The importance of scaling in patients with braces

Treatment with fixed braces is the right choice if you need to straighten your teeth and enjoy a beautiful, healthy smile. At the same time, daily oral hygiene must be a priority, even though it can sometimes be a challenge when you have metal or ceramic braces. The small spaces between the brackets and wires can easily trap food debris and bacterial plaque.

When undergoing orthodontic treatment, poor oral hygiene can lead to complications that affect the health of your teeth or gums. Thus, a lack of proper hygiene promotes the build-up of bacterial plaque, which is responsible for periodontal disease, halitosis (bad breath), demineralisation and, ultimately, tooth decay.  

For this reason, professional cleaning, carried out by specialists in the dental surgery, is essential for patients wearing braces, as food debris tends to accumulate and bacterial plaque develops whilst the braces are in place.  

Professional cleaning is a set of procedures carried out in the dental surgery, aimed at the complete removal of bacterial plaque, tartar and tooth discolouration. This includes ultrasonic scaling (to remove supragingival and subgingival tartar), professional polishing (to clean all tooth surfaces with a special abrasive paste), Airflow (to remove stains and bacterial plaque from hard-to-reach areas) and fluoridation (to prevent demineralisation). Regular professional cleaning (every 3–4 months) is an indispensable part of the prevention strategy and an essential component of orthodontic treatment. It helps achieve a final result that is not only functional but also aesthetically pleasing, stable and healthy in the long term.  

Braces and bacterial plaque

As proper tooth brushing is made more difficult, special attention must be paid to oral hygiene during treatment with braces. The presence of brackets on the teeth creates areas where food debris can become trapped, thus creating an environment conducive to bacterial growth which can lead to gingivitis, tooth decay and bad breath. The toothbrush no longer glides smoothly over the surface of the teeth, and brushing movements must be adapted to clean around each bracket, which requires more time and patience when brushing.  

If not removed regularly, bacterial plaque leads to complications that can affect the outcome of orthodontic treatment or even oral health, impacting quality of life. Braces do not cause hygiene problems in themselves, but they create an environment conducive to the build-up of bacterial plaque. Without appropriate and consistent oral hygiene, the risks of local complications increase significantly during orthodontic treatment. 

What risks arise in the absence of regular professional hygiene

• White demineralisation spots, which are early signs of tooth decay and frequently appear around the brackets. These spots affect the aesthetics of the smile after the braces are removed and require dental treatment.
• Tooth decay occurs due to bacterial plaque, which produces acids that damage the enamel, potentially leading to extensive tooth damage and compromising the tooth’s vitality.
• Gum inflammation which, if left untreated, can cause gum recession or even bone loss, which may lead to tooth mobility or even tooth loss.  
• Bad breath (halitosis)
• Slower orthodontic alignment, as chronic inflammation affects the quality of the bone and supporting tissues. Consequently, the duration of orthodontic treatment is prolonged and the stability of the final result may be compromised.
• Compromised final aesthetic result. Even if the teeth are aligned from an orthodontic perspective, white spots, cavities or inflamed gums drastically affect the final appearance of the smile.
• The need for much more expensive treatments following complications. 

The difference between daily brushing and professional scaling 

Daily brushing is done at home, twice a day, to remove recent bacterial plaque and is essential for maintaining oral health. Interdental hygiene methods, such as dental floss, a water flosser or interdental brushes, must be added to daily brushing. However, these cannot remove mineralised plaque (tartar) and their effectiveness is unsatisfactory in hard-to-reach areas (subgingival or around braces).  

For this reason, professional cleaning plays a very important role. Prophylaxis sessions, as they are also known, are carried out every 3–6 months, depending on the case, and aim to remove supra- and subgingival tartar, old bacterial plaque and stains deposited on the tooth surface. A comprehensive prophylaxis session involves professional brushing, Airflow and ultrasonic scaling.  

To maintain good oral health, both home dental hygiene and professional cleaning sessions are necessary. 

Gum inflammation and bleeding

These are common problems that occur in patients undergoing orthodontic treatment. They are caused by the build-up of bacterial plaque, which is encouraged by the presence of areas where plaque can accumulate around the braces. If this is not removed properly, it can lead to gingivitis, in which case the gums become red, swollen and bleed very easily when brushing or using a mouthwash.

If left untreated, gingivitis can progress to periodontal disease, which involves damage to the bone and the tissues supporting the teeth, leading to tooth mobility and the need to extract the affected teeth. Another complication that may arise is gingival hyperplasia; the affected gums may cover the teeth and dental appliances, making oral hygiene even more difficult, which can slow down or even complicate orthodontic treatment. Bleeding when brushing is not normal; it is the first sign of gum inflammation. Many patients make the mistake of avoiding brushing in areas where they bleed, which perpetuates and worsens the inflammation. 

Development of dental caries

The development of cavities between teeth and under braces is a common complication for those wearing braces, as these are the areas most difficult to reach when brushing. Bacterial plaque and food debris become trapped in these areas. Through fermentation, acids are formed that attack the enamel and lead to demineralisation and, subsequently, tooth decay.  

In the case of interdental caries, these can develop without pain and without visible signs. Therefore, regular check-ups and professional cleaning play an essential role in detecting these cavities at an early stage and treating them before complications arise.  

Cavities under braces occur due to the retention of bacterial plaque around the brace for a prolonged period. Cavities of this kind begin as demineralisation (matt white spots), and if left untreated, they can develop into carious lesions that progress beneath the brace. However, if detected early, fluoride gels can be applied to halt the demineralisation. If carious cavities are already present, prompt treatment and the placement of a filling are recommended. In severe cases, it may be necessary to temporarily remove the orthodontic appliance to treat complications.

Halitosis (bad breath)  

Halitosis whilst wearing braces is caused by poor oral hygiene, which allows food debris to become trapped in areas that are difficult to reach when brushing. Bacterial plaque and tartar contain bacteria that produce volatile sulphur compounds (which smell like rotten eggs), leading to the unpleasant odour. The presence of untreated cavities or gum inflammation causing infections in the oral cavity can also be a cause of bad breath. By following good oral hygiene practices at home and undergoing regular professional cleanings at the dentist’s surgery, we can prevent halitosis. 

Professional dental cleaning for patients with braces should be carried out every 3–4 months, rather than every 6 months, which is the recommended interval for patients without braces.

There are several reasons for this:

• Fixed braces (metal or ceramic) make oral hygiene more difficult.
• Bacterial plaque and tartar build up more quickly due to the retention pockets created by the braces. Consequently, the risk of complications that may affect the progress of orthodontic treatment is higher.
• The risk of gum inflammation and associated complications is higher in people wearing braces.
• The risk of demineralisation and tooth decay is higher, and regular check-ups at the dentist can help detect these issues at an early stage and prevent them from worsening.
• It helps maintain good oral health and thus achieve the desired orthodontic result without complications. 

Stages of the procedure – ultrasonic scaling, Airflow and polishing

• The dentist assesses oral hygiene and, if necessary, provides guidance on personalising brushing technique using a plaque disclosing agent (in the form of a tablet, solution or gel). This stains the bacterial plaque on the teeth and makes it visible to the patient. It is an extremely effective tool for assessing brushing technique, correcting mistakes and motivating the patient.
• Professional brushing using a special rotary brush and abrasive paste that thoroughly cleans the tooth surfaces.
• Dental floss for removing food debris between the teeth.
• Ultrasonic scaling to remove supragingival and subgingival tartar. This is completely painless and removes hard plaque deposits from tooth surfaces and interdental spaces.
• Airflow is a jet of water, air and fine powder that removes bacterial plaque and food stains (caused by coffee, tea, smoking and coloured foods). It cleans thoroughly, both supra- and subgingivally, around braces and in the spaces between teeth.
• Fluoridation, which involves applying a fluoride gel or varnish to prevent the development of cavities and demineralisation.

Is scaling painful or risky for braces?

Scaling is safe, painless and absolutely essential for those wearing braces. It is performed using ultrasound, which vibrates gently and removes hardened plaque deposits from the tooth surfaces without damaging the enamel or gums. If there is gum inflammation, the patient may experience slight sensitivity. If necessary, a local anaesthetic can be used. If carried out regularly and correctly, scaling is not only risk-free but is also a key factor in maintaining good oral health and achieving the desired orthodontic outcome. 

Regular professional teeth cleaning appointments during orthodontic treatment offer numerous essential benefits for oral health.

Scaling prevents gingivitis and maintains gum health

Patients with fixed braces are more prone to gingivitis and its complications, as the braces create areas where food debris can become trapped and is difficult to remove. The key to maintaining healthy gums is regular professional cleaning, alongside correct brushing technique at home, twice a day, combined with the use of interdental cleaning methods (dental floss, mouthwash or interdental brushes).

Scaling maintains the aesthetics of your smile

Orthodontic treatment is not just about aligning the teeth, but also about maintaining a clean, healthy and aesthetically pleasing smile throughout the treatment and after the braces have been removed. An aesthetically pleasing smile requires rigorous oral hygiene, free from gum inflammation, bad breath, tooth demineralisation and cavities. To achieve this, regular professional cleaning plays an extremely important role. This can prevent gingivitis, demineralisation and tooth decay, and can help maintain oral health throughout orthodontic treatment; or, if these conditions already exist, it can lead to their detection and treatment at an early stage, thereby preventing the need for painful and costly treatments. Even if the braces are temporary, the aesthetics of your smile must be maintained consistently throughout orthodontic treatment and beyond, for the rest of your life.

Scaling reduces the risk of demineralisation

Reducing the risk of stains or demineralisation during orthodontic treatment should be a key priority. The white spots that appear around the brackets are areas of demineralised enamel caused by the build-up of bacterial plaque and the acids it produces. These are the first signs of tooth decay and may remain visible even after the braces have been removed. They are caused by poor oral hygiene, combined with a diet high in sugars, carbohydrates and highly acidic liquids. To reduce the risk of these spots appearing, the foods mentioned above should be avoided and correct brushing technique must be practised. Regular professional cleaning plays a key role in reducing the risk of these spots appearing, through deep cleaning and the professional application of fluoride gels or varnishes, in some cases.