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Hi Dr. Supan,

I hope you are doing well. I recently got braces a few months ago and I’m due for a dental cleaning soon. I called the dental office to ask if they would like me to have my wires removed before the cleaning and they said it was fine if I kept my wires in. I am curious to know if it is better to have the wires removed or left in for a dental cleaning.

Should I get my wires removed before a dental cleaning or leave them in?


Thank you!

Answer




Hello Mai,

Sorry for the delay.

I am going to approach this question from three angles. I will explain what I do in my office and why. Secondly, I will explain the pros and cons of doing this and why in some circumstances this may not be feasible/practical. And the third point I would like to address is simply  an general discussion of  dental hygiene and prevention measures to help ensure optimal dental health during normal orthodontic treatment.

# 1. Our office Procedures  

You specifically asked:   “Should I get my wires removed before a dental cleaning or leave them in? “  

I would say that if possible, and if you can get a quick follow up appointment to have the wires put back in, then by all means please do so.  In our office we have several dental offices which we work with who request that wires be removed if possible for routine dental hygiene appointments at their office.  Other offices have no preference. In our office  if we know that a patient is having a  cleaning/dental hygiene appointment at their  general dentist’s or Pediatric Dentist’s, I will often volunteer to remove the wires temporarily, provided the patient can return soon thereafter to have them put back in.

The decision to remove wires is also sometimes influenced by how well the patient takes care of their teeth. Some of our younger adolescent male patients simply to not exercise sufficient dental hygiene and puffy gums (gingivitis) and teeth covered with dental debris and plaque are not unheard of.  These type of patients not only are referred back to their dentists for cleaning sometimes 4 or more times a year, but we will often insist that the wires be removed so that a more efficient and thorough cleaning, scaling, and polishing can be performed.

Conversely, I also often have patients who have absolutely immaculate teeth and really have their brushing and flossing down to an art. For them removal of the wires for a cleaning would be of only limited value, and so I leave the wires in place.

Incidentally, the use of clear aligner therapy such as with Invisalign or Clear Correct  has an advantage of allowing easier dental hygiene appointments.

#2. Pros and Cons of removing wires for dental hygiene appointments.  

In brief, the Pros include:

Enhanced ability to perform a thorough cleaning
Patient can brush & floss more thoroughly during the period the wires are out
Gum tissues which are sometimes inflamed have an opportunity to recover.
Enhanced ability of dentist to diagnose other dental problems such as cavities, failed restorations, etc.
For adults with periodontal ( gum) conditions, the enhanced ability to perform periodontal probings.

The Cons include:

The patient is inconvenienced by an additional appointment to the orthodontist to have wires placed back in.
Orthodontic progress can be substantially interrupted if the patient does not immediately return to have wires put back in.
Likewise, certain teeth may begin to shift and tip in unfavorable ways if wires are left out too long.
Some very busy orthodontic offices may not be able to accommodate such requests for this extra service.
In some cases, such as when only limited sectional wires are being employed,  removal of the wires may only have a very limited benefits.
Orthodontic wires are sometimes used to employ inter and intra arch elastics, and any jaw repositioning efforts will be interrupted.
For patients receiving lingual orthodontics where the wires are on the insides of the teeth, wires removal may be more complex.
Without wires, the braces may rub against the cheeks and be a little more uncomfortable.

#3. Other Prevention Measures worthy of Consideration.  

The point of a dental hygiene appointment for cleaning is to keep the teeth and gums healthy. There are many other measures that can be used to complement regular cleaning appointments.
A professional prescription strength tooth paste with higher levels of fluoride can be used to help prevent decay and decalcification.

A fluoridated over the counter mouthrinse can also be used to prevent decalcifications/decay particularly in areas in between the teeth where so called “flossy fillings” are often needed.
Flossing or the use of small proximal brushes can be used to better clean in between the teeth.
A more cautious diet restricting sugary foods and drinks that can promote decay is also important; sugary colas and other soft drinks particularly if consumed throughout the day can affect hygiene.

Also for certain teeth such as molars and premolars that have very grooved surfaces, the use of dental sealants can be very helpful; ask you dentist for recommendations.

So in summary, here are the take home points:

1)   Yes, have the wires removed if you and your orthodontist can manage the necessary appointments
2)   Make sure to schedule a follow up appointment to immediately have the wires, elastics, put back in.
3)   Check with both the orthodontist  and the dentist for advice on whether such wire removal is appropriate & worthwhile  for your particular situation; every patient is different.
4)   Regular cleanings and check-ups are an essential part of the orthodontic treatment and should generally be scheduled every 6 months.

In summary, I hope my comments have been helpful. As you know Mai, the website here encourages readers like you to rate the answers and to resubmit with follow up questions. Good luck with your upcoming cleaning appointments. If you would like to submit a follow up I would be happy to answer in more detail.

Mai, thank you for writing.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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