Topics on this page:
	Why Oral Hygiene is Especially Important During Orthodontic Treatment
	Basic Tool: Tooth Brush
	Dental Floss
	Interdental Brush
	Hygiene Protocol with Removable Appliances
	Hygiene Protocol with Braces
	Nutrition
	Fluorine

Why Oral Hygiene is Especially Important During Orthodontic Treatment

Fig.1 : Samle of a removable Aappliance

Braces have an important function: by using them teeth are moved from a wrong into a right position. Often an orthodontic treatment is started with a removable appliance (Fig.1). These appliances are made of acrylic, screws and wires and the patient himself puts them into the mouth and takes them out.

A fixed appliance like this one (Fig.2) consists of bands and brackets which are attached to the teeth. An arch wire connects the bands or tubes with the brackets (bracket: Fig.3).

Fig.2 : Example of a e brace

This wire produces forces and thus enables the teeth to move into their right position. Treatment time with fixed appliances usually takes a period of 2 - 3 years. At the end of treatment all patients are glad to get rid of the wires and brackets and that the teeth are in the postion the dentist wanted them to be in.

Fig.3 : Bracket, enlarged picture

But your delight might be impaired, if you developed tiny cavities next to the braces, especially if it happens at the front teeth. Sometimes you see white spots only, however these can turn into caries very quickly

Let us state it clearly, there is a reason for spots and tiny cavities. The reason is plaque on the teeth. Plaque is created by millions and millions of bacteria building a tight net, nourished by the sugars in your diet.

Plaque is not easy to see, but it is easy to feel. Move your tongue over your teeth before brushing them and you will notice the coated surface which feels kind of furry.

Plaque can be made visible with a colouring pill. Chew one pill and rinse. Look into the mirrow and you will see red coloured plaque. If the plaque is blue it is already two to four days old. If plaque is not removed it causes caries and gum diseases, and finally the teeth will be lost.

That's why everyone - young and old - should remove the plaque from the teeth every day and reduce sugar in the diet. But that is easier said than done.

Fig.4 : Plaque is built up on the acrylic of the removable appliance Many people develop caries despite brushing their teeth. That's because they brush their teeth the wrong way. Plaque is built up on the acrylic of the removable appliance(Fig.4).With braces plaque is easily and very fast built up next to the brackets and bands, wherever there is a niche for it. Therefore brushing the teeth means brushing the surface of the teeth and not the metal.

Fig.5a : Tooth brush with a short brush

Fig.5b: Special bushing for electirc tooth brush during orthodondics treatment

Fig.6:Don't use tooth brushes with V shap

Tools to help us:

Basic Tool: Tooth Brush

It is best to use a manual tooth brush with a short brush head which enables you to reach every tooth surface. Use a brush with a straight brush head and end rounded nylon bristles for a soft gum treatment.(Fig.5a, 5b).

Using tooth brushes with a big brush head often makes it difficult to reach the posterior region. Tooth brushes with V shaped not end rounded bristles hurt the gums and are inefficient in plaque removing (Fig.6). Sine bacteria can grow on natural bristles we advise you not to use them.

The next tool is the

Dental Floss

Fig.7: Example - using of a dental superfloss

To clean the interdental spaces, which are not accessible by the toothbrush, you use the dental floss You can use what you are comfortable with, the dental floss can be waxed or unwaxed and you can remove the plauqe with a small or broad one.

Since it is not so easy to use a normal dental floss under an archwire, we recommend to use "superfloss" which has a reinforced end that enables you to thread it under the archwire. Part of the Superfloss is fluffy which is great for removing plaque.(Fig.7).

Fig.8: Interdental brush

Tool no.3 is the

Interdental Brush

The interdental brush is especially good in cleaning the toothsurface next to the braces (Abb 8).

Hygiene Protocol with Removable Appliances

On a daily basis removable appliances have to be brushed thoroughly with a toothbrush and toothpaste and are then rinsed under running water.

In case of tartar on the acrylic it can be cleaned in an ultrasonic bath at the office.

You brush and clean your teeth as usually with a tooth brush and dental floss.

It is best to tilt the toothbrush against the gums and with a vibrating movement clean tooth per tooth

The inner surfaces of the teeth are especially difficult to clean, in the lower jaw because of the tongue, in both jaws because of the front teeth.

Not to miss a single tooth or a tooth surface it is best to make it a rule to start e.g. at the outer surfaces from the back to the anterior, then the inner surfaces and then the occlusal surfaces.

Fig.9: Example - Using dental floss

The interdental spaces are accessible with the dental floss only. You thread an approximately 30 - 40 cm long dental floss (or superfloss) under the archwire and with up and down movements you clean the interdental surfaces of two neighbouring teeth (Fig.9).

It is important to use the dental floss on a daily basis.

Additionally electrical tooth brushes are available making toothcleaning easier through special movements of the brushhead. Your dentist and your orthodontist will give you advice about advantages and disadvantages of electrical tooth brushes.

Hygiene Protocol with Braces

Abb 10. It is especially important to clean the tooth surfaces on both sides of the metal archwire

Abb 11. It is best to clean the tooth surfaces next to the braces with an interdental brush

With braces cleaning your teeth is much more difficult:

Simple brushing is not enough because food and plaque collects on the tooth surface next to the braces. Therefore it is especially important to clean the tooth surfaces on both sides of the metal archwire. You always have to tilt the tooth brush against the tooth surfaces which are under the archwire. (Fig.10)

Like with the ususal tooth brushing you must not forget to clean the inner- and occlusal surfaces. In order not to miss a single tooth or a tooth surface it is best to make it a rule to start e.g. at the outer surfaces, then the inner surfaces and then the occlusal surfaces.

To clean the interdental spaces it is best to use superfloss since it is easy to thread. It is important that you - whatever floss you use - floss every day.

It is best to clean the tooth surfaces next to the braces with an interdental brush (Fig.11).

You go in with the brush from the gums to the crown and clean the tooth and then you do it the other way round from the crown to the gums. It is the only way to clean the tooth surface under the archwire from food and bacteria.

Cleaning you teeth thoroughly will take you quite some time, especially in the beginning, but you have to spend the time if you want to protect your teeth.

Nutrition

A proper diet is important to keep teeth and gums healthy. Your diet should contain a variety of foods: fresh fruits, fresh vegetables and as little sugar as possible. Unfortunately there is sugar hidden in many foods ( e.g. cornflakes, alpen-yoghurts, ketchup, cola...) .

With braces be careful when biting off otherwise the braces could become loose.

Fluorine

Additionally to tooth cleaning and diet, fluorine is the third pillar in prevention of decay. Fluorine penetrates the enamel and hardens it, making the teeth more resistant to acid, which is produced by the bacteria and dissolves the enamel on the surface.

Especially with braces it is not enough to use a tooth paste with fluorine, you need to additionally use a mouth rinse with fluorine after brushing your teeth, and then rinse for a minute. Or you use a fluorine gel once a week.

Sometimes all of the above is not enough to prevent decay and gum disease. If the dentist has diagnosed with a saliva test that many decay enhancing bacteria are in the mouth and on the teeth, he will prescribe you a drug to reduce the bacteria. These drugs contain Chlorhexidin and are used either as a mouthrinse or as a gel.

The aim is a dentition without decay and healthy gums.