Wearing braces introduces a unique challenge to oral hygiene, as the brackets and wires create numerous tiny surfaces where food particles and plaque can easily become trapped. Cleaning these areas thoroughly with a toothbrush alone is nearly impossible, making interdental cleaning—or flossing—a necessary daily ritual. Neglecting this step allows bacteria to thrive in the tight spaces between teeth and around the hardware, setting the stage for significant oral health complications.
Immediate Damage to Gums
Failing to floss allows bacterial plaque to accumulate rapidly along the gumline, particularly in the sheltered areas immediately next to the brackets. This buildup triggers an inflammatory response in the soft tissues, a condition known as gingivitis. The gums react by becoming red, swollen, and tender, often leading to bleeding when brushing or even during light contact.
This inflammation results from toxins released by bacterial colonies feeding on trapped debris. Swollen gum tissue may even begin to grow excessively around the brackets, a condition called gingival hyperplasia, making it harder to clean effectively. Severe gum swelling can physically interfere with the orthodontist’s ability to perform necessary wire adjustments during scheduled appointments. If the inflammation progresses, gingivitis can turn into periodontitis, which attacks the bone supporting the teeth, potentially compromising the stability of the teeth being moved.
Permanent Enamel Damage
The most severe consequence of poor flossing with braces is permanent damage to the tooth surface. Plaque not removed from interdental spaces and around the bracket bases produces acids as a byproduct of bacterial metabolism. These acids attack the tooth enamel, the hard, protective outer layer, by drawing out essential minerals.
This process of mineral loss is called decalcification, the earliest stage of decay. When braces are removed, these areas appear as opaque, chalky white spots or lesions on the tooth surface. These white spots are often irreversible, creating a permanent cosmetic defect. The bracket acts as a shield, protecting the enamel directly underneath it, while surrounding neglected areas become permanently damaged.
If the acid attack continues unchecked, decalcification progresses beyond a cosmetic issue into a structural one. The early white spot lesions can break down completely, leading to dental caries, which are true cavities. These cavities require restorative dental work, such as fillings, and can lead to severe decay that may delay the orthodontic treatment timeline. Daily interdental cleaning is the only effective defense against this permanent acid-induced erosion.
Specialized Flossing Techniques
Successfully cleaning around orthodontic hardware requires specialized tools designed for the job. The primary obstacle is getting the floss underneath the main archwire that connects the brackets. A floss threader is a simple, flexible loop of plastic used to guide a section of regular dental floss under this wire.
To use a floss threader, you first thread about 18 inches of floss through the loop, then carefully insert the stiff end of the threader under the archwire between two teeth. Once the threader and floss are pulled through, the threader is removed, allowing you to grasp the floss on both sides to clean the adjacent tooth surfaces. You must gently move the floss up and down in a C-shape against each tooth, reaching beneath the gumline, before pulling the floss out and repeating the process for the next space.
Alternative tools can simplify this routine, such as Superfloss, which features a stiffened end pre-attached to spongy and regular floss sections, eliminating the need for a separate threader. A water flosser uses a pressurized stream of water to dislodge food particles and plaque from around the brackets and under the archwire. While water flossers are effective at supplementing hygiene, they should be used in addition to, and not as a replacement for, manual flossing, which provides the necessary friction to scrub the tooth surfaces.