Periodontal Disease: A Ruthless Monster Of Orthodontic Treatment

The first in place and most important factors that -decisively- impinge on orthodontics’ success consist of specialist planning and patient compliance. Meeting at checkups guides forward or backward steps in treatment.

Nonetheless, prospectively, before installing braces or ordering clear aligners, an orthodontist evaluates the patient’s medical records, refers them for periodontal clearance, and discards potentially threatening plaque accumulations and existing dental caries.

Indeed, orthodontics consists of a planned process, but plans might derail under certain circumstances. Slow response of the periodontal ligaments, poor oral hygiene, and an inadequate diet, are some of the considerations leading to a re-evaluation progression.

From a patient’s perspective, getting the most out of orthodontic treatment means maintaining a strict hygiene regimen insofar as much as avoiding bacteria accumulation on teeth and gums.

For Instance, gum disease affecting periodontal ligaments restricts planned displacements of teeth, and treatment might turn counterproductive, loosening teeth. This article discusses what comes next to periodontal disease during orthodontic treatment.

What Can Occur if I Fail to Follow Hygiene Recommendations During Orthodontic Treatment?

Recapping and adding, the attention concentrates on the patients and their role in the plan progression. The patient is the main subject, contributing the most to a treatment’s success. The commitment of the patient to results is the number one factor to consider when identifying the most prevalent causes of treatment delays and potential failure; we present a schematic chronology next:

The Cause of the Problem

Poor oral hygiene leads to food particles and debris that accumulate between teeth, wires, and brackets’ nooks and crannies. We don’t notice, but bacteria are everywhere, including our mouths.

Bacteria feed from food residues, decomposing sugars into an acidic matter. As food accumulation increases, so does bacteria reproducing on a clustering environment named biofilm.

Biofilm serves two purposes. It acts as a protective shield against bacteria and sticks in the form of dental plaque to the tooth’s protective layer named enamel eroding it.

So, first, once it penetrates further layers of the tooth, it causes dental caries, severely damaging it and producing intense pain, debilitating the tooth’s structure cracking it, and ultimately contaminating the tooth’s pulp.

Secondly, bacterial plaque could form next to the gums, penetrating the soft tissue and causing mild gum problems, also known as gingivitis. As a result, patients might experience swollen gums and slight bleeding, especially when brushing their teeth. In these circumstances, a dentist might prescribe a more detailed hygiene routine.

The Problem

In some circumstances, however, especially when a patient poorly cares about dental hygiene, a mild gum inflammation (gingivitis) might not recede, worsening into Periodontal Disease or Periodontitis.

What Is Periodontal Disease?

When a patient neglects the importance of good oral hygiene, plus the patient already presents an existing case of gingivitis, after approximately 72 hours, the bacterial attack produces hardened tartar from plaque to stick in the borderline between teeth and gums.

The hardened matter irritates the gums, but at a certain point, again, when a patient persists in skipping brushing, flossing, using mouthwash, and visiting a dentist periodically, gingivitis turns into periodontal disease (periodontitis).

To picture the case, a layer divides the gums and the bone that separates from each other. The result is food entering the newly formed space called pockets.

Once food enters the pockets, bacteria feast inside the gums producing infections that require a more serious approach, and a specialist (periodontist) must enter into action to treat the infection before it spreads through the bloodstream. So, moreover, what connotation does this has for a patient wearing braces? (orthodontic patients).

Can a Patient Wear Braces When Having Periodontal Disease?

No, a patient with periodontal disease shouldn’t have braces installed. In this sense, an orthodontist follows a hygiene protocol before installing braces, assuring a patient is clear from gingival problems before starting a treatment with braces or clear aligners.

However, during treatment, there is an increasingly high possibility of developing a mild case of periodontal disease that starts with bleeding while brushing and flossing.

The orthodontist might make specific recommendations or refer the case to a periodontist to address it while it is manageable and might suspend wire tightenings until the problem disappears.

The specialist resumes the treatment once having the periodontist clearance. But, if you want to know why this is so crucial, periodontal problems might affect the ligaments that allow teeth displacements. Straining affected and weak ligaments might cause the tooth to loosen.

Furthermore, to get a better image of periodontal health’s role in this matter, we include a list of all gum disease levels signifying that even at the first level, orthodontic treatment might suffer a delay that increases as the case worsens.


This is a treatable stage in which the gums bleed inadvertently while brushing or flossing and usually requires extra attention to the hygiene mechanisms used by the patient, especially if wearing braces.


A patient might experience swelling and pain in the gums with consistent episodes of bad breath. The dentist de-escalates plaque from the gum line and adopts a wait-and-see approach to monitoring the gums returning to normal.

Early Periodontitis

The main characteristic of this stage is that plaque hardens to tartar, potentially leading to tooth decay, and when left untreated, it can severely compromise the underlying portion of the jaw.

Moderate Periodontitis

Despite its name, moderate is serious. The gums recede, and teeth deteriorate to the point you might feel them lose. The infection spreads to the jaw with episodes of unexpected discharges of disgusting fluids.

Advanced Periodontitis

Associated with intense pain, the jawbone compromises due to the infection that weakens the bone (bone loss) and gums structure that cant hold teeth, and patients might lose one or more denture pieces (tooth loss ) during the infection or later on.

What Are the Oral Hygiene Measures During Orthodontic Treatment?

The recommendations for proper oral hygiene during braces treatment are the same for all braces-wearing patients, and they include the following:

Regular Brushing

Use a soft-bristled toothbrush with a bit of fluoride toothpaste to identify problematic spots. Clear away debris to the best possible, spending at least an extra minute per mouth quadrant. Then, inspect and repeat, alternating with circular and vertical movements.


We recommend using an interdental brush that fits the spaces between teeth and maneuvering them to clean between the wires, nooks, and crannies that form in brackets. You might complementary use a water irrigator (water flosser) to direct a jet of water against a clogged spot.


Use a braces special mouthwash to eliminate as much bacteria as possible.

Visit a Dentist

Despite how meticulously you practice your oral hygiene routine, you might encounter that after several months a slight plaque accumulation appears. Even if you don’t see it, there is a high possibility of it being there.

Take your time and visit your dental hygienist at least every six months, especially during braces treatment for dental cleanings.

Don’t Take Your Oral Health to Chances

At Markham Orthodontics, we plan your orthodontic treatment program to prevent any gingival occurrence, working with you immediately on the slightest development possibility. So, schedule an appointment, and commit to a program that will help you get a beautiful smile and functionally healthy teeth structure.