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Writer's picturePeter T. Phan

Clean teeth make happy teeth (and patients)!

So, you want to make sure your treatment with us at New England Smile Orthodontics is a success. Well, one of the most ignored parts of treatment is oral hygiene. It's not just about brushing twice a day. We need to brush EFFECTIVELY many times a day.



What can happen if we don't brush our teeth well enough? Besides cavities, we need to be mindful of halitosis (BAD BREATH) as well as gingivitis and periodontal disease. Plaque and tartar have bacteria and their waste mashed into a chunk of old food and debris. It's not pleasant for the gums and bone to have plaque and tartar irritating them. As a result, we end up with swollen gums and a lot of bleeding. If left long enough to irritate the gums and bone can lead to periodontal disease. I tell my patients that the gums are slow to respond in these situations, so it may take a several days before they get "fed up with the plaque" and start bleeding. Likewise, it will take several days of consistently good brushing before they trust that the plaque is gone for good an the bleeding stops. So, while bleeding is a sign that your gums are irritated, you need consistently remove the plaque effectively for them to revert back to normal. Tartar needs to removed by your dentist or hygienist, so scrubbing hard is only doing more harm than good.



Another issue we often see with poor oral hygiene are what we call decalcifications (decal for short), white spot lesions, or white scars. These scars are demineralized areas where plaque or tartar sat for so long that the acid waste from bacteria have etched the enamel. Think of etched glass. This is a permanent mark on the surface. Remember, your braces or aligner attachments have sealed that specific spot on the tooth. It's the areas around the braces or aligner attachments that are at risk of decal/white spot lesions/white scars. These are effective mini cavities that rehardened. However, even though the enamel has remineralized it looks VERY different from normal enamel. Hence, you get a white scar/white spot lesion. It takes little time for enamel to begin deminerlization - as little as 30 minutes of continuous acid contact. That means just several days of consistently sub-par brushing can lead to decal marks on your teeth.



So, it's important to brush well, and brush often.


Read on to see how we can brush for success to finish our orthodontic treatment with happy, healthy teeth for a beautiful smile.


  • Get started: Remove any elastics and discard them (you’ll replace them with new ones after you’re done brushing). If you're using Invisalign remove those as well (obviously :)

  • Floss in between each contact point, and be sure to wipe the floss along each side of the teeth.



  • Rinse, and then check your teeth: Rinse thoroughly. Examine teeth and braces in the mirror and remember to look for any remaining food particles or plaque.

  • Brush each wire: Move top to bottom, and all the way around upper and lower teeth.

  • Be gentle, and brush the braces or attachments, teeth, and gum line:

    • We recommend brushing your teeth for at least two minutes, twice daily.

    • That means each quadrant of your mouth gets 30 seconds.

    • Electric Toothbrushes typically have a built-in timer that pulses or beeps every 30 seconds to let you know when to switch areas of the mouth. As you’re brushing, make sure to clean all areas of the tooth. Some people find they get the best clean going tooth by tooth. Keep in mind this time is just a guide, and it might be necessary to brush your teeth for longer than 2 minutes to ensure proper oral hygiene… especially with braces.

  • However, brushing often throughout the day really ensures you're minimizing the risk of cavities, decal, and gum disease. So, don't hesitate to brush more than twice a day!

  • Fluoride concentration: If the dentist or orthodontist feels you are at greater risk of tooth decay, they may increase the fluoride concentration by

    • (i) prescribing a stronger toothpaste,

    • (ii) applying fluoride varnish to their teeth two to four times a year when they visit them or

    • (iii) asking them to use a fluoride mouthwash at a different time than tooth brushing.

  • Spit, but do not rinse after brushing:

    • Rinsing after brushing will dilute and wash away the fluoride toothpaste which is needed to strengthen your teeth. This dilution effect is why even a mouthwash straight after brushing reduces effectiveness, as it dilutes the fluoride around your teeth.

  • Keep up regular visits:

    • Staying on track with your treatment means that while you see us regularly for orthodontic adjustments

    • You also need to maintain appointments with YOUR REGULAR DENTIST FOR CLEANINGS.

    • Having extra cleanings with your dentist is also a great idea to help keep your teeth healthy. We often recommend having a cleaning every 3 months.


You can also visit "Videos and Simulations" to review our many videos on taking care of your braces.

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