Orthodontics is the specialized area of dentistry that diagnoses and corrects crooked and misplaced teeth and can improve both the appearance of the mouth and face, and the function of the jaws. Orthodontists use a variety of appliances including braces, removable clear aligners, and retainers to move teeth and hold them in their new positions. Since abnormal bites, or malocclusion, are first noticed between the ages of 6–12 years as the permanent teeth erupt, most orthodontic treatments occur between 8 and 14 years old. However, it is possible for orthodontic treatment to be carried out at any age, if the mouth and teeth are healthy.
While undergoing orthodontic treatment, it is important to keep the mouth very clean through thorough and frequent oral hygiene, including between-teeth cleaning, and to maintain a healthy and balanced diet.
For instructions on how best to clean your teeth and the orthodontic appliance
If you should use a fluoride mouthrinse
If you get sore spots where the brackets or wires start to rub
If you see white spots on your teeth near any of the brackets
If your gums are red or swollen and bleed while brushing
Follow all instructions carefully
Return for regular review and adjustment appointments
Avoid sugar-containing foods
Avoid very hard foods, sticky foods, and chewing gum
To call your dentist if you notice anything come loose from the appliance
You are at greater risk of gum disease and dental decay while the appliance is in your mouth
The typical appliances used are:
Figure: Braces are brackets and wires fixed to the teeth with strong dental adhesives. They re-align the teeth.
Figure: Aligners are removable transparent plastic trays which re-align the teeth.
Figure: Retainers are removable devices made of clear plastic and wires and are used to hold the teeth in position towards completion of treatment after the braces have been removed.
Malocclusion refers to crooked or misplaced teeth and an improper alignment of the upper and lower jaws. Occlusion is the relationship of the upper and lower teeth when they come together at such times as chewing or at rest. Malocclusion may include a cross-bite, where teeth on both sides of the mouth are not symmetrically aligned, or an overbite, where there is excessive vertical overlap between the upper and lower incisors.
Malocclusion may lead to a variety of complications such as disfigurement of the mouth and face, speech impairment, dental decay, gum disease, embarrassment, teasing, and lack of self-confidence.
Malocclusion has many causes. These range from heredity, genetics, and various growth disorders to thumb sucking (beyond the age of four years) and accidents and injuries as well as premature loss of baby teeth. Your dentist will be able to give you information about any irregularities in your bite; if treatment or further advice is needed they can refer you to an orthodontist for further assessment.
Orthodontists are dentists who have undergone at least two additional years of advanced training in tooth movement and facial development. Abnormal bites or malocclusions typically start developing when the permanent teeth begin erupting into the mouth at age 6–7 years. The American Academy of Orthodontics recommends that children with orthodontic problems should be seen no later than age 7. Ask your dentist or pediatric dentist if you have an abnormal bite or malocclusion that should be treated by an orthodontist. The earlier that treatment commences, the greater the chance of a very satisfactory outcome. Orthodontic treatment can however be performed at almost any age in healthy people with healthy mouths.
Orthodontic brushes are designed with a unique V-cut bristle arrangement to clean both teeth and orthodontic brackets. Also an ‘end-tuft’ toothbrush is helpful in cleaning around the brackets. As the design of your appliance and its brackets will be individualized to you, seek the advice of your dental hygienist with respect to taking care of your mouth and keeping it healthy.
First, follow any advice that your orthodontist or dental hygienist provided. While wearing braces, special attention needs to be given to cleaning your teeth and the orthodontic appliance as both dental plaque and food particles can easily get trapped between the teeth and gums and the appliance. Here are some commonly accepted recommendations for tooth-brushing:
1. Remove any rubber bands fitted to the appliance (you will need to replace them with new ones after brushing)
2. Use a specially designed brush for orthodontics (with “V” cut bristles) such as the GUM® Orthodontic toothbrush. Apply fluoride toothpaste. Brush at least twice a day and if possible after every meal.
Note: If you prefer to use a regular toothbrush, that’s OK. Just make sure you use a high-quality brush that has tapered bristles such as the GUM® Technique® Deep clean or GUM® Technique® Complete Care to reach in all the difficult-to-clean areas.
3. Place the brush at a 45-degree angle to the tooth, pointing toward the gums, and use a gentle circular motion on each tooth ensuring the bristles can reach into the gaps between the teeth and under and around the brackets and wires of the appliance.
4. Brush on both the outside and inside surfaces of all teeth, and do not forget the biting surfaces too.
5. The whole procedure should take about three or more minutes to do thoroughly. When you think you have finished, spit out the toothpaste and check in a mirror to make sure there are no bits of food still trapped anywhere.
6. Perform your regular between-teeth cleaning with either floss or interdental brushes. If using floss, a floss-threader will help thread the floss between the teeth and under the wires. You can also use small specially designed “interdental brushes” or GUM® Soft-Picks® that reach between the teeth and remove the dental plaque as effectively as dental floss.
7. Don't forget to re-apply any rubber bands.
8. If you notice any bleeding from the gums or small white spots appearing on any of your teeth, visit your dental professional.
Cleaning between your teeth is as important as ever when you have braces. Floss comes in all sorts of presentations. You may find ‘floss-threaders’ that are loops of nylon can help you thread the floss between the teeth and under the wires and brackets. There is also a type of floss that is in pre-cut lengths and has stiffer ends to help in threading.
Flossing for many people can be difficult even without orthodontic braces. You can also use small specially designed ‘interdental brushes,’ or GUM® SoftPicks®, that reach between the teeth and remove plaque as effectively as dental floss. If you encounter difficulties in cleaning between your teeth, consult a dental hygienist.
In the first few days after having new braces fitted, it is quite usual to experience some rubbing or sore spots. They should disappear after 5–10 days. Keep up the oral hygiene routine recommended by your orthodontist as:
- The brackets and wires can trap dental plaque and food particles between the gums, the teeth, and the appliance leading to gingivitis or dental decay, and
- A clean mouth will reduce any infection in the sores and help healing.
If your braces start rubbing and sores form between your normal orthodontic appointments, check with your orthodontist or dentist as it may be that a wire or bracket has broken and should be repaired.
Orthodontic wax is available and helps alleviate the rubbing. A small pea-size amount can be placed over the bracket that is causing discomfort and will provide some temporary relief. Cleanse your hands and brush your teeth before wax application. Make a small ball out of the wax and cover each of the problematic areas. Remove the wax before tooth-brushing and replace afterwards with a new piece.
GUM® Interdental Brushes are perfect for cleaning between archwires and teeth and for larger spaces between teeth. Just find the size or sizes of GUM® Proxabrush® Go-Betweens® Cleaners you need, gently insert into the space, and clean with a gentle in-and-out motion. For oral hygiene on the go, use GUM® SoftPicks® and the GUM® Ortho Travel Toothbrush.
Braces are attached to your teeth by strong adhesive, but may become loose as a result of eating certain foods. Avoid hard foods such as nuts, hard candy, pretzels, tortilla chips and hard pizza crust. Avoid chewing ice! Raw apples and carrots should be cut into smaller pieces and chewed gently. Corn on the cob and popcorn are best avoided.
Also, avoid soft and sticky foods such as caramels, filled chocolates, soft candies, and chewing gum. These will get stuck in between the braces and the teeth and will increase your risk of dental decay. It is important to rinse thoroughly after meals to remove any food particles.
The environment of the mouth changes with the presence of braces. Dental plaque can build-up in areas between the appliance and the teeth and gums that is difficult to clean. Also, food particles can get trapped in those same difficult to reach places.
Dental plaque reacts with sugar to produce acids which can dissolve the minerals from the tooth enamel. When this first happens, the affected area of the tooth looks bright white compared to the normally slightly yellow shade of the surrounding healthy enamel. These ‘white spot lesions’ are an early form of dental decay. If left untreated, they may progress to form cavities. White spots can be unsightly and may spoil your new appearance when the braces are removed and the orthodontic treatment is completed.
White spot lesions can be avoided by keeping the consumption of sugar-containing foods and drinks to a minimum, tooth-brushing twice a day with a good quality toothbrush and a fluoride toothpaste, and using a fluoride mouth rinse if recommended by your dentist or dental hygienist.
Don't let these avoidable disfiguring spots spoil your new smile—avoid sugary foods and drinks and keep your mouth as plaque-free as possible, despite the difficulties encountered by the wire and brackets of the appliance.
Figure: White spot lesions are a form of early dental decay and often occur during orthodontic treatment when oral hygiene and diet have not been optimal.
All fluoride-containing products help prevent dental decay. While undergoing orthodontic treatment with braces or aligners it is much harder to keep your teeth clean as the appliance traps dental plaque and food particles in hard to reach areas between the teeth and the appliance. These factors all lead to an increased risk of tooth decay or cavities. The very earliest form of tooth decay appears as a white spot where the tooth has lost some of its mineral content. Like all decay, even white spots can be unsightly.
Fluoride rinses for daily use contain 0.05% sodium fluoride and should be used in accordance with the manufacturer’s labeling once per day. Very large bottles of fluoride mouthrinse contain a lower dose of 0.02% sodium fluoride and should also be used in accordance with the manufacturer’s labeling and can be used twice a day.