Decalcification of Tooth Enamel and Caries
Dental braces are usually anchored to the teeth and thus interfere with both natural self-cleaning and home dental care. A traditional removable brace, as inefficient as it is for tooth movement, can at least be taken out for dental hygiene. So it does little therapeutic benefit, but also does no damage to tooth enamel.
A fixed brace, on the other hand, is on the teeth even when brushing. It creates roughness, nooks and crannies where without braces there would only be smooth enamel surfaces. For this reason, a fixed brace automatically increases the amount of hygiene required.
Young patients in particular, who arrive at orthodontic practices holding their parents’ hands without having any motivation of their own to undergo treatment, tend to be somewhat negligent when it comes to cleaning their teeth and occasionally get so-called enamel calcifications, i.e. whitish discolourations of the enamel around the brackets, during treatment with fixed braces. In the worst case, this discolouration can progress to brownish tones and eventually to caries.
It is not the fixed braces that destroy the enamel, but the dental plaque
It is not the effect of the fixed braces that destroys the enamel. Healthy, undiscoloured enamel always appears under the brackets after the braces are removed, even with very poor dental hygiene. It is the plaque that is not removed during (negligent) dental care that destroys the enamel: thus an oral hygiene problem that can be completely avoided with a little motivation and skill.
The often lamented, ugly decalcifications usually get a little better after the end of treatment, but often remain visible for life. Orthodontists can take preventative measures here by only fitting fixed braces to patients with good oral hygiene and monitoring dental hygiene at every follow-up appointment. Unfortunately, many orthodontists do not understand this important area as their responsibility.
And patients themselves should know that without good oral hygiene, dental damage can occur and clean their teeth very reliably when brackets are stuck on.
Tip: for young patients with no interest in braces and poor oral hygiene, it is best to avoid orthodontic treatment. Switching to hygiene-friendly but ineffective removable braces will not help these patients either, because it is precisely this group of patients who do not wear removable braces. So it’s better to keep your hands off braces!