When observing new braces, many patients notice that the small attachments—known as brackets—appear to be bonded very high on the tooth, almost touching the gumline. This perception is common and often raises concerns about potential discomfort or incorrect placement. Brackets are the hardware that serve as handles, securely holding the archwire that applies the precise forces necessary to move your teeth. Their position is calculated to the millimeter to ensure successful tooth movement and a stable final result.
The Orthodontic Goal of Bracket Placement
The placement of each bracket is a highly precise procedure based on biomechanical principles, not just visual aesthetics. The overarching goal is to align the bracket slot with the center of the clinical crown, which is the visible part of the tooth above the gum tissue. This central position, often referred to as the facial axis point, is selected to ensure the bracket is centered on the tooth’s vertical long axis. Aligning the bracket this way allows the archwire to express the correct angle, or “tip,” and rotation, or “torque,” built into the appliance system.
Precise vertical placement is paramount because even a minor error can significantly alter the intended tooth movement. For example, a vertical placement error of just 3 millimeters on a premolar can result in an approximately 15-degree change in the tooth’s final torque position. Such a deviation compromises both the bite and the long-term stability of the result. The orthodontist relies on this mechanical ideal to achieve the planned root and crown positioning.
Anatomical and Treatment Factors Causing Gum Proximity
Brackets appear close to the gums due to a combination of natural anatomy and specific treatment strategy.
Short Clinical Crown
One anatomical reason is the presence of a short clinical crown, which is the naturally short visible portion of the tooth. If the crown is dimensionally short, the mathematically determined center point for bracket placement is inherently closer to the gum tissue. This circumstance is not a placement mistake but rather a necessity dictated by the size and shape of your tooth.
Strategic Repositioning
Alternatively, close proximity may be a deliberate part of the treatment plan to achieve specific tooth movement. Orthodontists intentionally shift the bracket’s vertical position to create intrusive or extrusive forces. For example, placing a bracket closer to the chewing surface (incisally) is used to intrude a tooth, effectively pushing it back into the gum tissue to correct a deep bite. Conversely, placing a bracket closer to the gumline (gingivally) is used to extrude a tooth, helping to close an open bite or improve gum line symmetry. This strategic repositioning utilizes the archwire as a lever to generate the desired movement, ensuring the therapeutic force is delivered correctly.
Managing Hygiene and Irritation Around Close Brackets
When brackets are placed near the gumline, maintaining excellent oral hygiene becomes more challenging, increasing the risk of plaque accumulation and gum inflammation, known as gingivitis. The braces create additional areas where food particles and bacteria can become trapped, causing irritation to the delicate gum tissue. This irritation is often temporary, but it requires diligent care to prevent persistent problems.
To effectively clean around brackets near the gums, you should use the following tools and techniques:
- Use a soft-bristled toothbrush angled at 45 degrees toward the gumline, carefully cleaning both above and below the bracket.
- Utilize interdental brushes, as their small, tapered heads can reach into the tight spaces between the wire and the bracket.
- Rinse daily with a fluoride mouthwash to remove any remaining particles and strengthen the enamel against decay.
- If the bracket or wire causes simple irritation, rinsing with a warm saltwater solution can help soothe the inflamed tissue.
- Apply a small piece of orthodontic wax directly over the problematic part of the brace to create a smooth barrier, protecting the cheek or gum tissue from rubbing.
When to Seek Professional Adjustment
While minor irritation and temporary swelling are expected, certain symptoms indicate a more serious issue that requires an immediate visit to your orthodontist. You should seek professional guidance if you experience severe or persistent pain that lasts longer than a week, or if you notice chronic bleeding when brushing. These signs can indicate a worsening inflammatory response or a deeper problem.
Another concern is gingival hyperplasia, the excessive overgrowth of gum tissue. This occurs when chronic irritation and plaque buildup cause the gum tissue to swell and grow over parts of the bracket, making cleaning difficult. If the tissue overgrowth is severe and does not improve with heightened hygiene, the orthodontist may need to intervene, sometimes using laser treatment or minor surgical procedures to reshape the gumline. You should also contact your orthodontist if a bracket becomes loose, or debonded, as this will stop the necessary tooth movement.