What is the recommended maintenance routine for teeth with orthodontic (orthodontic) braces?

Recommended Maintenance Routine for Orthodontic Braces

Patients with orthodontic braces should brush their teeth at least twice daily with fluoride toothpaste, floss daily with specialized flossing tools, use fluoride mouthrinse, and maintain regular dental check-ups every 3-6 months to prevent demineralized white lesions and ensure optimal oral health during treatment. 1

Daily Oral Hygiene Practices

Brushing

• Brush teeth at least twice daily (after meals and before bedtime) using fluoride toothpaste to prevent dental caries and maintain oral health 1, 2
• Use a small, ultra-soft-headed, rounded-end bristle toothbrush (an ultrasonic toothbrush may be acceptable) 1
• Brush within 30 minutes after eating and before bed, ensuring the gingival portion of the tooth and around brackets are thoroughly cleaned 1
• Rinse toothbrush in hot water to soften the brush before using 1
• Brush tongue gently from back to front 1
• Rinse brush after use in hot water and allow to air dry 1
• Change toothbrush when bristles are not standing up straight 1
• For children under 6 years, use only a pea-sized amount (0.25g) of fluoride toothpaste to minimize swallowing 1

Flossing

• Floss at least once daily using specialized orthodontic floss or floss threaders to clean between teeth and under wires 1
• Waxed floss may be easier to use and minimize trauma to the gums 1
• If flossing causes bleeding that doesn't stop after 2 minutes, consult your orthodontic team 1

Rinsing

• Rinse with a fluoride mouthrinse to provide additional protection against demineralized white lesions 3, 4
• Consider using 0.05% sodium fluoride mouthrinse twice daily for high-risk patients, which has been shown to significantly increase remineralization of incipient caries 3, 4
• Rinse, swish, and spit with a bland rinse (1 teaspoon salt, 1 teaspoon baking soda in 4 cups of water) several times a day to help maintain moisture, remove debris, and reduce plaque accumulation 1
• Avoid commercial mouthwashes with alcohol base or astringent properties 1
• After brushing with fluoride toothpaste, either rinse briefly with a small amount of water or not at all to retain more fluoride in the mouth 1

Professional Care and Follow-up

• Schedule regular dental check-ups and professional cleanings every 3-6 months based on periodontal disease status and clinical needs 1
• Professional application of fluoride varnish every six weeks during orthodontic treatment has been shown to reduce demineralized white lesions by almost 70% 5
• Consider high-fluoride toothpaste (5000 ppm fluoride) for high-risk patients, which has been shown to significantly reduce the development of demineralized lesions during orthodontic treatment 4

Special Considerations

For Removable Appliances/Retainers

• Remove appliances before brushing teeth 1
• Brush and rinse removable appliances after meals and at bedtime 1
• Remove from mouth for long periods (at least 8 hours per 24 hours) and soak in appropriate cleaning solution 1
• For clear retainers, follow manufacturer's specific cleaning instructions 6

Additional Measures

• Use a rubber dam during dental procedures to minimize formation of droplets, spatter, and aerosols 1
• Consider using high-velocity air evacuation and proper patient positioning during dental visits 1
• Moisturize the mouth with water or artificial saliva products if experiencing dry mouth 1
• For lip care, use animal or plant-based oils such as beeswax, cocoa butter, and lanolin to prevent drying and cracking 1

Common Pitfalls to Avoid

• Inadequate cleaning around brackets and wires, which can lead to plaque accumulation and demineralization 7, 8
• Using hard-bristled toothbrushes that can damage gums and enamel 1
• Neglecting to clean between teeth and under wires, where food particles commonly get trapped 1
• Consuming sugary foods and beverages, which significantly increases risk of demineralization and decay 1
• Ignoring early signs of gingival inflammation or white spot lesions, which require prompt attention 7, 8
• Using petroleum-based products on lips, which can cause drying and cracking 1

By following this comprehensive maintenance routine, patients with orthodontic braces can minimize the risk of developing dental caries, gingival inflammation, and demineralized white lesions during treatment, ensuring optimal oral health outcomes.