The Importance of Good Oral Hygiene with Braces

Orthodontic treatment with braces can benefit a person’s life in many ways, including making good oral hygiene easier. Braces can lead to a beautiful smile with straight teeth that are easier to brush and floss throughout a lifetime. But, when braces are on the teeth, it is more difficult to brush effectively. Food can become trapped around the braces, allowing bacterial plaque to grow in these hard-to-brush areas. If plaque is not removed regularly, the bacteria accumulate and produce harmful acid that eats away at the tooth enamel by removing calcium (a process called decalcification). Eventually, this acid attack can create unattractive white spot lesions around the braces. These white spots are signs of cavities in their initial stages. Unfortunately, white spot lesions do not go away after braces are removed but remain as permanent reminders of poor oral hygiene during orthodontic treatment. White spot lesions can progress to mature cavities if hygiene does not improve (i.e., holes through the enamel). Bacteria around braces can also lead to gingivitis—a condition characterized by unsightly red, swollen, painful gums that bleed easily. If gingivitis is not reversed, it may lead to gum recession and bone loss around the teeth.  Therefore, good oral hygiene during orthodontic treatment with braces is very important to prevent white spot lesions and gingivitis.  Proper brushing, flossing, and regular visits to the general dentist (usually every 6 months) during orthodontic treatment are important to prevent white spot lesions and gingivitis.

The following are guidelines for appropriate brushing with braces:

  1. As a general rule, use a soft-bristle toothbrush.  Toothbrushes generally have bristles that are either “extra soft,” “soft,” “medium,” or “hard.” The type of bristle should be clearly labeled on the package of the toothbrush. “Extra soft” is usually too soft to clean the braces effectively, and “medium” and “hard” are generally too abrasive for the gums. A manual toothbrush can be very effective, but some research suggests that some electric toothbrushes may be superior at removing plaque around braces.1,2  A manual toothbrush is usually adequate to maintain good hygiene; but, if an electric toothbrush motivates a patient to brush more regularly and if it cleans slightly better, it may be worth the investment.
  2. Brush each side of each bracket (bracket refers to a single brace). Typically, braces are rectangular or square with 5 surfaces to be brushed—a front, a top, a bottom, and two sides. The toothbrush can easily brush the front, but it must be angled downward to brush the top and upward to brush the bottom of each bracket.  The bracket surface nearest the gum line is the area most commonly affected by white spot lesions (see picture above). This area is relatively difficult to clean. A toothbrush generally cannot effectively brush the sides of a bracket because the wire connecting the brackets prevents easy access. A “proxabrush” is an important accessory that can be used to clean the sides of the brackets.  Proxabrushes can be purchased at most grocery and drug stores in the dental aisle or online (e.g., Amazon.com).
  3. Remember to brush all other areas of the teeth!  In addition to brushing around the braces, brush near the gum line and brush the biting surfaces and the back surfaces or each tooth.

See the Following Videos

Brushing

How to brush around braces with a manual toothbrush.

Proxabrush

This video shows how to correctly use a “Proxabrush” with braces.

References:

  1. Erbe, Christina, et al. “Efficacy of 3 toothbrush treatments on plaque removal in orthodontic patients assessed with digital plaque imaging: a randomized controlled trial.” American journal of orthodontics and dentofacial orthopedics 143.6 (2013):760-766.
  2. Silvestrini Biavati, A, et al. “Manual orthodontic vs. oscillating-rotating electric toothbrush in orthodontic patients: a randomised clinical trial.” European journal of paediatric dentistry 11.4 (2010):200-202.