What do Tom Cruise, Jodie Foster and Brooklyn Beckham all have in common? They’ve all undergone visible orthodontic treatment – although Tom is the odd one out since he wore his braces as an adult. As oral healthcare professionals, it is heartening to see any news item or public figure that promotes dental treatment in a positive light, because it makes it so much easier for us to help our patients. But awareness of retainers and the fact that people in the media are wearing them is only half the story. There is still a lack of understanding about the significance of oral hygiene before, during and after the braces come off.
When it comes to teeth straightening treatment, most people assume that retainers are purely for children and teenagers. However, despite the obvious advantages at any age – a more attractive smile and so improved self-confidence, for example – it is particularly important for younger patients to have properly aligned teeth for healthy development of the face and jaws. In addition to this, improved occlusion assists the eating process and as such aids digestion, while straighter teeth are much more straightforward to clean, and accordingly the risk of oral disease is reduced.
But let’s not get carried away with the end result. How savvy are younger patients about their oral hygiene during orthodontic treatment? At least the mantra to brush twice daily seems to have seeped into the public consciousness, but do they know that they should use a fluoride toothpaste when brushing and do they know why they should be doing any of this at all?
Naturally an effective cleaning routine will help patients to avoid gingivitis, caries and bad breath. However, almost certainly, most young patients will not have heard of white spot lesions (WSLs). A classic complication of orthodontic treatment, WSLs cause considerable dismay as they are often revealed once the braces have been removed. Having spent quite some time looking forward to the day when they no longer have to wear a retainer, this is understandably quite a blow to the patient.
The sad fact is that the patient should shoulder at least some of the blame. White spot legions, or unsightly spots of decalcified enamel, are the all-too-frequent result of plaque being allowed build up on areas around the brackets of the orthodontic appliances. The plaque acids attack the teeth and cause noticeable damage that is not easy to treat, and in some cases the marks are permanent. As ever, prevention is better than cure, and the only way to control plaque is to frequently remove it. There’s no question that oral hygiene requires a little more effort from patients who wear braces, but it is by no means impossible.
Although the patient must bear responsibility for thoroughly cleaning his or her teeth and retainer on a regular basis, it does fall to the oral healthcare provider to ensure that patients are suitably educated, and endeavour to encourage and motivate them at every appointment. Once you have covered why oral hygiene is so essential, next follows the how. Finding the right routine to suit each individual patient is the key to compliance. Fortunately, there are many products available on the market that can be recommended.
Special toothbrushes, such as single tuft toothbrushes or those with ‘V’ shaped bristles, give patients extra control and manoeuvrability to clean their teeth as well as the wires and brackets associated with braces. It is also advisable to support toothbrush use with an adjunct for interproximal cleaning. Dental floss is the most universally recognised option, however, once educated in their usage, many patients find interdental brushes easier and more comfortable to employ. Unlike dental floss, interdental brushes have space-filling attributes, which is why they are so much more effective at cleaning and plaque removal. Mouthwash is another excellent addition to any oral health care routine for a patient receiving orthodontic treatment, especially if the formula contains chlorhexidine, generally considered to be the ‘gold standard’ for antimicrobial agents.
There’s perhaps one last point worthy of note when managing the care of younger patients. It is all very well giving the child or teenager information and support, but don’t forget that parents have a significant impact on their children’s oral health. For example, studies have shown that mothers with poor oral health, or lacking in education, emotional health or knowledge of healthy eating, are more likely to bring up children who experience similar oral health problems. Clearly, in order to best help young patients, we need to include their parents or guardians in our patient education wherever possible.