The hygienist's role in orthodontics

Orthodontics can transform your smile - but while you have a brace on your teeth are at risk and good care of your teeth is essential to prevent any problems.

The Beginning: in General Practice

Before a referral for orthodontic treatment, it is helpful to see the hygienist who works in your dental practice to to assess your oral hygiene. If you have a problem, the hygienist will help you improve your standard of dental care so that you are fit enough to commence orthodontic treatment.

Your hygienist can suggest an oral hygiene kit to use at the pre-orthodontic stage. The recommendations are likely to include:

• a powered or manual toothbrush

• disclosing tablets (to help show where you need to pay more attention during brushing two or three times a week)

• an interdental brush or floss (to help clean between your teeth)

• a fluoride mouthwash

You will need a demonstration of how to use these items in order to maintain a high standard of oral hygiene.

You could also be asked to complete a food diary, which will be assessed by your hygienist who may suggest changes to your eating habits to reduce your risk of decay.

The Start: commencing orthodontic treatment

Once your oral health is satisfactory, you will be in a position to begin your course of orthodontic treatment. Before the brace is fitted, your hygienist may like to clean and polish your teeth - but not on the same day.

When the brace is fitted you will be given dietary advice about the foods you should avoid during treatment; for example, hard foods like apples and carrots should be cut up, and chewy foods like toffee avoided, for fear of damaging your braces. Frequent intakes of fizzy drinks and sweets/chocolate are to be avoided as there is an increased risk of decay while you have a brace.

You should be given advice about the oral health kit you will need at this stage. Recommended contents may include:

• an orthodontic toothbrush or a mini toothbrush head for the electric brush

• a single tuft toothbrush

• a floss threader with floss or a small interdental brush

• interdental brushes of a larger size to help clean under wires and around brackets

• disclosing tablets or solution

• a fluoride mouth rinse

• orthodontic wax to relieve any discomfort from rubbing on the lips or cheeks and prevent ulceration of the soft tissues.

It will be explained that at the beginning you can expect some aching of the teeth and tenderness on biting, but this should soon pass off. Some soreness of the cheeks or lips may be experienced in the early stages. There may also be similar discomfort after the wires are tightened at later visits.

The Middle: during orthodontic treatment

It is time consuming to keep the mouth healthy during treatment. Orthodontic brackets and bands create many recesses and food traps which greatly favour growth of bacterial plaque. It is not easy to remove all the plaque from around orthodontic brackets but important that you do so, and plenty of time needs to be set aside for this each day. Regular visits to your hygienist can help you in maintaining a good technique for plaque control. The hygienist can also help with removal of any hard deposits or stains accumulating on the teeth and this is most easily done while the wires are removed when your brace is adjusted.

During each maintenance appointment, your hygienist can monitor your oral health. If your gums are very inflamed, plaque control may be supplemented with agents such as a chlorhexidine paste or spray. Your eating habits will also be checked to confirm that you are controlling the risk of decay.

It is not unusual to experience some sensitivity as the teeth move. This can be eased somewhat by using a desensitising toothpaste but the symptoms usually abate after the treatment has completed.

The active phase of orthodontic treatment can last up to two years or even more which is a long period for your teeth and gums to be at risk, so it is important to maintain good oral health throughout

The End: After the treatment.

Almost everyone has retainers after the fixed appliance is removed. Many have a fixed retainer which is left in place in the long term to avoid drifting of these teeth. A fixed retainer is a particular challenge to effective plaque removal and will need close attention from you on a daily basis. Your hygienist can advise on the best method and will also offer regular professional cleaning to remove stains and calculus deposits. This is particularly important if you are susceptible to gum disease.

Although good oral care during orthodontic treatment is demanding, the results obtained make it really worthwhile with a smile you will be proud to display