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Now, that may sound like an unusual answer, so let me explain. Puffy, swollen, bleeding gums, and bad breath are often associated with braces during orthodontic treatment. The issue is bacteria (germs) that are invading the gum tissue (gingiva), and initiating an inflammatory response. That is the body’s attempt to mobilize infection fighting agents and bringing more blood to the site. This biological infection-fighting response at the tissue and cellular level is involved and complex. However, the cure for bleeding gums is not.

A simple way to explain what is happening is to tell the story of oral plaque. What is plaque? Everyone knows plaque is that white greasy stuff that accumulates on the teeth, usually at the gum line. But where does it come from? Plaque is rotting food particles and bacteria. The bacteria are eating the rotting food particles. Since the plaque accumulates at the gum line against the teeth and the bacteria have “no brains,” they also eat the skin off the gums. This lets the blood out and bleeding occurs. It’s really that simple.

So, what is the solution to the problem? Remove the bacteria by removing the plaque. The purpose of brushing your teeth frequently is to remove food particles, the large pieces that resemble the recently eaten food, before they become smaller pieces that go into solution with the saliva. The microscopic food particles and the microscopic bacteria, mixed with the saliva, can move into the small spaces between and around the teeth. At this point, little damage is being done. However, slowly, over a 24-hour period, the bacteria becomes concentrated enough to do damage. The bacteria “eat” the skin off the gums and bleeding occurs. The bacteria also produces an acid that etches, or “eats” away, at the surface of the teeth. The acid causes white, roughened areas on the surface of the teeth that eventually become soft. As these areas become deeper, they are called “tooth decay.” So how can this destructive process be stopped or controlled? I’m sure by now you have figured it out: “remove the bacteria.”

The procedures used to manage the bacterial process are usually referred to as “plaque control.” Frequent and properly directed tooth brushing is the first line of offense. Next, flossing is necessary at least once every 24 hours to “stir up” the plaque before it can become concentrated enough to do damage.

Ok, so why stop brushing your teeth? When children begin to learn to brush, they chew on the brush and taste the toothpaste. Next Mom says, “move the brush,” and the response is a back and forth motion. Now, “get the top ones.” And, that is usually it. And, that’s how most orthodontic patients brush their teeth. When I see food and plaque around the braces and I tell patients that they have to “brush better,” they do the back and forth motion on the biting surface of the teeth faster and harder “out of habit.” At the next appointment, Mom can confirm that he has become the “best tooth brusher” in the house, brushing 8 times a day. But there is still plaque on the teeth and braces, and bleeding gums. He brushed his teeth, but stayed away from areas that bled. The problem is, that while I am looking at the braces, the patient is brushing the biting surface of the teeth. Therefore, when I say stop brushing your teeth, I’m trying to change the focus to scrubbing the braces. So now I tell patients, “Don’t brush your teeth, but instead scrub your braces.” Open wide, place the toothbrush in your mouth against the cheek, then bite down with the upper and lower front teeth edge to edge. Now scrub all the braces back-and-forth, up-and-down, in little circles in both directions, working from the back teeth to the front teeth. Then stop, open wide, put the brush on the other side against the cheek, bite down on the front teeth and proceed to scrub in the same manner. Remember, brushing your teeth is a learned skill, which means you can get better. It just takes practice.

We invite you to contact Sabat Orthodontics today to learn more about oral hygiene with braces in Parma and Brecksville, Ohio, and to schedule an appointment with Dr. Michael Sabat. Our orthodontist and team look forward to seeing you!