Keeping healthy teeth and gums is essential for our aesthetic appearance, but also for our health; and when using an orthodontic device, hygiene should be even more meticulous.
It is very important to wash your teeth always after every meal, and this must be done for 2 to 3 minutes. The aim of hygiene is to eliminate any food remains, and to prevent plaque formation on teeth, which is the most frequent cause of dental conditions: cavities, lack of calcium (white stains on enamel), or gum diseases, such as gingivitis or periodontitis, with symptoms such as very thickened gums which prevent tooth movement, and bleeding.
With an orthodontic device, our recommendation is that teeth must be washed in front of the mirror and with a good light, in order to confirm that teeth are clean, and there are no food remains between the wires; this must be confirmed not only in the front teeth, back teeth must also be observed.
For a good mouth wash it is essential to have a good toothbrush, some toothpaste, and to use an adequate brushing technique.
A good toothbrush must feature a small head for good access to any area in the mouth, and a straight and flexible handle, with soft bristles that won’t damage gums.
The toothbrush must always be kept dry, and it should be wet before putting it inside your mouth. Besides, it must be replaced by a new one as soon as its bristles become open or torn. During Orthodontic treatment, they should be replaced every 3 months. Some toothbrushes for Orthodontics feature a central row with shorter bristles, to better reach all areas.
The main role in mouth hygiene is played by the toothbrush, while toothpaste will only play a helping role. Fluoride toothpastes must be used, because they improve tooth resistance to cavities. No abrasive pastes should be ever used, because they will wear enamel away. Besides, as they are scented, they will leave a pleasant fresh feeling in your mouth.
Firstly, the elastics or any other removable device which can make hygiene difficult should be removed. In order not to forget any part of the mouth, it is advisable to follow the same sequence always, and to brush in front of a mirror, to confirm what is done and whether it is well done.
You must always use the electric toothbrush we will provide you, because it is much better than the manual one, and the brushing technique is much simpler: there is no need to do any movement, because the rotating head will do it all. You must only apply the toothbrush on the tooth, and stay 5 seconds with every tooth. In order to clean adequately the area of the tooth close to the gum, which is the most sensitive one, the toothbrush must be held at a 45⁰ angle towards the gums.
Teeth should not be brushed horizontally, because the gums and tooth necks could be damaged. You must start with the last back tooth on one side, and end up with the last back tooth on the other side.
Once the upper dental arch has been cleaned, the same must be repeated for the lower arch, following the same technique described. After this, the chewing surface of the back teeth must be brushed, as well as the inner faces of all teeth.
It is important not to leave any area unbrushed; special attention must be paid to interdental holes and spaces.
Finally, the tongue should be cleaned, to remove any remains or germs.
Don’t forget that hygiene during the orthodontic treatment is not only about teeth, but also includes devices, which should be perfectly clean, as they will also hold bacterial plaque.
Other useful tools for cleaning:
1) Interproximal toothbrush, to keep clean those areas the electric toothbrush can’t reach, such as the spaces between teeth and back teeth. It is very easy to use, and its recommended use is without toothpaste, after a good teeth cleaning, and in front of a well lighted mirror. It is also useful for cleaning braces when food remnants are observed, by introducing the interproximal toothbrush under the wire arch.
2) Dental floss as a complement of brushing, because it is useful to remove pieces of food and germs from between the teeth. As this is a rather slow and detailed procedure, we recommend doing it only once a day, ideally at night, and to use unwaxed floss.
The use of dental floss is the same for patients with or without fixed orthodontic devices, with the exception that it is easier to use in patients with braces if we use a threader in order to pass the thread under the wire.
Some dental floss brands are already sold with an incorporated threader, such as Superfloss by Oral-B. This Superfloss features 3 different parts: first, a rather rigid and short part (A), then a sponge section, which will be the one to clean teeth (B), and finally a long section of traditional dental floss (C).
How to use the threader?
1) Insert the short and rigid part of the Superfloss under the wire arch that you are wearing.
2) Clean the side of each brace with the sponge part.
3) Move the dental floss between the teeth, rubbing the surface of each tooth. Remember that dental floss must reach up to the gum border, and must even be introduced a couple of millimetres inside the gum, but without hurting. The floss must be moved down from the gum to the border of the tooth.
4) Carefully, remove the dental floss and repeat the same procedure for all teeth.
3) Mouthwash as a hygiene aid after a good brushing. They don’t replace brushing, because bacterial plaque would prevent mouthwash action: this would be like taking a shower with a raincoat. There are different types of mouthwash: those with fluoride will help to strengthen enamel against cavities, and are used once a day or once a week, according to their pharmacological formulation. Other mouthwashes contain antibiotics, such as clorhexidine, which must be used, mostly, when there is gum inflammation. Finally, there are mentholated mouthwashes which are only useful to leave a pleasant feeling of freshness in the mouth.
4) Irrigators or dental douches. These are devices which project a pressurized water jet with the objective of removing food remains built up in interdental spaces and braces. They don’t remove bacterial plaque, so this is a recommendable device, but not essential.
5) Travel toothbrush: Always take one with you, in order to wash your teeth at any time.
6) Plaque-disclosing tablets: They don’t clean the mouth, but are a good tool in order to improve dental brushing, as they will disclose if we are not doing it adequately. It consists of a substance called erythrosine, which will stain in red any dental plaque; it is available as tablets. We will dissolve one tablet in our mouth by sucking it, and the places where there is dental plaque will appear red; these are the places where we should clean better.
7) Cleaning Orthodontic Devices. Each time we take a device out of our mouth, we should clean it. For this, we can use liquid soap like the one we use for our hands, or simply tap water and a nail brush or a toothbrush only used for this. No toothpaste is required. After washing the device, we will rinse it, and finally, if we must put it away, we must dry it well before putting it inside the box. Every time we are going to wear it, it is advisable to moisten it.
Once a week we could use those tablets used for cleaning dentures, which are sold in pharmacies. Simply put the device into water with one of these tablets, in order to disinfect it and clean it better.
Brush your teeth well after each meal, without leaving more than 15 minutes between the meal and the brushing; use an electric toothbrush, and use it adequately; use fluoridated toothpaste, and brush in front of a well-lighted mirror. An excessive intake of sweets and sugary foods must be avoided; keep a healthy, rich and balanced diet, because the lack of certain vitamins will lead to the development of some gum diseases; and finally, visit your dentist at least once a year, for an examination and dental cleaning.
Keeping teeth clean is the patient’s responsibility; lack of cooperation by the patient in terms of hygiene can prevent treatment progress. Occasionally, this will force us to remove the devices, because in these conditions the orthodontic treatment will be harmful rather than beneficial.