How to brush your teeth properly with braces

Maintaining rigorous oral hygiene during orthodontic treatment is one of the most important factors in ensuring a good final result. Whether with fixed braces or clear aligners, the presence of appliances in the mouth creates new areas where plaque and food debris can accumulate.

When brushing is not adequate, the risk of cavities, gingivitis and white spots (decalcifications) increases significantly. For this reason, learning how to brush your teeth properly with braces is not just a recommendation — it is an essential part of the orthodontic treatment itself.

Why is it more difficult to maintain oral hygiene with braces?

Orthodontic appliances introduce additional structures onto the tooth surface — brackets, wires, elastics or aligners — which make natural cleaning by saliva and chewing more difficult. These irregularities favour the retention of bacterial plaque, especially along the gum margins and around the brackets.

Without an adapted technique, conventional brushing becomes insufficient. Plaque accumulation can trigger gum inflammation and, in the medium term, compromise tooth enamel.

Plaque accumulation around brackets

Brackets create small hard-to-reach areas where food debris is easily trapped. If not effectively removed, bacterial plaque produces acids that demineralise the enamel, potentially causing cavities or permanent white marks.

Gum inflammation during orthodontic treatment

The constant presence of plaque near the gums may cause gingivitis, characterised by redness, swelling and bleeding when brushing. Although common during treatment, it should not be considered “normal” — it is a sign that oral hygiene needs to be reinforced.

Decalcifications and white spots after brace removal

One of the most frustrating complications is the presence of visible white spots once braces are removed. These marks result from the initial loss of minerals from the enamel and are a direct consequence of insufficient hygiene during treatment.

How to brush your teeth properly with fixed braces

Brushing with fixed braces must be more meticulous and structured. It is not enough to brush “over” the brackets — it is necessary to systematically clean all tooth surfaces and gum margins.

Ideally, brushing should be carried out after every meal, for a minimum duration of two to three minutes.

Choosing the ideal toothbrush

A manual toothbrush with soft bristles or an electric toothbrush with an orthodontic head may be used. Electric toothbrushes often make plaque removal easier in harder-to-reach areas, but technique remains the determining factor.

Three-level brushing technique

Brushing should be done in three distinct areas:

1. Above the brackets, angling the toothbrush towards the gumline;

2. Directly over the brackets, using short and controlled movements;

3. Below the brackets, directing the bristles towards the area where the bracket is attached to the tooth.

This method ensures that no critical area is left uncleaned.

Frequency and use of fluoride toothpaste

The use of fluoride toothpaste is essential to strengthen enamel and reduce the risk of decalcification. In some cases, specific products with a higher fluoride concentration may be recommended, depending on the patient’s individual risk.

The role of floss and hygiene aids

A toothbrush alone cannot remove plaque between the teeth. During orthodontic treatment, this limitation becomes even more evident.

Dental floss with floss threader

Dental floss remains essential, but it may require the use of a floss threader to pass around the metal wire of fixed braces. Although more time-consuming, it is indispensable for preventing interdental inflammation.

Interdental brushes

Interdental brushes are particularly useful for cleaning the spaces between brackets and along the gum margins. They should be selected in the appropriate diameter for each space.

Oral irrigators

Oral irrigators can be an effective complement, especially for patients with greater technical difficulty. However, they do not replace brushing or flossing.

Fluoride or antiseptic mouthwashes

These may be recommended in specific situations, as a temporary complement in cases of gum inflammation or increased cavity risk.

Oral hygiene with clear aligners: specific care

Although clear aligners are removable, this does not mean hygiene is less important — on the contrary, it requires strict discipline.

As the aligner completely covers the teeth, any food residue or plaque can become “sealed” against the enamel, increasing the risk of cavities.

Always brush before replacing the aligner

The aligner should never be replaced after eating or drinking (except water) without brushing the teeth first. Otherwise, sugars and acids remain in prolonged contact with the enamel.

Proper cleaning of the aligner

Aligners should be rinsed with cold water and gently brushed with a suitable toothbrush. Abrasive products or hot water should not be used, as they may deform the material.

Avoid sugary drinks while wearing the aligner

Sugary or acidic drinks may seep underneath the aligner and increase enamel demineralisation.

Signs that oral hygiene may not be adequate

Early identification of signs of inflammation or demineralisation allows the routine to be adjusted before permanent complications arise.

1. Red or bleeding gums

Frequent bleeding during brushing is a clear sign of gum inflammation associated with plaque build-up.

2. Persistent bad breath

This may indicate bacterial retention in areas that are not being properly cleaned.

3. Whitish marks near the brackets

These are early signs of enamel decalcification and should be assessed quickly.

4. Visible plaque accumulation

If plaque is easily visible around the brackets or along the gum margins, brushing technique needs to be improved.

Successful orthodontic treatment starts with daily hygiene

Orthodontic appliances are a tool to correct tooth positioning, but the success of treatment also depends on the patient’s daily commitment to oral hygiene.

Proper brushing prevents complications, protects enamel and ensures that, when the braces are removed, the final result is not only aligned, but also healthy.