Here in the real world, there is an exception to every rule, and today I’m shedding light on a subject many orthodontists may not want you to know about: sometimes orthodontic treatment can promote or worsen periodontal—also known as gum—disease.
This is an important topic because gum disease is common among adults. Half of all Americans have some form of it, according to the Centers for Disease Control and Prevention. Nearly 65 million American adults have mild, moderate or severe periodontitis, which is the more advanced form of periodontal disease. In adults 65 and older, more than 70 percent have periodontitis, according to a study published in the Journal of Dental Research.
You might be thinking, “Dr. Sanders, why are you wasting your time on this topic, when most of your patients are kids?” The truth is that many of our patients are not children. They’re parents of patients who have decided to undergo treatment themselves, and they’re adult professionals who want to improve their smiles. The American Academy of Orthodontists estimates that nearly one in four orthodontic patients today is an adult.
That means it’s getting more important to understand the oral health implications of orthodontic treatment in patients who have some form of periodontal disease.
Orthodontic treatment can help prevent gum disease…
Sometimes the gum disease/orthodontic treatment issue can seem similar to the argument about which came first: the chicken or the egg. How can orthodontic treatment exacerbate and ultimately prevent periodontal disease?
The likelihood of developing gum disease is less when your teeth are properly spaced and aligned, because your gums fit snugly and properly around aligned teeth. A snug-fitting gum line leaves little room for nooks and crannies where plaque and bacteria accumulate and promote infection.
Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation, according to information on the Colgate website. The more plaque and tartar you have, the higher the likelihood of of developing gum disease.
It’s also difficult for gums to achieve that snug fit around misaligned, overlapping or widely spaced teeth.
Dentists and periodontists can show you the best oral hygiene techniques for crooked, crowded teeth, even if they are difficult to keep clean. They may suggest unique tools and ways of threading floss to clean around bridgework or slide beneath arch wires if you already have braces.
Properly aligned and spaced teeth are easier to keep clean through brushing and flossing, and those who complete orthodontic treatment often find themselves more dedicated to good oral hygiene because they are enthusiastic about protecting the investment made in their oral health.
…but orthodontic treatment also can cause or exacerbate gum disease.
Sadly, the risk of getting gum disease can increase during orthodontic treatment, because braces can trap bits of food. Dislodging food from around orthodontic appliances requires more time than regular tooth brushing, and also requires more tools to effectively do the job.
Food particles that aren’t properly removed become plaque, and that can lead to gingivitis, the first stage of gum disease.
For patients who already have gum disease, the prescribed teeth movement during orthodontic treatment can worsen their condition by increasing bone loss around the teeth. It is possible for the destructive activity of gum disease to be accelerated during orthodontic treatment.
Can I get braces if I have periodontal disease?
If you have periodontal disease and you had hoped for orthodontic treatment to improve your smile, don’t despair. Treatment is possible, but first we must get your periodontal disease under control. Prior to beginning orthodontic treatment in some patients, I often work in tandem with general dentists, and even periodontists, which are dentists who specialize in the prevention, diagnosis and treatment of periodontal disease.
We all want you to get optimum results from your orthodontic treatment, and that begins with getting your periodontal disease under control. Deep cleanings and other treatments may be necessary to achieve that. Once your teeth and gums are in a healthier state, we can move on to the next step.
Invisalign might be a good option for patients who have periodontal disease, due to the ability to remove your aligners to brush and floss.
Rather than conventional brackets and arch wires, Invisalign uses a series of clear plastic aligners that gradually shift your teeth into proper position. You remove the aligners when eating, drinking and practicing oral hygiene. This can be beneficial to patients trying to control their periodontal disease, because it eliminates the additional appliances around which food particles can become lodged.
It also gives you the added bonus of having an aesthetic orthodontic treatment process that is virtually invisible to others.
Keeping gum disease at bay during orthodontic treatment
We want your teeth and gums to remain healthy throughout orthodontic treatment, which is why we stress the importance of maintaining routine dental exams and professional teeth cleanings with your regular dentist throughout orthodontic treatment.
My staff and I are happy to answer questions you may have about oral hygiene during treatment, and we give each patient an oral hygiene kits complete with dental floss, travel tooth brushes, floss threaders, soft picks and proxy brushes. We’ll explain what these tools are used for, as well as how to use them. All of them are handy when it comes to removing food particles that can lead to gum disease.
I invite you to call our office today if you would like to learn more about orthodontic treatment for people who have gum disease. I will conduct a comprehensive examination and offer treatment recommendations. I also will work closely with your dentist or periodontist to get your oral health in shape and ready for orthodontic treatment. You’ll be on the road to a more beautiful smile before you know it!