Straight to the point

04 December 2020
4 min read

Amanda Sheehan discusses the relationship between orthodontics and oral hygiene.

According to the British Orthodontic Society, tooth straightening is in high demand with over 200,000 children and teenagers in England and Wales having treatment within the NHS every year, and with growing numbers of adults and young people seeking treatment on a private basis.

A wealth of media sources consistently support that working from home has given people more time to consider their own appearance, and also the opportunity to do something about it. When people can’t spend their money on holidays or visits to the shops, that discretionary spending might well be diverted towards cosmetic dentistry. Innovations such as clear aligners make treatments less invasive, and less visible.

Advancements in technology make the production of orthodontic devices simpler and quicker. Clear aligners may be popular currently, but they can also be considered a foothold for the whole industry, raising awareness and requirement for the whole range of orthodontic interventions.

The downside of this is the rise of so-called ‘DIY braces’. To combat this the British Orthodontic Society has launched Safe Brace, a joint initiative with the Oral Health Foundation to provide impartial advice on orthodontic treatment. To achieve a safe and effective outcome, patients must firstly consult and then maintain regular contact with a qualified dental professional. The ongoing relationship between the patient and their dentist, and identifying a suitable and appropriate daily oral hygiene regime are key to getting a satisfactory result at the end of the treatment.

Ahmad Nounu owns the Black Swan Dental Practice in Crewkerne, a private practice covering a semi-rural area in the South West of England. Ahmad sees the patient-dentist relationship as fundamental to any successful course of treatment for teeth straightening. Due to the current situation, Ahmad now undertakes many of his initial consultations online. He feels that technology has unlocked many advantages for both the practice and the patient. Obviously, accessibility is one factor; it’s so much easier for both parties to schedule consultations when you can remove travel, social distancing and disinfection of the surgery from the equation. Also, patients can feel more relaxed about considering a major financial and lifestyle change from the comfort of their own home and will be reassured that they are coming to their decisions at their own pace.

That said, all prospective patients still need to physically visit both their dentist and dental hygienist before they commit to a teeth straightening treatment and this is currently a pinchpoint in terms of availability. Ahmad’s private practice is currently seeing additional patients, as there is pent up demand from those who can’t get into NHS practices. This is leading to scheduling issues to meet the added demand from both these patients and new cosmetic dentistry patients. Ahmad has resolved this by making additional slots available out of hours and at weekends. This has rapidly reduced waiting lists at the surgery and has been welcomed by patients who find this extra availability quite convenient.

With patients coming to their dentist primarily for cosmetic procedures, this additional engagement with the practice and particularly with their dental hygienist / therapist, has resulted in some added benefits. The oral health of prospective orthodontic patients can vary considerably. Ahmad’s team has picked up many underlying conditions and problems during these consultations that may otherwise have gone undetected and been able to implement treatments for these, before starting their orthodontic interventions. Where a patient is choosing to access dental care for cosmetic procedures, it presents an opportunity to improve their general oral health. As the success of the procedure is dependent on their engagement and participation, they are more likely to be motivated to follow instruction.

Now more than ever there is quite an array of different devices, approaches and techniques for straightening teeth, some of which can be fitted directly in the dental practice. Once the orthodontic device is in place, the role of oral hygiene, diet and the hygienist themselves really come to the fore. Regular consultations with the dental hygienist and adherence to an oral hygiene regime are procedures that simply can’t be compromised. It’s an ongoing commitment on the part of both the dental professional and the patient themselves.

Patients who are keen to undergo a tooth straightening procedure may not fully comprehend just what the treatment will involve. With increased contact, either virtually or in person, this can be easily overcome. The fitting of the device is only the first step on the journey to a straight and healthy smile. For instance, the classic ‘train-track’ brace can harbour bacteria and debris between the wires and can require specialist brushes to clean really effectively – a standard toothbrush won’t necessarily reach every part of the tooth surface. Interdental brushes (IDB), specialist brushes and floss all have a part to play in keeping teeth and devices in a clean and hygienic condition – but patients won’t be familiar with the array of oral hygiene devices or how to use them unless they receive specific instruction. Many interdental brushes can be adapted and tailored to patients. Again, technology can be a useful tool here – online tutorials and virtual appointments can help and many dental manufacturers – for example, TePe – have created online resources that practitioners can signpost patients towards and staff can receive complimentary training and demonstrations so that they can deliver up to date advice information and guidance.

Visual aids can be extremely helpful when explaining both brushing techniques and potential pitfalls of poor dental hygiene to patients. A picture is worth a thousand words when illustrating what can happen with factors such as poor or incomplete cleaning. To provide even more detail, demonstrator models and personalised diagrams are incredibly useful and engaging for patients.

Technology has taken this one step further, with some medical devices even sending data directly through smartphones to clinicians – this is a function that’s only likely to expand as time goes on.

However, although online sharing of information is great, nothing can ever really replace regular physical check-ups with a qualified dental professional.

In short, when our patients undertake a teeth straightening procedure, they need to understand that they are entering into a partnership with their dental professional. Orthodontists, dentists and hygienists/therapists will offer their knowledge, expertise and insight into the best process and techniques to achieve the desired result. Manufacturers might provide innovative products and educational resources to assist in cleaning and maintenance of both the teeth and orthodontic appliances. Technology can facilitate communication and information sharing. However, we all understand that this will all be in vain without ongoing and daily commitment on the part of the patient to an effective oral health regime. Working together with our patients, they can achieve the results that they desire – as long as they put the effort in and we take the time to signpost them to the right products and demonstrate the techniques for using them effectively

References available on request.