When patients come to me for a braces consult, the first thing I do is check for cavities. Cavities may not have anything to do with crooked teeth, or how a patient bites, but they’re a good indicator of oral hygiene and how that particular patient may care for his or her teeth with braces on.
If we decide to start orthodontic treatment, I send my patients to get their cavities fixed, and whatever else they may need. The last step is an appointment with the dental hygienist and then we can get started with braces.
Orthodontists will generally not place braces on teeth with cavities. Cavities are more urgent than braces and they should be fixed as soon as possible. Many times, those cavities are deeper than the patient might think, which can lead to those teeth needing crowns, root canals, or even extractions.
I know you might be in a hurry to wear braces, but it’s better to have healthy crooked teeth than straight teeth with cavities. It’s also really important to do things in the right order.
Your orthodontist will instruct you on what needs fixing, but if you’re curious about what to expect, we’ll cover it all in this article.
Why it’s important to fix cavities before getting braces
You might be shocked at the number of cavities your dentist may discover at your appointment if you haven’t been to the dentist’s office in a while.
Cavities come in many shapes and sizes, but by the time you can clearly see them yourself in the mirror, it’s a little late. Some cavities start out as brown stains inside the molar grooves – those are easy enough to spot early. But the worst kind of cavities is interproximal, which is just a fancy word for cavities between teeth.
Interproximal cavities are difficult to spot, and it’s usually only your dentist who can see them or discover them on a panoramic X-ray. They usually look like shadows underneath the enamel, and you can’t really tell how deep they are until you go in with a high-speed burr and open them up.
Oftentimes, these cavities in between teeth are so deep that they reach the tooth’s nerve, and you’ll need a root canal to save your tooth from infection and a crown on top to prevent it from breaking.
Now imagine if you needed all that dental work while having braces on. Things would get much more complicated. Here’s why:
- Dental hygiene is more difficult with braces on. Plaque on your teeth will cause cavities to grow deeper. Bacterial plaque will also cause gingivitis and bleeding gums, which can make any dental intervention more challenging. This is not to say you can’t keep good oral hygiene with braces, but many patients struggle with this.
- You may be feeling pain from your cavities or dental infections and think it’s coming from your braces. You may think this pain is normal and put off going to the dentist’s office.
- Your cavities may be much larger than you think. Aside from dental fillings, you may need several root canals, crowns, extractions, and/or dental implants. You can get implants while wearing braces, but it’s best to have most of your dental work done before starting orthodontic treatment.
- Some teeth may need to be extracted, which changes the course of orthodontic treatment. You may think you only have cavities, but some teeth are beyond saving. If you need extractions, depending on their location, you can have those gaps closed with braces.
Why get cavities fixed before getting braces? Because it’s the right thing to do. Because your health is more important than your looks. And because braces can wait and you can start orthodontic treatment at any age.
How long after a filling can you get braces?
If you only have small to medium-sized dental fillings, you can have braces placed right away. Stay vigilant for any tooth sensitivities, especially to cold and sweet foods.
If you’re getting root canals or dental surgery, such as root-end resection (apicoectomy), it’s best to wait a few weeks, even months. Moving a tooth that’s previously been treated for infection is like opening Pandora’s box. Most of the time it’s fine, but in some cases, the tooth can flare up again.
The same goes for large fillings, it’s best to wait a couple of weeks before getting braces. Large fillings are usually close to the nerve, and we need to make sure the tooth adjusts to the new filling.
Can you get cavities fixed while wearing braces?
Aside from getting X-rays at the beginning of your orthodontic treatment, you will also be getting them throughout your braces journey. Digital panoramic X-rays are great for detecting early cavities, especially those dangerous interproximal ones.
But wait, now that you have braces on, can you do anything about it?
No worries, your orthodontist will prep your braces so that your dentist has access to your cavity and can fix it without any issues. Usually, it’s just the archwire standing in the way. You’ll most likely have the archwire removed and then put back on once you get your filling done.
Braces aren’t a deal breaker when it comes to other dental work. Yes, they make dental impressions a bit more tedious, but most other procedures work the same they would if you didn’t have braces. So you can get fillings, crowns, and even teeth extracted with brackets on your teeth.
If you have aligners, it’s even easier to do dental work, but your trays may no longer fit the same and you may need new ones. All the more reason to solve your dental problems before getting started with clear aligners – you’ll potentially save money and time.
Can you get cavities under braces?
What about braces causing cavities? I hate to see it, but it does happen. With or without braces, dental plaque causes cavities. Failing to floss causes cavities. And it’s really easy to brush superficially and avoid flossing if you have large brackets standing in your way.
We mostly see three types of cavities after removing braces:
- White spot lesions. These types of cavities are on the front side of teeth and follow the contour of where braces once stood. Their chalky appearance may get better with time, but most often they’ll need to be corrected with some sort of composite filling or veneers.
- Interproximal cavities. Cavities between teeth can happen to anyone who’s not flossing enough, whether they have braces or not.
- Molar cavities as a result of improper bite turbos or molar bands. Unfortunately, these types of cavities often go unnoticed until the treatment is over.
What you can do, as a patient, to prevent these cavities is to floss daily, preferably at night, brush your teeth thoroughly after every meal and go to regular hygienist sessions and dentist check-ups.
Demand X-rays if your dentist or orthodontist hasn’t been taking them regularly, and don’t be afraid of radiation – modern techniques barely have any.
If you’re considering getting braces, I’m sure your oral health matters to you. And if that’s the case, start with what’s most urgent.
Bleeding gums? See a periodontist and have your teeth and roots scaled and cleaned up. Cavities? Talk to your dentist and come up with a plan to fix them all. Missing teeth? Team up with your dental surgeon and orthodontist to create space for implants and dental crowns.
Dentistry is a huge field and all specialties are interconnected. Take it one step at a time and you’ll get to the smile you want and deserve.
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