For an orthodontist, there’s nothing worse than treating a patient that has poor oral hygiene. Not just because it’s unappealing, but because red, swollen gums that bleed at the slightest touch can make treatment much more difficult, to the point that braces need to be removed.
Gums will grow over braces because of poor oral hygiene, but some factors may accelerate gum inflammation. These include pregnancy, puberty, medication, and even systemic disease. Severely swollen gums don’t always return to their normal size during treatment and may need surgical intervention.
Whether you’re a parent or a patient dealing with swollen gums growing over braces, you’re right to be worried. We’re here to explain what triggers this problem, how to prevent it, and how to fix gingivitis before it gets too bad.
Why healthy gums are important for orthodontic treatment
Maintaining healthy gums is important. That’s why we brush our teeth, go to regular dentist checkups and visit our periodontist as we grow older. But maintaining gum health while wearing braces is even more important. Here’s why.
Braces tend to accumulate a lot of plaque around them. Brackets have all sorts of nooks and crannies that hold on to food, and the enamel in between braces and gums is often hard to clean. Those colored elastic ties around braces also hold on to food debris, and so do ligatures.
As a result, if you’re not meticulous with your oral hygiene, plaque will quickly build up. If a thick layer of plaque accumulates around your gumline, it will irritate your gums and may cause them to swell and grow in size. In some extreme cases, swollen gums may cover half the surface of the teeth or more.
Gums that cover half the tooth are a huge inconvenience during orthodontic treatment because:
- Bonding new brackets is nearly impossible. Bonding requires a clean, dry enamel surface. Touching the irritated gums will cause them to bleed, making bonding impossible. Even when the tooth surface seems dry, serum coming from the gums could blend in with the bonding material, causing the bracket to fall off.
- Hygiene gets even worse, and gums grow even more inflamed. Because gums bleed at the slightest touch, patients often avoid brushing their teeth properly. Understandably, it hurts, and there’s quite some blood in the sink after each brushing session. It’s a vicious circle, and more plaque builds up underneath the swollen gums.
- Severe, persistent gingivitis is a precursor to periodontal disease. Even in young patients, having their gums swollen for long periods can lead to those gums detaching from the tooth and creating pockets where even more bacteria will grow and create damage. Gum pockets will lead to premature tooth loss, that’s why we take periodontal disease so seriously.
- Swollen gums increase the risk of white stains on teeth. Persistent white stains after orthodontic treatment are actually demineralization lesions, where bacteria started attacking enamel, causing permanent stains around where the bracket used to sit.
So you see that the things we hate to see the most in our offices – brackets that keep falling off, gum disease, permanent damage to teeth – they’re all linked to poor hygiene and gum inflammation. But, hygiene aside, some people are more prone to having these problems, so let’s see if you’re at risk.
5 reasons why gums are growing over braces
Some fortunate patients don’t get swollen gums no matter how bad their hygiene is. And others get massive gingivitis for seemingly no cause at all. There are some medical conditions that cause generalized gingivitis, as well as some tooth particularities that cause certain teeth to have gum problems.
1. Poor hygiene
It’s time to dive deeper into this issue, because it’s so obvious, yet so overlooked.
You may be brushing after every meal, yet still have plaque on your teeth. This happens because you haven’t mastered a good brushing technique. We’ll cover hygiene in a different article, but here are a few tips to get you started:
- Purchase an electric toothbrush;
- Purchase an orthodontic oral hygiene kit;
- Get a water flosser;
- Get dental plaque-disclosing tablets.
Brush your teeth twice for a while until you understand where plaque hides and how to remove it. After the first brushing session, chew on plaque-disclosing tablets and see where your teeth turn blue (or whatever color it is that you bought). Brush for a second time, angling your toothbrush in various positions, to get every last bit of plaque.
Use small interdental brushes to get to areas that are more difficult to access. Don’t forget to floss, water floss, and use mouthwash.
And whatever you do, don’t go to bed without brushing your teeth – that’s a sure recipe for disaster.
If you’re a parent to a child that has braces, don’t expect them to just know what they’re supposed to do. Check them often after brushing, and teach them oral hygiene habits or brush them again yourself if they’re not doing a thorough job.
2. Bracket placement & Tooth size
Some patients have really small teeth, and the brackets tend to cover a large portion of their surface. This is especially true for premolars, lower incisors and lateral incisors.
Some brackets, like the tubes that go on molars, may have very large pads and cover most of the molar area, leaving just a thin strip of enamel at the gum line that you need to keep clean.
And lastly, some situations call for a very high placement of the bracket, close to the gum, which makes it difficult to clean.
Gum inflammation in these scenarios may not be your fault, but you will need to be even more careful with your hygiene than a regular patient.
3. Pregnancy gingivitis
I don’t like working on my patients’ teeth while they’re pregnant, and I try to avoid starting an orthodontic treatment while the patient is pregnant, but life happens and sometimes it’s unavoidable.
The problem with pregnancy and braces is that hormonal changes cause the gums to be extremely puffy. In some cases, they can swell significantly and grow over braces. The same hormones can also cause teeth to feel loose, which, admittedly, can speed up treatment, but it’s not something we particularly like to see.
The best thing to do is to support the patient in maintaining good oral health and only apply minimal forces, especially if the gums are already irritated.
4. Puberty gingivitis
Fortunately, puberty gingivitis isn’t that common during treatment, but I’ve seen some cases, and had a severe form of it myself, as a child. We sometimes see this type of gingivitis in preadolescent boys and girls, between the ages of 11 and 13.
Puberty gingivitis doesn’t develop in the absence of plaque, so poor oral hygiene is still to blame, but the reaction to the plaque is extreme: gums will get bright red, swollen, and painful, and climb over braces. The patient’s tonsils and lymph nodes may also swell up, and the child will have difficulty eating and swallowing.
If your child has this, and it’s severe, he or she may need their orthodontic treatment to be interrupted until the issue is resolved.
5. Systemic disease
Your gums are an indicator of health or disease throughout your entire body, and often they’re the first sign that something else may be wrong. Gums that swell and bleed could signal a more serious condition like:
- Chron disease
We hope that’s never the case with our patients, but it’s never a bad idea to check with your general practitioner.
And lastly, any preexisting periodontal problem may flare up and get even worse on certain teeth, during orthodontic treatment. But your orthodontist should have a clear inventory of whatever is wrong with your gums, and you should be under the strict supervision of a periodontal specialist.
What happens if gums are severely swollen over braces?
If your gums are severely swollen and grown over braces, you’re probably at the point of no return. But you know this doesn’t happen overnight.
I repeatedly warn my patients whenever their oral hygiene is off, send them to dental hygienist appointments, show them pictures of severely swollen gums, and lastly, “threaten” that I’ll take their braces off.
Severe cases of overgrown inflamed gums may require braces to be removed. It’s not a threat or revenge – it’s the best thing to do for the tissue to heal. As long as there’s a constant irritant in the form of brackets that harbor food and bacteria, the inflammation will never go away.
After the braces are removed, the patients will undergo multiple dental hygiene procedures in the dentist’s office, use chlorhexidine rinses at home and keep perfect oral hygiene until the gum inflammation subsides. Only then can orthodontic treatment resume.
More often than not, a surgeon needs to remove the excess gum growth using a laser or a scalpel, which sounds scary, but it’s painless and leads to faster healing.
Gums that grow over braces are a serious threat to your treatment and the overall health of your teeth, gums, and bone. Your orthodontist has the right to interrupt treatment or refuse treatment altogether if you’re not following their indications and brushing thoroughly. But if you ever get severe gingivitis, know that there’s treatment available, and your orthodontist and dentist are there to help you.