Tooth Decay Prevention Techniques For Individuals With Braces

Introduction

With braces, there are more nooks and crannies for food to get caught in and plaque to build up on in your mouth. If your teeth are not cleaned properly, sugary and starchy foods, in particular, produce food acids which can cause staining and damage to the teeth – discolouration of the teeth, general demineralisation of the tooth enamel, and tooth decay. Therefore, it is very important to maintain a balanced diet and to moderate the consumption of these foods.^1,2

There is also evidence that while wearing braces inadequate oral hygiene can lead to periodontal (gum) disease. Individuals with braces must also be more committed than others to keeping their teeth clean because they are more susceptible to dental problems. Successful orthodontic treatment comes from a team effort involving the patient, the orthodontist, and the general dentist all being motivated to contribute to proper oral hygiene. 

There can be severe consequences if good oral hygiene is not maintained– at worst, it can mean that the braces must be removed early, and any decay must be dealt with before orthodontic treatment can continue. This can be time-consuming and costly. It is better to take a preventative approach and safeguard the teeth starting with ensuring that your toothbrush is a good one.

The importance of good oral hygiene during orthodontic treatment 

Proper oral hygiene is a must from the day the braces are fitted until the day they are removed. An individual brace-wearer’s cleaning routine might take a little extra time, but this is nothing compared to the extra dental work needed to correct problems caused by poor oral hygiene.

Food particles easily stick to the brace brackets and in between the teeth, making it easy for plaque to build up. The bacteria in plaque react with food to produce acids, which can lead to demineralization (the loss of minerals from the enamel) and tooth decay. In particular, sugary foods and acidic drinks can cause painful cavities.² Plaque can also cause white spots on teeth, signifying decalcification of the enamel. Gums can become red and puffy, and in more severe cases, this can lead to gingivitis (inflammation of the gums).¹ These are all things that can also set an individual back in the time required to correct their dental alignment.

Common dental problems experienced by people with braces

Food can easily become trapped around the braces and if not removed can lead to many of the issues stated below.

Plaque is a problem for everyone, but it is especially problematic for those with braces as it forms more easily around the braces on the surface of the teeth. If it is not removed, it can leave a permanent white scar on the surface of the tooth.¹

The act of brushing will not remove all the plaque, so to effectively clean the plaque off the teeth and braces, it may be necessary to use a disclosing agent. A disclosing agent is a very useful tool for preventing tooth decay in those with or without braces, as it acts as a motivation and guideline to effectively remove all plaque on the tooth surface.³

The agent temporarily stains the plaque and will reveal the areas that have been missed while cleaning. With this knowledge, the individual can go back to clean the missed areas more effectively. 

An additional issue involves small white marks forming on the tooth surface, indicating the start of tooth decay. Finally, those with braces are at high risk of developing swollen gums and decalcification around the braces.¹

With proper oral hygiene and specific products, individuals with braces can prevent these issues and in turn have a healthy, attractive smile.⁴

Oral hygiene practices

Because braces may trap food and absorb plaque against the teeth and brackets, it is very important to follow a good, more rigorous routine for oral hygiene. It is often recommended that the routine should take double the amount of time it takes for someone without braces. 

An individual with braces should brush after every meal to remove any food that may be stuck in the brackets. It is also wise to carry a travel toothbrush, that way if there is no access to a sink, a person can still brush their teeth well. 

Another helpful tool for removing food that is stuck in brackets is an interdental toothbrush. These are tiny brushes that can be used to clean between the wires and the teeth. 

Rinsing and water picks that apply water at pressure are also different ways to clean teeth to make brushing more effective.⁵ Additionally, electric toothbrushes have been said to clean teeth better than normal toothbrushes, especially those fitted with a small brush head.⁶ After every session of brushing, the mouth should be rinsed with water or a fluoride rinse.

It may be difficult to remove some food particles that get stuck around bands and wires, so it is important to schedule professional dental cleanings and examinations. Dental hygienists are usually able to get to the hard-to-reach spots that the brace-wearer is not able to clean well by themself.

Flossing is important for removing food that is stuck between the teeth, but braces can make it difficult to floss. During orthodontic treatment, the dental hygienist will show you how to use a floss threader.⁷

Use of mouthwash

Mouthwash is an essential complement to brushing and flossing. Because it is a liquid, it can reach between the teeth and into the crevices of orthodontic appliances making it a viable additional defence against cavities. Braces and other orthodontic appliances do not cause the high plaque content which can lead to cavities, but they do make it more difficult to remove the plaque with brushing and flossing. 

The fluoride in toothpaste and chlorhexidine mouthwash can prevent this damage and even repair small areas of damage, but without plaque removal, the fluoride has little effect. Thus, the combination of brushing with fluoride toothpaste, flossing and using mouthwash is key for preventing tooth decay during orthodontic treatment.⁸

Dietary considerations

Acidic foods and drinks

Acidic and sugary foods can cause tooth decay and cavities. Foods and beverages such as citrus fruits, tomatoes, fruit juices, soft drinks, and vinegar should be limited and consumed with a meal to minimise the acid attacks on teeth. Always rinse with water after eating and remember to maintain your regular oral hygiene routine.²

Hard and sticky foods

Try to avoid hard foods such as nuts, boiled sweets, and carrots. Hard foods can damage wires and brackets. Minimise the intake of sticky foods such as honey, toffee, and sweets. These types of foods can stick to the surface of teeth, encouraging tooth decay.²

Beneficial foods

Foods that are rich in vitamins and minerals are recommended for those with braces, as they will accelerate the healing process which occurs naturally for anyone who has wounded their mouth. For example, a diet including sufficient eggs, meats, fruits, and vegetables can benefit teeth as they contain many of the essential nutrients for maintaining general health as well as enough protein for tissue repair. 

Proteins are considered building blocks for our bodies and are necessary for the formation of new tissue, including new skin tissue as well as other types of tissues that are beneficial when preventing the decalcification of the teeth. 

Although wholemeal bread is considered a good food choice as a source of wholegrain, consuming bread can lead to plaque development because the bread easily sticks to the teeth. If you consume bread, be sure to meticulously brush and floss afterwards to remove all the grains. This also applies to starchy foods such as pastas, pretzels and crisps as these foods tend to stick and are broken down to simple sugars. A tooth-healthy alternative to these kinds of snacks would be rice-based. Any type of rice is far less likely to cause cavities or gum disease.

It is recommended that you drink water after every meal or snack, or even during snacks to rinse out food particles from your braces. Failure to rinse increases the chances of getting cavities. 

Additionally, a lack of water can cause someone to become dehydrated and suffer from dry mouth. This is unhealthy as saliva is a natural defence against tooth decay. Without adequate saliva, the chances of tooth decay are much higher. As well as the washing and dilution of food acids provided by water, the fluoride in it will help people with braces to preserve their teeth.¹⁰

Regular dental checkups

It is important to maintain regular visits to your dentist for check-ups and cleaning. The average recall time for a regular dental check-up is around 6 months, although if an individual is more prone to dental disease, the dentist may recommend a shorter time between visits. 

The orthodontic patient wearing braces may think that his or her general dentist no longer plays a role in their oral health since they are seeing an orthodontist. The opposite is usually true. It is very important that a patient with braces continues to see their general dentist for routine visits and cleanings. 

Your dentist would check the areas around the braces and other appliances for any spot caries and areas of plaque. They may also take X-rays to check for any new or potential cavities and problems under the gums, and assess the need for orthodontic treatment.

This is a good time to ask your dentist any questions you may have about oral health at home and the best products to use to keep your teeth and gums in top condition. In your six-monthly visits, the dentist can provide oral hygiene instruction, especially for those with fixed appliances, carry out professional cleaning, and monitor for the presence of decay. With all this in mind, these visits are essential to maintaining good oral health.¹²

Regular dental visits will enable early detection and treatment of any problems and the monitoring of the impact of any extra cleaning regimes you have been advised to carry out. Early detection and monitoring of any treatment is key to achieving optimum results for orthodontic patients.¹¹

Professional cleaning

At each visit to the general dentist, the teeth will be cleaned, flossed, checked for areas of tooth decay and gingival health monitored. The examination helps to prevent problems from occurring and can detect problems early, simplifying treatment. Cleanings and fluoride varnish treatments are also helpful to prevent decalcification during orthodontic treatment.¹²

Summary 

For individuals with braces, a conscious effort must be made and sustained to prevent tooth decay and they must spend more time cleaning their teeth. Regularly replacing manual toothbrushes, and buying an electric toothbrush with a small brush-head can be a helpful investment in ensuring that teeth are being cleaned thoroughly. Flossing is another important step in ensuring that teeth are kept clean. Normally, a floss threader would be used to aid individuals in flossing their teeth.

In conclusion, maintaining good oral hygiene for the orthodontic patient is truly an investment. High effort and conscientiousness will help to prevent the future disappointment of seeing irreversible white spot lesions and cavities. Although decay and white spots are not the end of the world, their repair tends to be time-consuming, expensive, and not necessarily of the same form and function as natural healthy teeth. Prevention is truly the best medicine and is much less costly and much less bothersome.