First, always use a soft toothbrush. The most important place to keep clean while your braces are on is above your braces (between the braces and the gums). Since this space is right next to the gums, it is impossible to brush the enamel surface without contacting the gums with the bristles. Hard and medium toothbrushes can damage gums and must be avoided.
Second, always start your brushing session using only a wet toothbrush, no toothpaste. While toothpaste contains ingredients that are important for the health of your teeth, the foam that it creates makes it hard to see what you are doing. After you have used water only to remove all of the food and plaque from around your braces, THEN you can add a pea-sized amount of toothpaste to your brush so that you can take advantage of the fluoride, whiteners, abrasives (yes abrasives!), and breath fresheners that are in the paste.
Third, while using only your wet tooth brush, begin removing debris from around the brackets and under the wire using a picking motion rather than scrubbing. Your toothbrush has approximately 2000 individual bristles that perform just like little toothpicks that can reach even the smallest nooks and crannies associated with your orthodontic appliances. Scrubbing does a decent job on the surface of the braces, but that action will not remove plaque and food that are caught under the wires and brackets.
Four, time yourself and spend at least two FULL minutes brushing your teeth. You should spend at least 30 seconds on your upper right side, 30 seconds on your upper left side, 30 seconds on your lower left side, and finally 30 seconds on your lower right side. You might think that you do this already, but most patients who time themselves find that they are brushing an average of only 30 seconds for their entire mouth!
Five, the best toothpaste to use is the one that tastes best to the patient and encourages them to brush for a full two minutes. Although there are differences in the ingredients used by the various manufacturers, research has shown that the most important variables when it comes to good oral hygiene is the TIME SPENT and the technique used and not the brand of toothpaste. If your child likes a particular brand because it has a cartoon character on the tube and you think it will help them brush longer, that is the one for them. Most modern toothpastes have fluoride, and that is really the most important ingredient.
Six, when you are done brushing in the morning, feel free to rinse your mouth with water to remove the foam left after brushing with your toothpaste. In the evening right before bed however, spit but DO NOT RINSE. Research has shown that the teeth receive just as much fluoride following this procedure as they do when you apply an expensive fluoride supplement. There is nothing wrong with using more fluoride, it just isn’t necessary if you leave a slight film of toothpaste on your teeth at night following brushing.
Lastly, although you can achieve excellent oral hygiene while wearing braces using an affordable manual toothbrush, I am a big fan of any technology that encourages my patients to spend more time brushing. Electric toothbrushes are wonderful and do a good job supplementing the manual movements of the toothbrush bristles over the teeth. Some brushes that vibrate have been shown to clean a little better than those that rotate. Again, I endorse any brush that makes my patients brush longer than they would otherwise.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.