Having braces is an exciting step toward achieving a straighter smile, but it introduces unique challenges to maintaining oral health. Cavities are areas of permanent damage to the hard surface of your teeth that develop into small openings or holes. The presence of orthodontic hardware complicates keeping teeth clean, which increases the risk of decay during treatment.
Why Braces Increase the Risk of Caries
The brackets, wires, and bands create numerous surfaces and small spaces where food debris and plaque easily become trapped. These components form physical barriers that are difficult for a traditional toothbrush to reach and clean effectively. This makes the mechanical removal of the sticky bacterial film challenging, especially in the areas directly around the brackets.
The bacteria in the accumulated plaque consume sugar from food and produce acid, which then erodes the enamel, the tooth’s hard outer layer. When the enamel is exposed to this acid for prolonged periods due to the difficulty of cleaning around the hardware, the rate of demineralization significantly increases. This is why orthodontic treatment is considered a risk factor for developing new dental caries.
Treating Cavities While Braces Are Installed
Cavities can be treated even with braces in place, although the process is more complex than a standard filling. Diagnosis sometimes requires specialized X-rays to see beneath the hardware. Treatment depends heavily on the location and size of the cavity.
For cavities located on a surface far from the brackets, such as the chewing surface, the dentist can often proceed with a filling without intervention from the orthodontist. However, if the decay is near a bracket or covered by the archwire, the orthodontist may need to temporarily remove the wire or the bracket itself to grant the dentist proper access. The dental filling is completed, and the orthodontic appliance is then promptly reinstalled, often requiring a coordinated, two-part appointment.
Addressing Decalcification and White Spot Lesions
A common consequence of poor hygiene around braces is decalcification, appearing as chalky white spots (WSLs). These white spot lesions represent an early stage of decay. They often become most noticeable once the brackets are removed, leaving a stark contrast between the healthy enamel and the demineralized area.
Treatment for these lesions is often aesthetic and typically occurs after the orthodontic treatment is complete. Minor white spots can sometimes be managed with professional fluoride treatments, which help remineralize the weakened enamel. For more pronounced lesions, a minimally invasive technique called resin infiltration involves applying a resin material to penetrate the porous enamel and blend the spot with the surrounding tooth color. Microabrasion, which gently removes a thin, superficial layer of the damaged enamel, is another option, though more severe cases may require cosmetic bonding or veneers.
Critical Hygiene and Prevention Strategies
Preventing decay requires a highly diligent oral hygiene regimen, beginning with brushing after every meal or snack to remove trapped food particles. A soft-bristled toothbrush is recommended, and the technique must focus on cleaning above, below, and around each bracket. An electric toothbrush or a specialized orthodontic brush can be particularly helpful for navigating the hardware.
Flossing is non-negotiable and requires specialized tools to clean under the archwire. Patients should utilize the following methods and tools for effective cleaning:
- Floss threaders or specialized orthodontic floss to guide material between teeth.
- A water flosser to dislodge debris and plaque from hard-to-reach areas.
- Regular use of a fluoride mouthwash to strengthen enamel and reduce harmful bacteria.
- Scheduled dental checkups and professional cleanings for early detection and professional fluoride applications.