Brace yourself – preparing patients for orthodontic treatment
Fixed orthodontic treatments have been a staple of modern dentistry, evolving into sleek, aesthetic and effective solutions. Young patients may be told they need a metal appliance to help manage a mechanical issue, such as an overbite. They may also seek treatment for the aesthetic benefits available.
To achieve these changes successfully, young patients need to understand the importance of diligent oral hygiene routines, as well as ways to manage any potential discomfort caused by the treatment.
Difficulties for care
Without effective oral hygiene, a fixed brace treatment could face difficulties. Between 50 and 70% of patients with orthodontic appliances develop gingivitis or white spot lesions,[i] and dedicated care should be taken to minimise this risk.
With the metal appliance in place, it could be more difficult to effectively cover the entire surface area of a tooth when brushing, meaning bacteria, lodged food and plaque are harder to remove. The presence of the brace also prompts a change in the bacterial flora of the plaque that builds up, presenting higher concentrations of acidogenic bacteria which contribute to a rapid caries progression.[ii] If plaque and food debris are not removed, pathogens can continue to thrive and create long-term oral health issues.
Finding ways to encourage young patients to keep up a regular oral hygiene routine can be difficult. A national survey found 23% of 12-year-olds, and 19% of 15-year-olds aren’t already in the routine of brushing twice a day;[iii] instilling this practice is vital to maximise successful treatment outcomes, creating minimal discomfort for the patient and developing effective habits for life. A conversation about the importance of brushing, and the consequences of lacklustre oral care should be had. With younger people so heavily invested in their mobile phones, asking patients to keep a visual record of their oral hygiene upkeep could provide targets to work towards at regular stages of the treatment, whilst offering visual evidence of the advantages of good oral hygiene for their appearance.[iv]
Another element of discomfort that patients should be aware of is irritation as a result of the physical appliance. Experiencing this pain without any warning could have an emotional impact on a patient,[v] and so it is a clinician’s duty to adequately prepare the patient for the potential difficulties a brace poses, providing well-informed advice to manage them.
A fixed brace can cause pain in simple ways. A metal element could scratch the inside of the cheek, gums or tongue in the early days of use, and freshly tightened wires can provoke soreness. Given time, a patient may begin to notice fewer difficulties, with pain subsiding as they become accustomed to the device.[vi]
The experience of pain immediately after the implementation of an orthodontic appliance can be dysphoric. The focus of the act of eating, for example, would ordinarily be on the food, its taste and texture. When a new fixed device instead makes this painful and uncomfortable, patients can feel their body does not work as it should. As individuals, we want to return to a state where the performance of these tasks does not bring atypical attention to the body, where it would normally go unnoticed and without interruption.[vii] In turn, recognising the new device as the source of the pain can be upsetting and frustrating, despite patients commonly feeling that the discomfort will be worth the eventual outcome.[viii]
A word of advice
Aside from warning of potential discomfort, clinicians could also recommend ways to help manage or minimise pain in these early days of treatment. A simple remedy such as applying an ice pack could relieve some discomfort in soft tissue,[ix] whilst a warm rinse of salt water could help to reduce inflammation and irritation.[x]
Another widely used and appreciated solution is orthodontic wax. It is designed to be moulded by a patient and placed over any protruding metal elements of a brace, preventing any scratching against gums or the oral mucosa. It can be especially useful when a wire shifts to an awkward position, or in the early days of having the appliance when the new sensation can be uncomfortable. It can be worn whilst asleep, and simply taken off before eating, to be replaced by new wax after a meal.
The perfect choice for your patients could be the Orthodontic Relief Wax Tins from Kemdent, for simple protection against discomfort on the go. The orthodontic wax is specially designed to be malleable in a patient’s hand, before providing a smooth barrier that effectively minimises pain. Plus, the 100% recyclable, planet friendly tins allow patients to access effective pain relief wherever they are.
For many young patients, getting a brace can be a nerve-wracking experience. By giving the appropriate oral hygiene directions and recommended ways to subside pain, the journey to a great smile can be convenient and comfortable
For more information about Orthodontic Relief Wax from Kemdent, please click here or call 01793 770 256
[i] Le Fouler, A., Jeanne, S., Sorel, O., & Brézulier, D. (2021). How effective are three methods of teaching oral hygiene for adolescents undergoing orthodontic treatment? The MAHO protocol: an RCT comparing visual, auditory and kinesthetic methods. Trials, 22, 1-11.
[ii] Khoroushi, M., & Kachuie, M. (2017). Prevention and treatment of white spot lesions in orthodontic patients. Contemporary clinical dentistry, 8(1), 11.
[iii] Depatment of Health and Social Care, Welsh Government, Department of Health Northern Ireland, Public Health England, NHS England, NHS Improvement, (2021). Guidance, Chapter 8: Oral hygiene. (Online) Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-8-oral-hygiene [Accessed August 2023]
[iv] Zotti, F., Dalessandri, D., Salgarello, S., Piancino, M., Bonetti, S., Visconti, L., & Paganelli, C. (2016). Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. The Angle Orthodontist, 86(1), 101-107.
[v] Kettle, J. E., Hyde, A. C., Frawley, T., Granger, C., Longstaff, S. J., & Benson, P. E. (2020). Managing orthodontic appliances in everyday life: a qualitative study of young people’s experiences with removable functional appliances, fixed appliances and retainers. Journal of orthodontics, 47(1), 47-54.
[vi] Ashkenazi, M., Berlin-Broner, Y., & Levin, L. (2012). Pain prevention and management during orthodontic treatment as perceived by patients. Orthodontics (Chic.), 13(1), e76-e81.
[vii] Kettle, J. E., Hyde, A. C., Frawley, T., Granger, C., Longstaff, S. J., & Benson, P. E. (2020). Managing orthodontic appliances in everyday life: a qualitative study of young people’s experiences with removable functional appliances, fixed appliances and retainers. Journal of orthodontics, 47(1), 47-54.
[viii] Kettle, J. E., Hyde, A. C., Frawley, T., Granger, C., Longstaff, S. J., & Benson, P. E. (2020). Managing orthodontic appliances in everyday life: a qualitative study of young people’s experiences with removable functional appliances, fixed appliances and retainers. Journal of orthodontics, 47(1), 47-54.
[ix] Ibikunle, A. A., & Adeyemo, W. L. (2016). Oral health-related quality of life following third molar surgery with or without application of ice pack therapy. Oral and maxillofacial surgery, 20, 239-247.
[x] Ortiz Jimenez, V., & Lewis, L. (2023). The Effect of Fluorouracil on Pathogenic and Non-pathogenic Oral Microorganisms and Microbial Interactions with Preventative Measures: A Preliminary Study