Patient Care, Orthodontics

The Orthodontic Patient: Simple Tips to Get You Through

By Jamie Collins, RDH on May, 11 2021
The Orthodontic Patient: Simple Tips to Get You Through
Jamie Collins, RDH

Jamie has been in the dental field for nearly 20 years, both as an assistant and hygienist. In addition to clinical practice, she is also an educator, speaker, and has contributed to multiple textbooks and curriculum development in addition to being a frequently published author.

Ah, the dreaded orthodontic patient. Hardware galore, severe gingivitis and enough leftover food impacted around the brackets to sustain the patient for a week. Nothing is easy and the tissue is sensitive, so where do we go from here?

Let’s face it: many teens lack stellar homecare routines, whether it’s showering or brushing their teeth. And brushing around ortho gear is far more difficult no matter the age of the patient. As hygienists, there are some tools at our disposal that can help make the job a little easier for ourselves and our patients, alike.

Most orthodontic patients arrive with the wire in place, while there are a select few who arrange to have it removed by the orthodontist for dental visits. Accommodate ortho treatment methods makes the hygiene appointment just a little different.

In general, you can use the ultrasonic to debride and help flush out just as you would any other patients, followed by hand scaling.

Post-Orthodontic Fixed Wires
For patients with ortho wires for fixed retainers, gaining access under the wire is challenging at best. The American Eagle Instruments Boge 513™ was created by a hygienist, and it features a specially shaped end to get up and under the wire. It’s the best I’ve found thus far for lingual retainer wire access.

We pick and scape with any instrument we can find to get that calculus under the wire on the lingual of the anterior, and the Boge 513 makes it just a little easier.

Polishing Around Braces
Now it’s time to change it up from the expected prophy angle, instead choosing an air polishing unit if you have one. For almost all cases, it’s more effective for biofilm removal in and around brackets than anything else.

The sandblast effect will adequately remove the leftovers that your ultrasonic was not able to reach. You don’t have to have a large and expensive unit to be able to use an air polisher. For occasional use, the small units are perfectly adequate. A pointed polisher can also be used with your hygiene handpiece as another alternative when the air polisher isn’t available.

The challenge of flossing is hard enough for patients who are not in orthodontic treatment. Most people with braces forego flossing for the duration of braces all together. But it doesn’t have to be a headache.

Oral-B has created Glide Pro-Health Threader Floss which is my all-time favorite for braces. The threader is built into the floss end, which eliminates re-threading through the individual threader each time. The threader end is also much thinner to send through the inflamed and sore contacts of patients with less than optimal homecare, making it just a little more comfortable.

My inner diva comes out when it relates to ordering a few products, including my prophy angle brand and having the Glide Pro-Health Threader Floss, which also works wonderfully under bridges.

Fluoride Applications
Fluoride is a must for most teens in orthodontics. With all the hardware making homecare difficult and food impaction likely, their caries risk is increased. Reduce the risk of decay and white spot lesions by applying fluoride varnish at each hygiene visit.

Using Varnish Pen™ makes the application process much easier with braces. This is an all-in-one system, meaning that you squeeze a tube and varnish runs through to the handle to the brush tip, so you’re not constantly re-dipping your brush in a well. Plus, you can do it all with one hand, and there’s plenty of varnish in the tube to give you the coverage you need around brackets.

For some, it may be beneficial to use a home paste such as prescription-strength Colgate® PreviDent® to help keep teeth strong while in braces.

Homecare Tips
We drill homecare needs into the heads of orthodontic patients, especially teens. The reality is, if it’s too hard, they won’t use it. Encourage patients AND parents to be involved to make future dental appointments easier for everyone, and reduce the risk of expensive restorative treatment once braces are off.

Recommend they use a power toothbrush and a Waterpik® daily. If they’re willing, they can try flossing with Oral-B threader floss. Suggest a prescription fluoride paste to use daily to reduce risk of decay, giving them every option to make those straight teeth pearly white when the appliances come off.

Each orthodontic patient poses a more difficult challenge and alters the method that I would use to treat their peers without braces. It doesn’t always have to be a dreaded experience for either party when you’re able to use devices such as air polishing and Boge 513 instruments to gain better access to all the hard-to-reach places of the mouth.

Help families protect their investment in oral care when you apply a fluoride treatment at each visit. I frequently joke with teens that we’ll both have a party when braces are off!

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