Eric G. Jackson, DDS, MAGD, FICOI, FICD, FADI
It is quite a blessing that orthodontic treatment (aka braces) has become such a commonplace practice in today’s society. It wasn’t too long ago that a “brace-face” was outside the norm and out of reach for most patients. While learning about the growth and evolution of orthodontics in a public health setting is both vital and fascinating (trust me…it is!), it’s not the focus of this article. Instead, I’d like to discuss a related topic…poor oral hygiene in orthodontic patients. Teeth are tough enough to keep clean, but when brackets, wires, and bands are adhered to the teeth for years at a time, the task at hand becomes quite a bit more challenging! Unfortunately my hygiene team and I often see a decline in oral health when orthodontic treatment is started. Yes, this is more prevalent in children and teens, but don’t fool yourselves…we see it in adult patients as well! But don’t fret, this doesn’t have to be the case! By the end of this article you’ll certainly be prepared to tackle oral hygiene during orthodontic treatment.
First, let’s discuss some of the consequences of poor oral hygiene during orthodontic treatment. These consequences really aren’t much different than when a patient ISN’T wearing braces. The difference falls on the amount of effort it takes to maintain a clean mouth with low bacterial levels. So what kinds of bad things can happen? The first thing that probably comes to your head is CAVITIES…and you’re correct! While there are countless scientific studies that demonstrate an increase of cavities related to poor oral hygiene, I think it’s safe to say we can skip the research and declare that this relationship has become common knowledge in most modern households. Cleaning braces is a tough job! All the orthodontic “hardware” that is installed in your mouth has a lot of nooks & crannies to clean. Insufficient hygiene leaves bacteria on the teeth and bacteria are the enemy! They cause the vast majority of dental issues across all age groups…including cavities. More bacteria = more cavities. What else can poor oral hygiene during orthodontic treatment cause? Cosmetic concerns! Bacteria tend to build up around orthodontic brackets and needs to be removed. If it isn’t, the acid produced by the bacteria will breakdown the enamel underneath, resulting in an unsightly chalky white “box” outlining the bracket. This process does not happen overnight, but should not be underestimated! Typically these white boxes won’t be very noticeable until AFTER the braces are removed. Don’t waste all the time, effort, and money spent on achieving an attractive and healthy smile only to yield a result like the one pictured here!
So far both our consequences have involved the teeth…but what about the gums! Poor oral hygiene during orthodontic treatment, especially in adult orthodontic patients, can absolutely wreck havoc on the gums. For reasons outside the realm of this article, pediatric and adolescent patients do not typically experience permanent damage caused by such gum disease but adult patients certainly do! Adult orthodontic patients need to be especially careful not to allow poor oral hygiene to create, or advance, gum disease in their mouths. Gum disease (aka Periodontal Disease) is an irreversible loss of gum and bone around the teeth due and is a malady afflicting millions of Americans. An additional note, there are a variety of additional negative consequences of poor oral hygiene during orthodontic treatment besides the major categories discussed here. Keeping your mouth as clean as possible during orthodontic treatment minimized the chance of ANY negative consequence from rearing its ugly head and is essential to keeping your teeth and gums healthy.
“So what should I be doing to keep my mouth clean and healthy during braces?” The answer I give isn’t really much different than the answer I give to those who ask it without braces: Do everything you can to remove as much bacteria as possible! Braces patients just have to work a bit harder than non-braces patients. How so? Let’s split up that discussion into two parts: 1) Inside the dental office (aka dental hygiene appointments) 2) Outside the dental office.
Inside the dental office (aka dental hygiene appointments)
We just finished the holiday season and started a new year. Quick…name a place and profession that’s SUPER BUSY right now…yep! The personal trainers and your local fitness center/gym! The holidays are over and the pounds have been packed on. Lots of people are looking for a professional trainer to help them get back into shape! Well, think of your dental hygienist as your dental trainer! Say Johnny Doe starts orthodontic treatment. During the beginning of treatment he tries his best to keep top-notch oral hygiene but at his next dental hygiene appointment his gums are swollen, bleeding, and bacteria/plaque is very high. He needs help from his dental trainer! In the same way that a person visits their trainer more regularly during post-holiday times of need, the dental patient should increase their visits per year during their orthodontic time of need. Copious amounts of data and opinion from orthodontists, general dentists, and dental hygienists support a reduced interval hygiene recall for orthodontic patients. Typically a dental hygiene visit every 3 or 4 months is successful at keeping the oral environment healthy in a braces patient doing their best at home. The additional visits not only allow for added professional cleanings but added examinations by both the hygienist and dentist…your professional dental trainers! By seeing orthodontic patients more often, the dental team can keep closer eyes on their dental health. Successes, failures, trouble spots, tips/tricks…all can be discussed before the negatives become too entrenched.
Outside the dental office (aka patient home care)
In addition to visiting your dental office more frequently, an orthodontic patient must do everything he/she can do to keep their mouth as clean as possible at home. After all, even with 4 visits to the dental office per year, there’s still 361 days you’re on your own! As I always say, good oral hygiene is based on three pillars: Brush, Floss, Rinse! First thing first…let’s talk toothbrushes. In my opinion, EVERYONE should be regularly using a rechargeable toothbrush like those made by Sonicare and Oral-B. This goes double for orthodontic patients. Countless studies confirm these types of toothbrushes are superior at plaque/bacteria removal compared to their manual counterparts. Next time you’re in the office, ask your hygienist to show you the Sonicare demonstration model we have. The painless yet powerful action of the brush is amazing and the stark differences between a manual version will be hard to ignore. Second pillar: Floss. Flossing is the #1 most ignored oral health care technique across all patients I see. Orthodontic patients especially have a tendency to “skip” the flossing because it’s, admittedly, just so time consuming to individually thread the floss to each site while navigating/avoiding the orthodontic hardware. Nothing is better than good ol’ (and inexpensive) string floss…but if that’s not your thing, there are alternatives. There are literally dozens of alternate options, each of which perform differently, so I’ll suggest you ask your hygienist about what might work best for you. With that said, my current favorite string floss alternative is the Philips Sonicare AirFloss. Similar to a WaterPik (another fantastic string floss alternative) it uses water to clean in between the teeth, but the AirFloss has a few special features that put it at the top of my personal list. Either product is excellent, easy/quick to use, and will certainly help those orthodontic (an non-orthodontic) patients who don’t pick up floss often. By the way, ever wonder if you should brush then floss….or should you floss then brush?? Check out the article I wrote several years ago that answers this very question! Visit our office newsletter archive on the website and select the 2014 1st Quarter edition. Finally the third pillar: Rinse! Once the first two pillars have been completed, a healthy habit is to rinse with a plaque reducing mouthwash, preferably one that also contains fluoride. My favorite is the Listerine Total Care Zero. This product combines the bacteria killing power of Listerine with a more effective fluoride uptake than the well known ACT rinse, all without any alcohol in the product. It is a wonderful product and spending 60 seconds rinsing with it after brushing and flossing is a great idea.
It should go without saying that upon completion of orthodontics, patients should not take it as an opportunity to downshift their supercharged hygiene habits to average! Hopefully the skills developed during their orthodontic treatment will transcend their time in braces and become lifelong practices. One final word of advice: treat any permanent orthodontic retainer you receive upon completion of orthodontic treatment the same vigilance you did when your whole mouth was full of brackets. These retainers work great but require extra effort just like the braces! We commonly see post-orthodontic patients slip back into “normal” or “average” hygiene habits that are good enough to keep most of their mouth healthy but are NOT good enough to maintain the areas around these retainers. As mentioned before, these devices are tough to clean and this can be a real problem over the long term. Be extra careful to keep these areas clean using the techniques mentioned.
Hopefully this article shed a little more light on this important aspect of dentistry. If you would like to speak about oral hygiene during orthodontic treatment, or any other dental topic, please feel free to call the office and schedule a complimentary appointment with me. Email and Twitter are also available options for communication. I am extremely passionate about modern dentistry and love discussing it with patients, so don’t hesitate to contact me.
Eric G. Jackson, DDS, MAGD, FICOI, FICD, FADI