Most people associate oral hygiene, flossing and brushing our teeth with the dentist, but don’t necessarily think of it when talking about orthodontic treatment. However, with the modern orthodontic treatment methods, brushing, flossing, and overall oral hygiene and health has become more important than ever, and there are several reasons for this.
In the distant past, the teeth were protected by bands or metal rings that went completely around every tooth, including the front teeth. Now-a-days, the biocompatibility and strength of the bonding adhesives are so good that bands are not as commonly used in today’s orthodontic treatments, except when an appliance is used.
When bands were standard, and during much of the initial time while bonding adhesives were being developed, the bands were sized, fit, and contoured to each tooth being treated. Once they were prepared, a bio-compatible orthodontic cement, or glue, was used during the final placement of the band. Contrary to what everyone would think, the purpose of the cement or glue is not to hold the band in place, although it does help secure the band to the tooth. The critical purpose of the cement is to fill the extremely small space between the band and the tooth surface, preventing decay causing bacteria from lodging and colonizing in that protected space.
The mouth is full of bacteria, and most of it is good bacteria and fulfills a useful purpose for us. Although the bacteria are a desirable part of our oral flora, if it over-grows the environment, it can become detrimental to us. If we do not clean the surface of the teeth daily, cavities causing bacteria multiply and colonize the tooth surface. As the colonies grow and organize, they turn into plaque which is a sticky film that covers the part of the tooth that does not get cleaned. If the plaque remains for a period, its’ acidic byproducts eat into the tooth surface, forming decalcifications that can eventually become cavities.
Decalcifications are areas where the tooth surface loses the minerals that provide strength to the enamel. Once this mineralization integrity is lost, the enamel structure becomes weakened and can crumble, leaving a void we commonly refer to as a cavity. Even if the tooth surface does not cavitate, it discolors with the loss of vital minerals. The discoloration is often a chalky white, but may also appear as a yellow, orange, tan, or dark brown area on the affected tooth. With cosmetic improvements like bleaching, whitening, bonding, and veneers, there are good options for fixing decalcifications and discolorations. However, the best fix is to prevent these from ever occurring.
Now, back to the old days of bands on every tooth. In those bygone days, the band and cement that covered the tooth acted as a great protectant against decalcifications and cavities. Wherever the tooth was covered by the band the tooth was protected, and usually the band went from the top part of the tooth and extended under the gum line. If brushing were poor, the patient could end up with a line across the tooth where the band ended, and the bacteria hid at the edge of the band. The biggest concern was if a band came loose, and the cement washed out from under it, and this went undetected for an extended period and allowed the unprotected tooth under the band to decalcify. Fortunately, this rarely occurred, but when it did, it could be a serious problem.
With modern adhesives and treatment techniques like clear aligner therapy (most referred to as Invisalign) the tooth has little protection against decalcifications and cavities. The braces are small and do not cover and protect the tooth except for the small area in the middle of the tooth that it covers. If brushing is poor and plaque builds up and decalcifies the tooth around the brace, it leaves a nice-looking bulls-eye discoloration. Bulls’ eyes are great in shooting sports, but not so great for smile cosmetics. Good brushing techniques minimize the risks of unsightly discolorations when the braces are removed, and every patient should be brushing at least twice a day, plus rinsing after every meal. Even if no toothpaste is used, brushing alone will improve the overall health of the teeth and gums, as well as providing more comfortable adjustments during treatment and better cosmetics at the conclusion of treatment.
With clear aligners, there are other considerations. There are no braces to protect a portion of the tooth surface. The bonded attachments used with aligners offer some minor protection to the teeth but are not absolute protection. Aligners have the additional disadvantage of holding any liquids and saliva that contains microscopic food particles and sugars against the tooth surface for as long as the aligners remain in place after drinking or eating. A diet that is high in sugars can be very hard on the teeth. Drinking any type of soda or sugary drinks with aligners in place can be extremely destructive to tooth enamel because they are typically acidic, plus they are high in sugar content. The sugars feed the bacteria in plaque, and they produce acid, which is what destroys the enamel, and if they are in an acidic environment this increases the enamel destruction. For anyone undergoing treatment with aligners, it is strongly recommended that they rinse their mouth and their aligners with water after drinking or snacking.
A good diet, a daily oral hygiene program, and regularly scheduled dental visits and hygiene appointments are the best preventive start and way to maintain great overall oral health. Having teeth that are straight and easy to clean is another great way to improve dental and general oral health. A good bite that generates functional forces that are appropriate and supported by the bite is another valuable addition to oral health and makes it easier to have healthy gums and supportive oral structures. Anything that improves or supports healthy teeth, gums, function and aesthetics is beneficial to oral health.
As the old time saying goes; an ounce of prevention is worth a pound of cure. This is particularly appropriate when it comes to decalcifications, discolorations and cavities. Great oral hygiene and prevention are the best cure!