The correlation between users of orthodontic appliances and an increased build up of plaque is well known. Plaque can lead to gum disease and enamel damage and this is significant for orthodontic patients whose access to the tooth surface is compromised. This issue is reinforced by the fact that orthodontic appliances trap food debris, particularly in the interproximal space that composes 40 per cent of the tooth’s surface – where conventional toothbrushes cannot penetrate. While patients wearing orthodontic appliances will of course benefit from straighter teeth and improved self-confidence once their treatment is complete, they need to be extra vigilant to ensure they maintain optimum dental and gum care throughout treatment.
The extra care needed to maintain the health of teeth for orthodontic patients requires attention, especially when considering that an Adult Dental Health Survey found that only 75 per cent of UK adults brush their teeth twice a day – this is matched by the population’s general failure to include additional cleaning methods such as flossing to daily oral health routines. Such indicators may suggest that adolescent orthodontic patients are potentially more susceptible to oral problems associated with braces such as white spot lesions if adjunct cleaning methods are neglected.
White spots represent a negative change to the enamel – an indication of the first signs of tooth decay if left untreated. This condition commonly develops in people who wear orthodontic braces since effectively cleaning and brushing around brackets and wires is a difficult task and may lead to an increased accumulation of plaque, if areas of the mouth do not receive sufficient regular cleaning. The known difficulty of flossing also contributes to the likelihood of the interdental spaces remaining unclean since the Adult Health Study also revealed that only 22 per cent of people use dental floss, implicating this failure as one reason why two thirds of adults have visible plaque – a known cause of gum disease.
Even still, an effective toothbrush technique will only clean up to 60 per cent of the tooth’s surface necessitating interproximal cleaning by adjunctive methods, particularly for orthodontic patients. The health benefits of interproximal cleaning cannot be stressed enough by dental professionals where plaque rapidly accumulates on the surface of teeth, around appliances. Reaching the interdental space is key to removing food debris, plaque and bacteria – all of which lead to long-term damage of the tooth enamel and gums if not managed by adjunctive methods.
This fact is compounded throughout orthodontic therapy since patients with wires between their teeth may find that flossing is less effective since it is unable to reach the gums underneath wires completely. The difficulty patients experience when using floss as an interdental cleaning product is that if not used properly, floss can cause irritation to sensitive gums affected by gingivitis. This is exacerbated by the fact that the interdental space needs to be filled entirely so that all food debris can be removed.
Dental studies have raised a potential solution to this concern by suggesting that the use of interdental brushes are more effective and less harsh than floss: “The use of interdental brushes is more effective in removal of plaque and results in a larger reduction of probing depth than the use of dental floss” (Christou et al, 1998). When considering the particular oral health issues that orthodontic patients are susceptible to, the need for a versatile alternative is paramount to maintaining long-term oral health.
The fundamental importance of making interdental cleaning accessible to all patients who may struggle with flossing, is especially pertinent when dental research reports a strong connection between periodontal disease and other conditions such as Alzheimer’s disease, diabetes, and cardiovascular disease where inflammation is the catalyst. Therefore the responsibility of dental practitioners to educate patients is strong, with due attention to oral care as a preventative for chronic conditions that are connected to gums where bacteria and disease can access the bloodstream.
Dental professionals aspire to achieve optimum oral care throughout orthodontic therapy. This need is most profound when considering orthodontic patients’ increased vulnerability to plaque. One way to ensure the prevention of enamel corruption and gingivitis is to offer products that are both easy to use and suited directly to purpose. Recommending interdental brushes could become an easy and natural part of a daily oral regime that preserves orthodontic appliances, and actually improves the overall health of the mouth.
Author: Howard Thomas
Christou V et al, ‘Comparison of different approaches of interdental oral hygiene: interdental brushes versus dental floss’ Journal of Periodontology, 1998.
This article was first published in the March 2014 issue of Dental Tribune UK