Dr. Hemant Patel, Principal Orthodontist at Liverpool Brace Place, BDS, Mo. Orth, RCS (ed), M Orth RCS (Eng), MRCPS (Glas).
Maintaining good oral hygiene is a particular challenge for patients with fixed orthodontic appliances. The presence of brackets, wires and bands make it particularly difficult to clean thoroughly and as a result it is common for plaque to accumulate on the buccal surface around the base of the bracket. Retained plaque represents a considerable clinical risk that demineralisation of the enamel will occur, resulting in white spot lesions. The development of gingivitis and hyperplastic gingival is also a well recognised problem during orthodontic treatment with fixed appliances. As an orthodontist who sees his patients once every 4-6 weeks I am unable to fully monitor patient’s oral hygiene on a daily basis, as such we go to great lengths to stress to all our patients the importance of maintaining a comprehensive daily oral care regime. This is a particular challenge for our teenagers patients, who generally achieve poor levels of compliance compared with our adult patients. For us the key components of an effective daily oral care regime are:
Patients are advised to use a small headed, medium texture orthodontic toothbrush. These brushes have a V-shaped thread contour which allows for simultaneous cleaning of the tooth surface and brace work. Used in conjunction with a fluoride toothpaste, twice daily brushing significantly reduces plaque retention and inhibits demineralisation of the enamel. For most patients we do also recommend the use of single tufted interspace brushes, which are extremely useful, both for cleaning around the gum margin and the appliance itself.
In the presence of fixed appliances many patients find flossing to be difficult and time consuming, this again being particularly true for younger patients. For most patients interdental brushes represent a far easier tool for interproximal cleaning and as such will invariably result in improved compliance. To facilitate access to hard to reach posterior areas, we recommend the Interprox Plus™ interdental brush, which due to its longer handle and pre-angled brush head is particularly adept for posterior cleaning.
While the use of an anti-bacterial, fluoride mouthwash must not be considered by patients an alternative to brushing and interdental cleaning, it is in our experience a highly effective adjunct. There is considerable clinical evidence showing that oral hygiene levels are significantly improved when anti-bacterial mouthwashes are introduced into patients daily oral hygiene regime. While daily mouthwash such as Fluorigard contain fluoride they do not have any anti-bacterial properties. For this reason we recommend Vitis Orthodontic Mouthwash. This mouthwash is alcohol-free and contains 225ppm Fluoride, Cetyl-Pyridinium Chloride (a highly effective anti-microbial) and aloe vera which soothes the gingival epithelium. We have found this to be very effective in reducing plaque accumulation, gingival inflammation and enamel demineralisation amongst orthodontic patients. Additionally, according to a recent single blinded, randomised study the use of a mouthwash containing 225ppm fluoride even immediately after brushing increases fluoride levels above those for brushing with a fluoride toothpaste alone.
References 1.Tufekci E et al. Angle Orthodontist: Vol 78; No 2; 2008 2. Duckworth RM, Maguire A, Omid N, Steen IN, McCracken GI, Zohoori FV. Caries Res. 2009. 43:391 – 396.