Is a dental cleaning necessary before getting orthodontic (braces) treatment, especially for patients with a history of periodontal (gum) disease or tooth decay?

Dental Cleaning Before Braces: Clinical Recommendation

Yes, teeth should be professionally cleaned before placing braces to establish optimal oral hygiene and reduce the risk of caries and periodontal disease during orthodontic treatment. 1

Rationale for Pre-Braces Cleaning

Orthodontic appliances create additional plaque retention sites and make oral hygiene significantly more challenging. Starting treatment with a clean slate—free of calculus, plaque, and existing gingivitis—is essential to minimize complications during the months or years of orthodontic therapy. 1, 2

• Fixed orthodontic appliances increase plaque accumulation, which directly leads to caries development and periodontal disease progression 3
• The risks of orthodontic treatment include periodontal damage, root resorption, caries, and enamel damage—all of which are exacerbated by poor baseline oral hygiene 2
• If orthodontic treatment results in tooth loss from periodontal disease or caries within a few years, the patient has not been helped despite malocclusion correction 1

Special Considerations for High-Risk Patients

Patients with Periodontal Disease History

For patients with existing periodontal disease or gingival inflammation, professional cleaning and periodontal stabilization are mandatory before bracket placement. 1, 4

• Periodontal disease can be minimized through effective plaque control, but starting treatment with active disease significantly increases risk of progression 4
• The high incidence of periodontal disease among adults indicates that routine dental care must be optimized before adding the challenge of orthodontic appliances 4

Patients with History of Tooth Decay

Patients with active caries or high caries risk require restorative treatment completion and professional cleaning before orthodontic treatment begins. 1, 2

• Orthodontic appliances make it nearly impossible to detect and treat new carious lesions during treatment 2
• Starting with untreated decay or poor oral hygiene virtually guarantees progression during orthodontic therapy 1

Establishing the Oral Hygiene Protocol

The pre-braces cleaning appointment should include comprehensive patient education on the modified oral hygiene techniques required during orthodontic treatment. 1, 3

Essential Patient Instructions:

• Brush with a soft toothbrush using gentle circular motions after meals and before bedtime 5
• Use fluoride-containing toothpaste to strengthen enamel against demineralization 5
• Employ interdental brushes daily to clean around brackets and wires 3
• Rinse with alcohol-free antimicrobial mouthwash (such as 0.2% chlorhexidine) to reduce bacterial load 6

Common Pitfalls to Avoid

The most critical error is placing orthodontic appliances on teeth with existing plaque, calculus, or active disease. 1, 2

• Do not assume patients will improve their oral hygiene once braces are placed—compliance typically deteriorates over time, not improves 4
• Younger patients (ages 12-15) demonstrate poorer oral hygiene compliance than older adolescents (ages 16-18), requiring more intensive pre-treatment education 3
• Failing to establish effective plaque control before treatment initiation sets the stage for irreversible periodontal damage and caries that can negate any orthodontic benefit 1, 2

Ongoing Maintenance Requirements

Patients should have professional cleanings every 6 months minimum during orthodontic treatment, with more frequent visits (every 3-4 months) for high-risk patients. 7, 1

• Regular professional monitoring is essential because the average patient does not follow an adequate home-care routine 4
• Most adults do not regularly floss, and even those who do show deterioration in plaque control over time 4