What Are Your Key Oral Hygiene Recommendations for Patients Undergoing Orthodontic Treatment?
India R. Chance, BSDH, RDH Dimensions Brand Ambassador
For my orthodontic patients, I always recommend brushing with a power toothbrush twice a day, using a water flosser with an ortho attachment, and rinsing with a fluoride mouthrinse. For patients who aren’t as compliant, I usually advise they add a prescription fluoride dentifrice to help with decalcification.
I like to show them gnarly pictures of decalcification on Google and what can happen if they aren’t cleaning around those brackets. They almost always respond with “ewww.”
Orthodontic patients need to be diligent at self-care to avoid demineralization. Regardless of whether the patient is using clear aligner therapy or traditional brackets, I recommend brushing with a power toothbrush using a high fluoride-content toothpaste, flossing at least once a day, and using a water flosser after every meal if possible. If the patient is in traditional brackets, I recommend floss threaders if his or her dexterity allows or an orthodontic flosser. If the patient is in clear aligner therapy, I recommend disinfecting the clear aligners with either soap and water, a foam cleanser that also has a whitening effect, or a clear mouthrinse. I also discuss the importance of nutrition to keep brackets from coming off and prevent decay. @lacyrdh @shygienist
I definitively recommend a power toothbrush and a water flosser because let’s face it … they’re probably not going to floss or brush properly. I would also add a prescription fluoride toothpaste.
Disclosing agent! Plastic dental mouth mirror so patients can see their entire mouths. A picture is worth a thousand words. A shower-based water flosser is helpful. I also recommend prescription fluoride dentifrice, 4-month recare intervals, interdental brushes, power toothbrush, and acidulated fluoride mouthrinse for more rapid uptake.
It’s unrealistic to think that a majority of older children, adolescents, or teenagers are going to spend the proper amount of time to throughly clean their teeth. My biggest tool is education in multiple forms. The most frequently used tool besides a toothbrush, in my experience, is the interdental brush. If they can’t properly access all areas with one of those, I recommend a plastic interdental pick. Let’s face it. Even though I’d like them to floss every day and use a water flosser, fluoride rinse, etc, most will likely only use one other tool that is simple and fast.
Brush on top and below the brackets! Yes, you can floss and you may not need a threader. Swish with water after meals.
Before my patients start any kind of orthodontic treatment, I recommend, in addition to a power toothbrush, they start using a water flosser to get their gums healthy. During active traditional orthodontic treatment, they should continue using their water flosser with the orthodontic tip. After ortho is complete, keep using the water flosser to keep their gums and beautiful teeth healthy!
I stress that, with ortho, they need to make sure they take more time! A minimum of 2 minutes, twice a day brushing. I show them some additional aids such as interdental brushes and recommend a power toothbrush. I don’t like to overwhelm them with too many products. @lavendercaps
Three-month recare for heavy buildup around brackets. Most important, check risk factors first. Air polisher if possible subgingival (glycine powder) and supragingival (sodium bicarbonate). If air polishing is not possible, polish first to get off all soft deposits, then use light ultrasonic instrumentation followed by hand scaling especially around the margins and sulcus, and then fluoride treatment. For self-care, patients should use a water flosser, interdental brush, and floss. Brushing techniques should be Charter’s and modified Bass. Obviously, a power brush with correct attachment if patients can afford one. As always, brush, floss, rinse, chew. My treatment varies depending on what the office has available. Even disclosing solution can be useful.
Brush at least three times a day with a power toothbrush. Interdental brushes, water flosser, prescription fluoride if appropriate, and 3-month recare.
With wires and brackets, I suggest a water flosser, prescription fluoride, and 3-month recare. During oral health instruction, I review two-step brushing: one time above the brackets, and one time below the brackets.
I definitely recommend a good quality power toothbrush and daily fluoride rinse to help prevent demineralization. It’s always great to talk about nutrition, not only to prevent the brackets from falling off, but to prevent decay.
Our self-care kits include ortho toothbrushes, interproximal brushes, floss threaders, and floss. We instruct each patient on how to use them. A 45° angle is important no matter which brush they choose. We recommend brushing after each meal or snack, and floss before bed. We will add prescription fluoride toothpaste to prevent demineralization, if we see need prior to bonding. We review their diet and advise drinking water with meals to swish food off their brackets as well as drinking only water between meals to reduce sugar accumulation. No sports drinks and keep milk and juices to a minimum and only during meals, preferably. With the lips unable to close entirely without strain, dry mouth is a constant battle, so replenish lip balm frequently and carry a water bottle. If they really struggle, then the parents need to assist them and they should be seen by their regular dentist/dental hygienist for exams/cleanings more frequently then twice a year. Remind patients/parents that the insurance may not cover the extra cleaning, but it’s worth it to ensure the self-care is to the level it needs to be.
From Dimensions of Dental Hygiene. September 2021;19(9):45-46.