Maintaining Good Oral Hygiene while Wearing Braces

The Challenge of Oral Hygiene with Braces

The issues start out small: some bad breath, slightly puffy and sore gums, whitened teeth (and not the good kind). These sorts of smaller issues progress into things much worse. Those slightly puffy and sore gums, for instance, likely represent gingivitis, an infection of the gums.

If left untreated, that infection will spread from the gum tissue to the ligaments and bones beneath the teeth. Once it spreads, dental professionals call it periodontal disease (or, periodontitis), and it can lead to some horrible results, including the loss of teeth.

The bad breath are the tell-tale signs of bacterial byproducts and signal that cavities are ripe for formation—or have already formed on the teeth. Cavities lead to tooth decay, and tooth decay to root canals—or loss of teeth entirely. Those whitened teeth (the bad kind) show decalcification at work. And guess what? In addition to making your teeth unsightly, eventually decalcification will progress to the point that you’ll lose your teeth.

And, though it pales in comparison to losing your teeth, improper oral hygiene can prolong your time with braces, or even make it so your orthodontist will have to remove the braces to allow you to take care of the gum disease issue before reapplying the braces (meaning a significant delay in your course of treatment).

If you’re not a good candidate for Invisalign, you’ll be forced to take some special care in your oral hygiene.

Proper Oral Hygiene Care with Braces

Toothbrush: The brackets of your braces make brushing difficult, so to reach the spaces around and just behind your braces, use a soft-bristle toothbrush. They’ll be able to reach those spots, and they won’t irritate your gums like a harder-bristled brush would.

Be aware that toothbrushes wear faster than we might think, so you’ll need to replace your toothbrush at least every three months—and definitely as soon as the bristles begin to splay and stop returning to their original configuration.

You may opt for an electric toothbrush, but be careful that the vibrating head doesn’t hit the brackets. It could end up knocking them loose. And remember that an electric toothbrush’s head is no more long-lasting than a manual toothbrush, so you’ll need to replace its head with the same frequency.

Toothpaste: The right toothpaste has two characteristics: 1) it contains fluoride (which protects and rebuilds your teeth), and 2) makes you more likely to brush (because you like the taste, or how it freshens your breath, most likely).

Mouthwash: Using a fluoridated mouthwash will not only freshen your breath, but also protect and rebuild your teeth.

Floss: Flossing the old-fashioned way can seem downright Herculean if you’re wearing braces, but luckily you can buy a floss threader (at any drugstore) and make the task simple. (For most people, floss threaders work quite well, but if you still struggle with flossing, ask your orthodontist about special orthodontic flossers.)

Interdental Brush: These are the little pipe-cleaner Christmas tree-looking things attached to standard toothbrushes. They make cleaning between gaps much easier. Make sure that your interdental brush is small enough to actually fit between the gaps in your teeth because you’ll only create problems if you jab an overly large one between your teeth.

Dental Visits: Your orthodontist is not your dentist. He has several years additional training that help him determine the proper course for realigning your teeth and jaw, and that’s his primary focus. He, or, more likely, his assistant, may offer a cursory cleaning at the beginning of an appointment, but this is more to facilitate his work than it is to clean your teeth. So visit your dentist regularly (probably every 3 months, but definitely within 6 months) to keep your teeth clean and healthy.

Brushing Technique: Ideally, you’ll be brushing your teeth 5 times a day: as soon as you wake up, right after breakfast, right after school or work, right after dinner, and right before you go to bed. Each of these brushing sessions should last a good 3 minutes. And after the final one you should floss and use the fluoride rinse. (It seems demanding, and it is, but you’ll thank me when you don’t end up with cavities and gingivitis—or worse.)

When you’re actually brushing, begin with your brush at a 45 degree angle to your gums and gently brush along the gum line, using small circular motions to cover each tooth individually. You should spend about 10 seconds on each tooth (hence, about 3 minutes all tolled); you should get in the habit of brushing in a particular pattern so that you’re never missing teeth.

And don’t forget the backs of the teeth. You should also brush your braces, pressing your toothbrush with enough force that the soft bristles move between the gaps in the wires. It’s extremely important that you get between these gaps because that’s where the food particles are going to build up and cause you trouble. So go over these areas again with the interdental brush.

Food and Diet: Avoid hard foods (like popcorn and nuts). Avoid sticky foods (like taffy and caramel). Don’t chew gum. If you’re going to eat crunchy foods like apples or carrots, chop them up first to make it easier on your braces.

You’ll also want to avoid particularly acidic foods that will wear down your teeth. Apples and oranges, sodas, even salsas—all of these are high-acid foods and will strip your teeth of their enamel if you don’t quickly brush the acid off.

Try lower-acid foods like bananas, melons, milk, carrots, lettuce, chicken, fish, eggs, soup, or crackers. Beware that starchy foods like chips and crackers cling to your teeth longer (and then bacteria break them down and damage your teeth), so, again, the lesson is that you need to brush regularly.


It seems like a ridiculous amount of work, but it’s absolutely worth it. Keep this routine up and you’ll avoid the complications of gingivitis, halitosis, and decalcification (and worse).

The issue with oral hygiene and braces is that the brackets and wires present bacteria with extra surfaces to hang on to, and they’re much more difficult to clean than what God gave you. If you’re lucky, you may be a candidate for treatment with Invisalign. With Invisalign, you take out your aligners each time you go to brush and floss your teeth, so your oral hygiene reverts to a pre-orthodontic care state. It’s incredibly simple that way, so do a local search for something like, “Invisalign Charlotte,” for instance, and ask a qualified orthodontist if Invisalign braces are an option for you.

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