Orthodontic Hygiene – a guest post by Dr. Bethany Rushworth

A common complication of orthodontics is tooth decay, although this can be prevented by appropriate cleaning and maintenance of the teeth and appliances. Decay develops as a result of acid production by plaque bacteria built-up on the teeth and around the orthodontic brackets. These brackets and attachments can be particularly difficult to keep clean, making them high-risk sites for decay. In some cases, the surface of the enamel will be altered as a result of ongoing acid attacks on the teeth, resulting in ‘white spot lesions’ around the brackets.

Toothbrushing technique

Before brushing, remove any removable parts of the brace such as elastics and clear aligners. The recommended technique for cleaning is the ‘modified bass technique’. The toothbrush should be moved in circular motions along the teeth, tipped at a 45-degree angle towards the gum line, with the bristles partly overlapping the gum. An electric toothbrush can make this easier. The teeth should be brushed for a minimum of 2 minutes, working your way around the mouth in sections, to ensure nowhere is missed. Once over and above the brackets have been thoroughly cleaned, the edges and biting surfaces of the teeth should be cleaned as well.


A fluoride mouthwash should be used at a different time to brushing, to avoid washing away toothpaste and to aid clearing debris from between the teeth. This should be spat out and not swallowed.

Interdental cleaning

Although this can be difficult with a fixed appliance, interdental cleaning is essential throughout orthodontic treatment. Prior to horizontal cleaning over brackets/attachments with the toothbrush, floss should be used to clear food debris and plaque from between the teeth. This can take practice and children should be reassured if they take some time to master the technique!

Interdental brushes such as those available from ‘TePe’ should be used vertically between the brackets and larger attachments, and between the teeth wherever they fit. Your dentist or hygienist will be able to help you establish the correct size to use and can demonstrate how to use them.


In accordance with the Department of Health guidelines for prevention, patients undergoing orthodontic treatment should be advised to use an appropriate strength fluoride toothpaste for their age. For those aged 8-10, 1,450ppm fluoride is recommended, and a sodium fluoride 0.05% daily rinse can also be prescribed. For those aged 10+, a toothpaste containing 2,800ppm fluoride can be used. Finally, for those aged 16+, a 5,000ppm fluoride paste is recommended.

Plaque disclosing tablets

A great way of highlighting plaque that has been missed during cleaning is with plaque disclosing solution or tablets. Following brushing the tablet is used according to manufacturer’s instructions, marking the teeth darker shades of pink/purple where plaque has been missed. It is advisable to use Vaseline on the lips prior to doing this to prevent staining.

School, work and travel

It is important that oral hygiene does not get forgotten about during the day or whilst traveling. Ensure you have access to your cleaning aids every day. Children should be encouraged to take a toothbrush and toothpaste to school with them, in order to clean their braces after eating.

Dental appointments

As well as orthodontic reviews, patients should still see their general dentist regularly to check for signs of decay and gum disease. Your dentist can recommend how frequently to attend but for most patients undergoing orthodontic treatment, this will be around 6-monthly.

Clear aligners

After washing hands with soap and water, clear aligners should be removed for cleaning. They should be rinsed in warm water, not hot as heat can distort the aligners leading to a poor fit. Aligners should be cleaned one at a time, using a soft toothbrush and a mild toothpaste. Cleaning crystals may also be used such as those provided by Invisalign. Denture cleaner and mouthwash should not be used for cleaning purposes as they can discolour the aligners. Aligners should always be removed whilst eating or drinking anything except water. They should be stored out of reach of pets and children in an aligner box, to prevent them being damaged or eaten!


A huge thank you to Dr. Bethany Rushworth for writing this post for my blog. I recently had the opportunity to meet her and was delighted when she offered to contribute an article to the site.