Caries treatment with braces

Do I need to treat tooth decay before braces are fitted?

Let's start with the fact that tooth decay should always be treated if it appears. Because, unfortunately, it will not go away on its own, but will get bigger.

But it is mandatory to have your teeth treated before braces. With braces in place, tooth decay is more difficult to treat. And locks, bars and springs on the teeth significantly worsen oral hygiene, so plaque accumulates more, and decay destroys the tooth faster.

Braces are not placed on teeth with decayed lesions, so you will need to have a consultation with a therapist and make sure your teeth are healthy before the system is installed.

Replacement of fillings prior to braces placement

Sanitation before orthodontic treatment includes not only treating tooth decay, but also replacing old, non-functional fillings. Which fillings need to be replaced?

• Overhanging fillings — restorations in which the composite material overlaps the gum and forms an uneven lateral surface of the tooth. Pieces of food get trapped under the overhanging edge and are difficult to clean even with dental floss.
• A loose filling edge, which is caused by shrinkage or the use of poor-quality materials. A leaky filling will cause rapid caries formation.
• “Flat” fillings on chewing teeth without restored cusps. The anatomy of the teeth directly affects the closure, so “flat” fillings will not have the necessary contact with the antagonist teeth. But they are changed not before orthodontic treatment, but after the removal of braces, when the correct alignment is formed.
• Exaggerated fillings, which also violate the natural anatomy of the tooth and interlock with the antagonist tooth at the wrong points. It may be sufficient not to remodel such teeth, but simply to grind them down.

How are cavities treated with braces?

External braces (vestibular)

If tooth decay has appeared after braces have been fitted, it must also be treated. The treatment process with braces depends on the location of the decay and the degree of tooth decay: sometimes the orthodontist's involvement is necessary — it is necessary to remove or place braces after treatment, and in some cases, the structure will not interfere with treatment at all.

1. Braces and arch do not need to be removed: caries on the inner surface of the teeth, on the chewing surface of the back teeth.

If the decay is located on the inner surface of the teeth, the chewing surface of the back teeth and the lesion is small, braces will not interfere with treatment. The therapist will have access to the treatment site and will perform the treatment according to the standard protocol: removal of carious tissue, antiseptic treatment, placement of composite restoration, polishing.

2. Need to remove the arc: contact caries

If decay has occurred on the contact surface, the arch will need to be removed to access the contact point. The therapist places a matrix between the teeth to recreate the correct tooth shape and contact point after the decay has been treated. After treating the decay, the orthodontist sets the arch in place in 5-10 minutes.

3. Need to remove the arch and brackets: contact caries, caries on the outer surface of the tooth, caries on the chewing teeth with lesions on the outer wall of the tooth.

If caries has appeared on the wall of the tooth where the bracket is installed, then you will have to remove the lock and the arch itself to create access. First, the orthodontist removes the arch, then with special forceps gently peels the braces off the tooth. After the therapist heals the tooth and installs the restoration, the orthodontist glues the bracket back on. Installing a bracket cannot damage a high-quality seal.
If decay has destroyed more than 50% of the tooth, it is recommended to place a temporary crown instead of a composite restoration and replace it with a permanent crown after orthodontic treatment.