Oral hygiene and orthodontics

Oral hygiene and orthodontics

Although fixed orthodontic appliances (braces) tend to retain food debris and dental plaque, it is possible to maintain clean teeth and devices during orthodontic treatment by having a good dental hygiene and following some basic rules.

A few facts about dental hygiene and orthodontics

  • Orthodontic appliances as such do not cause tooth decay, decalcification or gum disease but can contribute to the retention of food particles and dental plaque.
  • Tooth decay and decalcification spots are due to bacteria present in dental plaque.
  • Unless the debris is completely removed, there may be problems such as tooth decalcification or discoloration as well as gum disease.
  • White spots on teeth also known as tooth decalcification can grow up to become cavities if oral hygiene is not improved.
  • Although variation may exist in individual susceptibility to tooth decay, the best way to prevent cavities and decalcification is to properly follow oral hygiene guidelines that we will give you.
  • During the installation of orthodontic appliances, we will give you very precise oral hygiene instructions. We will demonstrate tooth brushing techniques and supply you with various types of toothbrushes. You will have all the tools you need to achieve an excellent oral hygiene.
  • We recommend that you continue to visit your dentist regularly during your orthodontic treatment.

No matter how much effort we put into cleaning and preparing your teeth before the installation of the appliances, only proper and continuous oral hygiene will contribute to keep your teeth clean and healthy. We will correct the position of your teeth but the maintenance of your teeth and orthodontic devices is your responsibility! Brush your teeth well, keep good oral hygiene and you can participate in our hygiene contest and maybe win some prizes while keeping your teeth and mouth healthy!

Dental plaque, a mass of bacteria

  • Several types of bacteria are normally present in the mouth. In fact, the mouth is the place in the human body where you will find the largest variety of bacteria! These bacteria are regularly found on the surface of the teeth. Shortly after tooth brushing, a soft and sticky deposit composed of proteins from the saliva is formed on the tooth surface.
  • This film allows certain bacteria to build up on teeth. Later, other types of bacteria will join them to create “colonies” which can become increasingly large. The bacteria will, in turn, produce an organic matrix that protects them from the outside environment.
  • If nothing prevents the growth and reproduction of bacteria, the colonies grow and become visible to the naked eye within a few hours. This is the white or yellowish material that is sometimes visible on the teeth.
  • Only mechanical action like tooth brushing can remove these bacteria. Improper toothbrushing not only leaves bacteria on the teeth but also food debris that can feed bacteria (especially sugar).


  • In addition, bacteria metabolism produces acid that attacks the tooth enamel by dissolving its surface and demineralizing it, causing tooth decay. If dental plaque remains long enough on the tooth surface, it incorporates minerals from the saliva and hardens into tartar.
  • Tartar, it’s no picnic! At this point, the mineralized plaque (tartar) is very hard and the only way to remove it completely is to see your dentist or dental hygienist for a professional cleaning (using ultrasonic and hand scalers, and curettes).
  • Click the video above to see live bacteria from dental plaque under the microscope. It is even more impressive if you watch it in full screen! Appetizing, right? This is what could be crawling on your teeth…

Not only teeth, gums too!

Bacteria in dental plaque and tartar that are near the gum line will gradually cause inflammation in that area (redness and bleeding of the gums). This will eventually promote gingival recession and can affect the bone that supports the teeth. The best way to avoid these problems is to break the chain reaction of bacteria as soon as possible by developing and maintaining good oral hygiene habits.

Hygiene and tooth brushing techniques

  • Teeth should be brushed thoroughly after each meal or snack.
  • A good brushing technique requires time and practice (the recommended amount of time is at least 2 minutes, twice a day).
  • We recommend the use of a brush with a compact head and soft bristles because this is less damaging to the gums.
  • Although there are “orthodontic” toothbrushes, all soft-bristled toothbrushes may be adequate.
  • It is important to apply just enough pressure on the toothbrush to feel the bristles against the gums.
  • In some cases, the use of an electric toothbrush can be an asset. Several toothbrush types are available on the market, but some are more effective than others.
  • If you want to use an electric brush, we recommend an ultrasonic toothbrush (e.g.: Sonicare), which uses a very high frequency of vibration referred to as ultrasound to remove plaque in more difficult-to-reach areas.
  • To learn more about ultrasonic electric brushes or to try one, ask our staff.
  • Oral hygiene aids: some products may facilitate the maintenance of your teeth.
  • Floss threaders for orthodontic braces: see photos below or visit the FlossFish website to see a demonstration video on the use of this product.
  • Interdental brushes: we will give you small orthodontic brushes to facilitate the access between the brackets and under the wire (proxabrush).
  • If your gums are sensitive or bleed easily when tooth brushing, let us know and we will evaluate the cause.

Brush or floss?

  • The basis of good dental hygiene is tooth brushing, but we also encourage you to floss your teeth.
  • It is obviously more difficult to floss with braces, but we can supply you with threaders and auxiliaries that can facilitate this task.
  • Flossing should be a complement to a good brushing technique but cannot replace it.
  • Here is why we do not insist on flossing with orthodontic appliances (braces) even if we strongly encourage it:
    • People spend a certain amount of time caring for their teeth and braces, which is normal. However, whether they use the toothbrush, dental floss or any other oral care product, they’ll rarely spend more time to complete these tasks than if they only brushed their teeth.
    • Unless you are very thorough and take the time to brush and floss your teeth properly, using the two techniques can result in a faster brushing and an incomplete flossing, which decreases the quality of the maintenance. Let’s remember that a good comprehensive and thorough brushing is the basis of oral hygiene.
    • We are not against the use of dental floss and other hygiene aids but, if they are used, the time devoted to oral hygiene must be increased accordingly to make the most of these complementary methods.
  • In conclusion, flossing does not replace adequate toothbrushing, but can be beneficial!
  • Remember: it is not necessary to brush all of your teeth… only those you wish to keep!

The “real” causes… and the solutions!

It is not rocket science, most people having oral hygiene problems, whether they wear braces or not, can blame them on three main reasons:

1- Bad technique: the brushing technique is deficient or inadequate

  • They brush long enough (brushing duration) but they do not reach the critical zones on the edge of the gum, behind the wires and around the brackets, to remove plaque and food debris.
  • It is important to press the bristles of the brush on the gum to massage it well during brushing.
  • Do gentle rotation movements on every surface of the tooth.
  • Perform a vertical movement of the brush from the gum toward the tooth.
  • Avoid brushing horizontally in a back and forth movement to minimize chances of wearing the tooth and gums.
  • It is preferable and less damaging for the gum to use a soft-bristled brush.
  • In doubt, use a small brush head rather than one that is too big.
  • Electric brushes can be used, but the same basic principles apply (access to plaque areas and brushing duration).
  • Brushing pressure: studies have shown that the optimal brushing pressure is about 150 grams (5 oz) which is equivalent to the weight of an orange. Brushing with too much pressure can damage the gum and teeth.

2- Brushing duration that is too short

  • In certain cases, the brushing technique is good, but the brushing duration is too short to “cover all” the dentition!
  • Most experts agree that an adequate brushing session must last for at least 2 minutes.

3- Insufficient brushing frequency

  • Someone may have a good brushing technique (as described previously), have an adequate brushing duration, but does not do it regularly enough. What is worse is if brushing is done irregularly using a bad technique and a duration that is too short. Brush your teeth after each meal and particularly before going to sleep.

Ensure that you have a good technique and brush long enough and regularly to minimize the chances of having decalcification, dental caries and gum problems.




Good oral hygiene

Examples of excellent dental hygiene

Problems to avoid

Examples of hygiene problems to avoid…







Examples of dental decalcification that appeared when hygiene was inadequate during an orthodontic treatment.







Picture above:

  • (A) Patient showing areas of decalcification before the treatment (arrows). Hygiene, without being perfect, is only average.
  • (B) During the treatment, the situation worsens; hygiene (brushing) is problematic, plaque accumulates around the brackets and the gum becomes red and inflamed.
  • (C) At the end of treatment, when the appliances are removed, several areas of severe decalcification are visible in both arches. An important carie is even visible on a lateral incisor (arrow). The gum is swollen and has an irregular outline (inflammation). Papillas have thickened. Several decalcification white stains affect several teeth.
  • (D) The patient started repairing the caries on a few upper incisors. Several other teeth must also be repaired. Hygiene has now improved and the gum gets back to a more regular outline and a normal color. The papillas are less swollen.




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