lis 07, 2022 - Ten tekst przeczytasz w 1 minutęTen tekst przeczytasz w 2 minuty

Experts Speak on Orthodontic Challenges in Home Dental Care


The impact of orthodontic care

It was clear from the discussion that both Ms. Fintineanu and Prof. Cardenas are passionate about their crafts. While acknowledging that braces and other appliances can be a sore subject (literally) for many patients, there is no doubting the tremendous value of these treatments toward excellent long-term oral health outcomes.

Ms. Fintineanu’s own personal experience as a youth helped shape her career path. She said she had “really bad teeth” as a child, and got braces at age 16. “Worst thing that happened to me – I didn’t want to smile.”

Then, she noticed the results. “When I saw my teeth straightening, the amount of confidence I got and the self-esteem growth... it was extremely life-changing for me,” she reflected. Ms. Fintineanu added that she’s now seeing a higher volume of adult patients receiving braces, and she gets deep fulfilment from seeing the way their confidence changes.

But driving the desired outcomes requires implementing the right measures and best practices at home. And that begins with cleaning and caring for the appliances themselves.

Cleaning and caring for orthodontic appliances at home

Ms. Fintineanu and Prof. Cardenas shared some of their best advice pertaining to three common types of orthodontic appliances: clear aligners, fixed appliances, and fixed expanders.

Cleaning clear aligners

“Aligners are very often forgotten when it comes to cleaning your teeth during orthodontic treatment,” said Ms. Fintineanu. “It’s common knowledge that one of the great assets of doing orthodontic treatment with clear aligners is the ease with which patients can keep their teeth clean, but the problem is patients are at a slightly increased risk of developing caries while they’re undergoing clear aligners treatment.”

The reality is that these aligners cover up many areas of the teeth, which can lead to incomplete cleaning and hidden food particles. Ms. Fintineanu says she’ll often look for teachable moments – when a patient comes in for a visit, and their aligner is full of food debris once removed, she’ll show it to them to illustrate the issue.

“The thing that’s missing when your aligners are on your teeth is the action of saliva,” she said. “So it’s very important to reinforce to your patients that they have to take their aligners out, brush their teeth and the aligners as well after every meal.”

The need to brush the aligners themselves is not always obvious to patients. “Sometimes people get surprised that they have to brush their aligners,” Prof. Cardenas noted. “It would be the same as taking a shower but not washing your clothes.”

When advising patients on cleaning their aligners, demonstrate how to guide the brush into all of the incisal edges and cusp tips, removing all plaque and debris. Emphasise that they shouldn’t use toothpaste for cleaning the aligner because its abrasive makeup can cause micro-scratches.

An added pointer from Ms. Fintineanu: for patients with a higher risk of cavities, recommend they brush with fluoridated toothpaste at night before bed, then pop in the aligner without rinsing to gain added protection. “Why not use aligners for more than they're intended for if it's not going to ruin or harm them?"

Cleaning fixed appliances

There are many different forms of fixed orthodontic appliances, which can be used in different areas of the mouth: buccal and lingual support on the teeth, fixed expanders on the upper jaw, fixed retainers, and so on.

“In general, for any type of fixed appliances, be very thorough to ensure no food is left behind, but also very careful so you don't detach any of the appliances that are in the mouth,” said Prof. Cardenas. Her specific recommendations are as follows.

  • Buccal appliances: Remove additional supports like intermaxillary elastics or wax before brushing. Use a 45-degree angle (the modified Bass technique) to achieve coverage over the braces and underneath the bands. An interdental brush can help reach difficult areas beneath the wires. 
  • Lingual appliances: Although caries are less likely to develop on the lingual side of your teeth – in part because of the tongue’s role in cleaning – it’s still important to vigilantly clean appliances located here. Brush on top of the appliance and use an interdental brush to get underneath. Be sure to get all the way back to the last molars. 
  • Fixed expanders: An interproximal brush can be one of the best tools available for effectively cleaning expanders, according to Prof. Cardenas. Point your patients toward options with longer handles so they can get to the deepest nooks with ease. Assure patients that the brushes are soft and pain-free – discomfort will occur only if food is left behind and the gingiva begins to swell.
  • Fixed retainers: People with retainers are at higher risk for plaque retention than those without. Promote extensive cleaning with a toothbrush and interdental cleaner. Also, if you provide orthodontic care for the patient, be sure to check during every visit if the fixed retainer has become detached on one or more teeth, and advise them to be hyper-aware of this because it can cause many unwelcome problems.

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