Oral Hygiene Tips for Teenagers with Braces

There is one outcome that orthodontists want to avoid above all others, and it is not a slow result or a broken bracket. It is finishing treatment, removing the brackets, and revealing a neat row of teeth with a chalky white square on each one where the bracket used to be.

Those marks are demineralised enamel. They are caused by plaque left around the brackets for months. They are permanent in the sense that they do not fully disappear, and treating them afterwards means further cosmetic work on teeth that were healthy at the start.

This article is about avoiding that, and the other predictable problems of brace treatment.

A bracket bonded to the front of a tooth creates a series of ledges, corners and undercuts. The archwire runs across the middle of the tooth and blocks the brush from sweeping normally. Elastic modules around each bracket are themselves porous and collect plaque.

The result is that plaque accumulates in specific, predictable places: around the base of each bracket, particularly on the gum side, along the gum line, and between the teeth where the wire makes conventional flossing awkward.

Those are also exactly the places that white spot lesions appear.

Brush after every meal and before bed — so typically three to four times a day rather than two. This is more than the standard advice, and it is deliberate.

Use a soft or medium brush, manual or electric. An orthodontic brush head with a V-shaped bristle pattern helps fit around the wire.

Clean each tooth in three passes: 1. Bristles angled down onto the top of the bracket from above 2. Bristles angled up under the bracket from below 3. Bristles at forty-five degrees to the gum line, above the bracket, using small circles

That third pass is the one people skip, and it is where gum inflammation starts.

Take longer than two minutes. Three is more realistic with a full fixed appliance.

Use fluoride toothpaste, and ask your dentist about a higher-fluoride prescription paste — these are commonly recommended during brace treatment and are a sensible precaution.

Spit, do not rinse at night.

Interdental brushes are the practical answer. A small interdental brush passes under the archwire and between the brackets, and reaches the area around each bracket base. They are far quicker than threading floss, which is why they actually get used.

Floss threaders or superfloss allow conventional floss to be passed under the wire. Effective but slow, and most teenagers will not do it consistently for two years.

A water flosser is a useful addition, especially for dislodging food from around the wire, and it is popular because it is easy. It does not replace mechanical cleaning.

Once a day, every day. Whichever method is used.

These are the most useful and least-used tool in orthodontic hygiene. A chewable tablet stains plaque a bright colour, showing exactly what has been missed.

Used once a week, they turn an abstract instruction into visible feedback — and they usually reveal the same two or three spots being missed every time, which is easy to correct once you can see it.

A daily fluoride mouth rinse is often recommended during brace treatment. Use it at a different time from brushing — mid-afternoon, for example — so it is not washing off the concentrated fluoride from toothpaste.

Two separate issues here.

Foods that break brackets and bend wires — mostly hard and sticky:

• Hard sweets, boiled sweets, ice

• Toffee, chewing gum, fudge, sticky sweets

• Nuts, popcorn (the kernels), hard crusts and crisps of the very hard kind

• Whole apples, carrots, corn on the cob — cut them up instead

• Biting into anything with the front teeth, including sandwiches and pizza crusts

A broken bracket means an extra appointment and usually adds to the overall treatment time. Our article on broken brace wires and orthodontic emergencies covers what to do when something breaks.

Foods and drinks that cause decay and white spots — mostly sugary and acidic:

• Fizzy drinks, including sugar-free ones, which are acidic even without sugar

• Energy drinks and sports drinks, which are among the worst for teeth

• Fruit juice and smoothies

• Sweets, chocolate and biscuits eaten between meals

• Anything sipped or grazed on over long periods

Frequency is what matters. One dessert with dinner is far less damaging than the same sugar spread across six separate moments in a day. Water between meals is the default.

Gums often become slightly puffy during brace treatment, and there are two causes with different responses.

Inflammation from plaque. The gums are red, swollen and bleed when brushed. This is reversible and the answer is better cleaning — bleeding gums are not a reason to brush the area less, they are a reason to clean it more carefully. Our article on why gums bleed when brushing explains.

Gingival hyperplasia, where the gum tissue genuinely overgrows and starts to creep over the brackets. Partly a response to plaque, partly a response to the appliance itself, and more common in teenagers because of hormonal changes. It usually recedes after the braces come off, but severe cases occasionally need treatment. Improved cleaning reduces it substantially.

If gums are bleeding every time, book a hygienist appointment rather than waiting for the next orthodontic visit. See our dental hygiene page.

Aching for a few days after each adjustment is normal. Soft food, and simple pain relief if needed, following the instructions on the packet.

Orthodontic wax covers any bracket rubbing the cheek or lip. Dry the bracket, roll a small piece of wax, press it on.

Ulcers are common in the first weeks while the cheeks and lips toughen up. Warm salt-water rinses help, and they settle.

A wire poking the cheek can be gently pushed flat with the blunt end of a pencil eraser, or covered with wax, and the practice should be contacted.

Sensitivity to cold is common and usually temporary. A sensitivity toothpaste helps.

Wear a mouthguard for contact sport. Braces plus an impact means lacerated lips and broken brackets. A guard made for someone in fixed appliances is the right choice — a standard boil-and-bite guard does not fit properly over brackets. Tell your orthodontist which sport you play.

Wind and brass instruments take a period of adjustment. Wax over the brackets helps in the early weeks, and most players adapt within a few weeks.

This is the point most often missed: orthodontic appointments are not check-ups. The orthodontist is monitoring tooth movement, not examining every surface for decay.

Continue routine dental examinations and hygienist appointments throughout treatment, at whatever interval you have been advised. Decay caught early during treatment is a small filling; decay found when the braces come off can be a considerably bigger problem.

Retainers are for life, not for a few months. Teeth move back if they are not retained — this is well established and is not a sign that anything went wrong. Our article on retainer costs, replacements and repairs covers the practicalities, and fixed retainers covers the bonded option.

Clean retainers the same way you would clean an aligner — cool water, no toothpaste, soak periodically. A fixed retainer bonded behind the front teeth needs superfloss or a threader to clean under the wire, daily, indefinitely.

Any whitening comes after treatment, once everything has settled.

If white marks are present when the brackets come off, tell your dentist early. Fluoride and remineralising products can improve the appearance of some early lesions, and there are conservative cosmetic options for the rest.

Fixed braces do not depend on you remembering to wear them, which is a genuine advantage for many teenagers. Aligners come out to eat and to clean, which makes hygiene simpler, but they only work if worn for the required hours each day.

Our articles on aligners versus fixed braces, helping teens stay compliant with aligners and oral care for aligner patients cover the comparison.

How often should I brush with braces?

After every meal and before bed — around three to four times daily, with a longer brushing time than usual.

What are the white marks people get after braces?

Demineralised enamel caused by plaque sitting around the brackets. They are largely preventable and do not fully reverse once established.

Can I use an electric toothbrush with braces?

Yes. Use a soft head and move slowly around each bracket rather than pressing harder.

What should I do if a bracket comes loose?

Contact the orthodontic practice. Cover any sharp part with wax in the meantime and avoid hard food.

Do I still need to see my regular dentist during brace treatment?

Yes. Orthodontic appointments do not include a full dental examination.

Are sugar-free fizzy drinks safe with braces?

No. They are acidic and contribute to enamel damage even without sugar.

If you or your child is in brace treatment and the gums are bleeding, or you are not confident the cleaning routine is working, a hygienist appointment with disclosing tablets will show exactly what is being missed.

You can contact our team at our Wimpole Street practice, or see our teeth straightening page.

This article provides general information about oral hygiene during orthodontic treatment and does not constitute individual dental advice. Specific instructions should follow the guidance of the clinician providing your orthodontic care. Wimpole Dental is regulated by the Care Quality Commission, and our clinicians are registered with the General Dental Council.

Next review due: 14 September 2027