Eating and cleaning

Question 1

Will the orthodontist give me toothbrushes and wax?

Accepted Answer

This depends on the policy of the individual clinic. Orthodontists usually provide the hygiene products you need, to make it easier to look after your teeth during treatment.

Question 2

What foods can't I eat with braces?

Accepted Answer

During treatment with braces, you need to avoid certain foods that can make brackets come off, damage the archwires or lead to plaque building up. These include nuts, popcorn, pretzel sticks, bagels, bread crusts (pizza crusts included), hard raw vegetables such as carrots, fruit with stones unless the stones have been removed first, hard chocolate with whole nuts, sticky sweets and biscuits. Foods that you have to bite into should also be eaten with extra care or cut up beforehand. Foods with strongly coloured seasonings such as curry, turmeric and ketchup can stain aesthetic braces, so it is best to avoid them.

Question 3

What foods can't I eat with aligners?

Accepted Answer

Aligners are taken out while you eat, which means the aligners themselves cannot be damaged by food. Even so, it is best to avoid certain foods that could break your teeth. These include extremely hard foods such as roasted corn kernels, popcorn and hard bread.

Question 4

What foods can I eat with braces and aligners?

Accepted Answer

Almost any food can be eaten, as long as it is in a suitable form and texture. For example, nuts can be ground, carrots grated, vegetables cooked and fruit cut into small pieces.

Question 5

What drinks can't I have with braces?

Accepted Answer

Drinks high in sugar and acid can corrode the metal parts of braces, making them rougher, which can hinder tooth movement and slow down treatment. In addition, the sugars in these drinks stick to the teeth and braces and are turned into acids that weaken the enamel and can lead to white spots – the first stage of tooth decay. To reduce the risk, it is advisable to limit how much of these drinks you have. If you do have them, it is best to rinse your mouth with water straight afterwards or to have a dairy product such as milk, ayran (a yoghurt drink) or cheese, which helps to neutralise the acids. Brushing your teeth immediately after acidic drinks is not recommended, because the enamel is temporarily weakened. It is best to wait around 40 minutes before brushing, to avoid further wear to the enamel.

Question 6

Can I eat and drink with my aligners in?

Accepted Answer

Aligners must be taken out whenever you eat, including for snacks between meals. The only drink you can have while they are in your mouth is water. All other drinks can stain the aligner material and spoil the way they look.

Question 7

Should I use a manual or an electric toothbrush?

Accepted Answer

Scientific studies comparing the effect of different types of toothbrush in patients with orthodontic appliances show that electric toothbrushes have no significant advantage over manual ones, or vice versa. Both types are effective at removing plaque. Differences in effectiveness depend mainly on brushing technique rather than on the brush itself. If you are already used to a particular type of toothbrush, there is no reason to change. If you use an electric toothbrush with braces or aligners, there is no risk of the brackets or aligner attachments (buttons) coming off.

Question 8

How often should I brush my teeth?

Accepted Answer

The World Health Organization recommends the following measures for maintaining good dental health: Brush your teeth twice a day for at least two minutes, with a manual or electric toothbrush. Clean every tooth surface using circular movements. Use a toothpaste that contains fluoride. Do not rinse the toothpaste away straight after brushing – instead, spit out the excess and leave the rest on your teeth so that the fluoride can be absorbed. Replace your toothbrush every three months. Clean between your teeth at least once a day with floss or interdental brushes. If you wear orthodontic appliances, it is recommended to brush at least one extra time a day, or after every meal. It is important, however, not to brush too aggressively.

Question 9

Is it easier to keep my teeth clean with aligners or with braces?

Accepted Answer

Keeping your teeth clean with aligners and with braces takes different kinds of effort. With braces, you need to clean the tooth above and below each bracket with a full-size (standard) toothbrush, then clean the sides of the bracket and the tooth under the archwire with a small interdental brush, and use floss for the spaces between the teeth. A water flosser is an extra tool for cleaning between the teeth, which can be used with or without braces. This whole routine takes the patient more time. When you wear aligners, to clean your teeth you need to take the aligners out, clean thoroughly with a toothbrush and floss, and wash the aligners themselves with a brush and soap. Overall, this routine is quicker. Scientific studies report no difference in how often teeth decay with braces compared with aligners. Of course, this is difficult to determine, because decay depends on hygiene, and the patients studied have different levels of hygiene. So what matters is learning how to clean your orthodontic appliance perfectly, whatever type it is.

Question 10

Can I clean my teeth with bicarbonate of soda (baking soda)?

Accepted Answer

Many people have heard or read that rubbing your teeth with bicarbonate of soda makes them whiter. Patients even think their dentist cleans their teeth with this kind of soda. That isn't the case. The polishing powder used in the dental surgery is made of tiny spherical particles so that it doesn't scratch the surface of the tooth. Ordinary bicarbonate of soda consists of sharp little crystals. They are very rough and abrasive. If you rub your teeth with them, you wear them down prematurely. Some patients end up wearing away the enamel completely and hollowing out the surface of their teeth. Nor does this happen slowly – you may see this effect after as little as a month of use. That is why bicarbonate of soda and all abrasives must not be used on teeth.

Question 11

Why does food change the colour of the elastic ties on my braces?

Accepted Answer

The elastic ties on conventional braces are made of silicone. This material can absorb the colourings we take in with our food. Spices such as turmeric, curry and paprika, and the foods and drinks that contain them, turn clear elastic ties bright yellow. The lighter the colour of the elastic ties you've chosen, the more likely they are to change colour. Blue ties combined with yellow food turn green, and pink ones turn orange. Green, yellow, dark blue and all dark, deep-coloured elastic ties don't change noticeably.

Question 12

Do aligner attachments stain from coffee or wine?

Accepted Answer

Aligner buttons (attachments) are made of a light-cured material and bonded to the enamel of the teeth. White fillings, build-ups and bonding are made of the same kind of material. Staining isn't expected if the button sits tightly against the tooth and its edges are well adapted and polished. If it does happen, though, the solution is to polish the edges of the attachment or, if it's defective, to replace it.

Question 13

Will my aesthetic braces discolour?

Accepted Answer

When aesthetic braces are first fitted, they look clean – white (ceramic) or clear (sapphire) – and as invisible as possible. Most often, when a patient wants their orthodontic treatment to look as discreet as possible, they choose clear elastics to hold the archwire in the brackets. The archwires can be white too, again for appearance. At the end of the appointment at which the braces are fitted, the patient leaves the clinic looking their best. Over the following days and weeks, depending on their habits (smoking, coloured drinks) and diet, the look starts to fade. The clear elastics start to turn yellow, and the white archwires gradually lose their coating and look more and more metallic. By the next orthodontic appointment, in some patients the aesthetic braces don't look quite so aesthetic. At the check-up the elastics and archwires are changed, and the braces' original appearance is restored. The reason aesthetic braces seem to turn yellow is usually the elastics, and changing them fixes the problem. The braces themselves change colour only very slightly, and only over a long period (years) in the mouth.

Question 14

How can I keep the clear elastic ties on my aesthetic braces clean?

Accepted Answer

Clear elastic ties stay clear the longest if you avoid the following foods, drinks and spices: Turmeric, curry, Indian food in general, beetroot juice, cherries, tomatoes, lyutenitsa (Bulgarian pepper relish) and ketchup, coffee, cigarettes, chocolate drinks, Coca-Cola and any drinks with artificial colourings. After eating a staining food or having a staining drink, it's a good idea to rinse the colourings away with water straight away and, if possible, to brush your teeth 40 minutes after eating. You can drink coloured drinks through a straw and take frequent sips of water.

Question 15

My aligner looks yellow, even though I don't eat with it in. Why?

Accepted Answer

If you clean your aligner with toothpaste, it scratches the surface and gradually turns it from clear to matt. A matt surface picks up more bacteria and colourings, which can make it turn yellow. If you clean your aligner with water only, that isn't enough, and saliva and bacteria stick to it. This shows up as a white or yellowish layer of plaque on the surface. It can be cleaned off, but it takes a lot of brushing and soap. If you wash it with soap and still notice a change in colour, try cleaning it more thoroughly. Other possible reasons for an aligner changing colour are: drinking coloured drinks with the aligner in; drinking coloured drinks without the aligner but putting it straight back in before the colourings have been rinsed away; and smoking with the aligner in.

Question 16

I've developed bad breath while wearing braces. What's causing it?

Accepted Answer

Bad breath can be due to stomach problems, while within the mouth the cause can be bacteria. If this problem appears while you're wearing braces or aligners, the first piece of advice is to have a clean below the gumline around the teeth (similar to removing tartar, but aimed at reducing the bacteria that have built up under the gums). The patient may be advised to use an anti-inflammatory mouthwash for a while, but unfortunately a mouthwash or any other product applied in the mouth is usually not enough on its own without a professional clean. This procedure is carried out at the dental practice and can be recommended by the orthodontist or the general dentist. Of course, the patient will also be given hygiene instructions to stop the problem coming back. There may be other causes of bad breath too, so see your orthodontist or general dentist if this happens to you.

Question 17

Can I eat without taking my elastics out?

Accepted Answer

You can – it just isn't very comfortable. You have to choose between the hassle of taking your elastics out and putting new ones in, and eating with them in, which can make an elastic snap unexpectedly.

Question 18

What's the right order for cleaning my teeth with braces?

Accepted Answer

This is a very important question that doesn't yet have a definitive answer. Many specialists recommend starting with the spaces between the teeth – i.e. with dental floss. That way, more fluoride from the toothpaste stays in the spaces between the teeth, making them more resistant to decay. In that case, the right order for cleaning your teeth is: 1. Rinse with a water flosser – to remove larger bits of food; 2. Clean with floss; 3. Brush your teeth with a toothbrush: 3.1 Clean the outer surfaces of the teeth; 3.2 Clean the inner surfaces; 3.3 Clean the biting surfaces; 3.4 Clean with an interdental brush if you wear braces; 4. Brush your tongue with a dedicated tongue brush – this reduces the bacteria in your mouth and gets rid of bad breath.

Question 19

Is rinsing with 3% hydrogen peroxide bad for my teeth?

Accepted Answer

Hydrogen peroxide has cleansing, antiseptic, whitening and deodorising properties. Despite these benefits, it is not recommended for daily use in the mouth. Rinsing or swabbing the mouth with a hydrogen peroxide solution is beneficial for inflamed gums and even for the throat, but 3% is a very high concentration and needs to be diluted. The recommended concentration for use in the mouth is 1% hydrogen peroxide, and it must never be swallowed. Because of the risk of swallowing it, rinsing with hydrogen peroxide is not recommended more than 2–3 times a month, and it is best to limit its use to times when there is inflammation in the mouth. Its concentration isn't high enough for you to see any whitening effect on your teeth, and it is dangerous if swallowed – so don't use it for whitening!

Question 20

Can I floss if I have a fixed retainer?

Accepted Answer

A fixed retainer is bonded to the back surface of the teeth. It is most often placed on the lower front teeth, but it can also be fitted on the upper teeth. It is bonded with composite material to the back surface of each individual tooth, and no material gets between the teeth. This makes flossing possible, but, just as when cleaning with braces, the floss cannot be passed between the teeth in the usual way with a sawing motion. Cleaning is done with floss designed for braces (with a stiff end), which is threaded under the retainer from the gum side and can clean the small triangle of gum at the base between two teeth.

Question 21

How do I clean my removable aligner-type retainers?

Accepted Answer

Clear retainers and aligners are cleaned with a toothbrush and soap. Don’t use toothpaste, because it contains fine polishing particles that scratch the surface of the retainer and make it dull. Besides spoiling the appearance of the retainer, a dull surface makes it easier for bacteria and stains to stick to it. Aligner-type retainers should not be cleaned with warm water or exposed to high temperatures, because they lose their shape. You can use a cleaning tablet for aligners and retainers at least once a week to keep the appliance hygienic.

Question 22

How can I whiten my retainer or aligner if it has turned yellow?

Accepted Answer

If you notice your clear retainer or aligner changing colour, the first step in restoring it is thorough cleaning with a brush and soap. You can get a whitening effect by soaking the retainer in a 3% hydrogen peroxide solution.

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