossing.
If plaque is left undisturbed, it hardens into calculus, also known as tartar, which requires removal by a dental professional. Tartar above the gumline accelerates enamel damage, while tartar below the gumline can lead to serious periodontal issues. Prolonged retention of plaque allows acid attacks to continue, leading to dental caries, or cavities, which are structural holes in the tooth. Brackets and wires increase the risk of decay because they shield bacteria, often requiring a dentist to temporarily remove hardware to treat the cavity.
Required Changes in Oral Hygiene Routine
Maintaining a healthy mouth with braces requires a significant upgrade to the daily hygiene routine, focusing on thoroughness and specialized tools. Brushing must be performed after every meal or snack, using a soft-bristled toothbrush and a fluoride toothpaste. The technique involves angling the brush both above and below the archwire to clean the tooth surface and the bracket effectively, requiring a minimum duration of two minutes per session.
Traditional flossing is nearly impossible with a fixed wire, making specialized tools necessary to clean between the teeth and under the archwire at least once a day. Floss threaders are small, flexible plastic loops that allow regular dental floss to be pulled beneath the wire to clean the interdental space. Interdental brushes, or proxabrushes, are small, tapered brushes designed to clean the spaces around the brackets and under the wires.
Water flossers, or oral irrigators, are highly recommended for their ability to use a pressurized stream of water to flush out debris and plaque from hard-to-reach areas. They should supplement, not replace, manual flossing. Regular professional dental cleanings and check-ups are also necessary to remove hardened tartar and monitor for early signs of enamel or gum problems. These are often scheduled every three to four months instead of every six.