The Ultimate Guide to Cleaning Your Teeth During Orthodontic Treatment

One of the most common treatments in all of Children's Dentistry is Orthodontic Tooth Alignment. Undergoing orthodontic treatment with braces or Invisalign requires that your teenager raise the bar with their home care efforts. We're talking more cleaning time and a whole new tool belt of cleaning instruments! So, what are the risks of not performing proper oral home care during orthodontic treatment? And, what are some simple things that you can do to minimize post-treatment complications?

Let's dive into this!

Risks & Orthodontic Treatment

Really, this section is about the risk of not cleaning your teeth well during orthodontic treatment. Braces and Invisalign involve use of metal brackets and tooth-colored buttons, respectively. Both are bonded to your teeth during treatment and, let's face it, both are obstacles to cleaning your teeth. A smooth surface is certainly easier to clean than a bumpy one containing a bunch of nooks and crannies. Well, if you don't take the extra time to properly brush and floss during treatment, here's what can happen:

• Gum Inflammation, Bone Loss & Recession. If the gums and bone around teeth experience chronic inflammation for long periods, loss of both can occur. This is one reason why many people experience gum recession following tooth alignment.
• Enamel White Spot Lesions. This is probably the thing that most drives orthodontic patients crazy. You spend 2 years straightening your teeth, get your braces off and notice big white blotches on your teeth. This is the result of enamel demineralization. Plaque accumulation around brace brackets causes this. Sometimes, you can reverse white spot lesions with high concentration fluoride treatment but this is not always the case.
• Cavities. If enamel demineralization becomes severe, cavities will occur. Orthodontic patients will typically develop cavities near the gumline under brace brackets on lower teeth and above brace brackets on upper teeth. Another common site for cavities is between teeth. This is because the archwire between brace brackets prevents your teen from flossing in a traditional way. They now have to thread floss under this wire at each individual site. So, flossing goes from a being 1 minute activity to being a 5-10 minute activity. One major advantage to Invisalign-based Orthodontics is that you can still floss between teeth with the simple, traditional technique!

Children's Dentistry & Oral Hygiene During Orthodontic Treatment

As mentioned above, you need an upgraded collection of tools to properly clean your teeth during orthodontic treatment. Toothbrushes and floss still provide the foundation. However, you'll now need floss threaders to weave the floss under your metal arch wire. Proxabrushes or "christmas tree brushes" (see photo atop this article for a reference) will also be useful for angling in between metal brackets. Many parents tell us that their teenager loves the electric toothbrush for cleaning around brace brackets as well. Here are some brief tips about cleaning time and technique that I hope you'll find useful:

• Without braces, your teen should take 3-5 minutes to brush and floss their teeth. With braces in place, that time should be closer to 7-8 minutes to achieve adequate cleaning. Most of this extra time is due to having to thread floss under the arch wire for each tooth. With Invisalign, flossing remains the same so the cleaning time is closer to 3-5 minutes.
• Tooth brushing technique changes slightly during orthodontic treatment. When brushing the biting/chewing edges angle your brush toward the metal brace bracket (upward for upper teeth and downward for lower teeth). When brushing the gum lines, angle the toothbrush toward the bracket for half the strokes and then angle toward the gums for half the strokes. Make sure you are pushing your lip sufficiently out of the way to access these gum line areas. Gum line areas easily collect and retain the most plaque compared to other areas of the teeth. This becomes even more true during Orthodontic treatment. Have your teen check their teeth around gum lines, Invisalign buttons or brace brackets for chalky white spots - this is a sign that plaque accumulation and enamel demineralization are well under way.
• Use proxabrushes to access around brackets and under arch wires. This is not a replacement for flossing but a supplement to the toothbrush and floss that you already use. Again, plaque accumulation = white spot lesions - it's that simple. So, your teenager should try their very best to clear out any plaque and food accumulation on teeth (especially before bedtime!).

Summary: Children's Dentistry During Orthodontics

Orthodontic treatment has become so commonplace that it is almost a rite of passage for teenagers (like having wisdom teeth removed). A successful treatment outcome involves not only straight teeth but also teeth that are healthy and esthetic looking. To achieve this, the level of diligence during cleaning must go way up. With this, comes increased cleaning time.

If your teenager has the right tools, they can efficiently clean their teeth easily and without frustration. In some cases, slightly more frequent dental cleanings (i.e. every 3-4 months during Orthodontic treatment) can help to keep teeth and gums healthy. Ask your Family Dentist to sit down with your teen to discuss what needs to be done to keep teeth healthy during treatment with Braces or Invisalign. Your teenager's increased effort and vigilance will go a long way to ensuring a successful treatment outcome.

I hope that you have found this article useful & thank you for reading!

Written by Dr. Kyle Hornby, Kitchener Dentist

If you would like to meet to discuss braces or Invisalign in Kitchener, please call us at (519) 576-8160 or request a consult appointment with me here.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your Kitchener Dentist or other qualified healthcare provider with any questions you may have regarding a dental condition or treatment.