Orthodontic treatment, commonly known as getting braces, is a significant commitment and investment in dental health and aesthetics. However, individuals with existing periodontal disease face unique challenges and considerations when seeking orthodontic treatment. This comprehensive guide explores whether you can get braces with periodontal disease, the risks involved, and how to manage and treat periodontal disease to ensure a successful orthodontic outcome.

Understanding Periodontal Disease

What is Periodontal Disease?

Periodontal disease, also known as gum disease, is a serious infection of the gums and the structures surrounding the teeth. It is caused by the buildup of plaque and tartar on the teeth and gums, leading to inflammation, bleeding, and, in severe cases, tooth loss. Periodontal disease is classified into two main stages:

Gingivitis: The earliest stage of periodontal disease, characterized by red, swollen gums that bleed easily. Gingivitis is reversible with proper oral hygiene and professional treatment.
Periodontitis: A more advanced stage of gum disease, where the inflammation extends to the bone and supporting tissues. This can result in the formation of pockets between the teeth and gums, bone loss, and eventually tooth loss. Periodontitis requires more intensive treatment and is not completely reversible.

Causes of Periodontal Disease

Several factors contribute to the development of periodontal disease, including:

Poor Oral Hygiene: Inadequate brushing and flossing lead to the buildup of plaque and tartar.
Genetics: Some individuals are genetically predisposed to gum disease.
Smoking: Tobacco use significantly increases the risk of periodontal disease.
Hormonal Changes: Hormonal fluctuations during puberty, pregnancy, and menopause can make gums more susceptible to inflammation.
Medical Conditions: Conditions such as diabetes, heart disease, and autoimmune diseases can increase the risk of gum disease.
Medications: Certain medications can affect oral health and contribute to gum disease.

Can You Get Braces with Periodontal Disease?

Initial Assessment and Diagnosis

Before considering braces, a thorough dental examination is essential to assess the extent of periodontal disease. This involves:

Clinical Examination: The dentist or periodontist will examine the gums for signs of inflammation, bleeding, and pocket formation.
Periodontal Probing: Measuring the depth of the pockets between the teeth and gums to determine the severity of gum disease.
X-rays: Dental X-rays help assess bone loss and the overall health of the supporting structures.

Treatment of Periodontal Disease Before Orthodontics

If periodontal disease is diagnosed, it must be treated and managed before starting orthodontic treatment. The steps include:

1. Scaling and Root Planing

Scaling and root planing is a deep cleaning procedure that removes plaque and tartar from above and below the gum line. This helps reduce inflammation and promote healing.

2. Periodontal Maintenance

Regular periodontal maintenance appointments are crucial to monitor the health of the gums and prevent the recurrence of gum disease. These visits typically occur every three to four months.

3. Surgical Interventions

In severe cases of periodontitis, surgical interventions such as flap surgery, bone grafting, or guided tissue regeneration may be necessary to restore the health of the gums and supporting structures.

4. Improved Oral Hygiene

Patients must adopt a rigorous oral hygiene routine, including brushing at least twice a day, flossing daily, and using an antibacterial mouthwash.

Considerations for Orthodontic Treatment with Periodontal Disease

1. Stability of Periodontal Condition

Orthodontic treatment can only proceed if the periodontal disease is stable and under control. Active inflammation and significant pocket depths must be addressed before braces can be considered.

2. Close Monitoring

Patients with a history of periodontal disease require close monitoring during orthodontic treatment. Regular visits to both the orthodontist and periodontist are necessary to ensure the gums remain healthy and free of inflammation.

3. Gentle Orthodontic Forces

Applying gentle and controlled forces during orthodontic treatment is crucial for patients with a history of periodontal disease. Excessive force can exacerbate bone loss and gum recession.

4. Customized Treatment Plan

Each patient’s treatment plan must be customized to accommodate their periodontal health. This may involve using specific orthodontic appliances and techniques to minimize stress on the gums and supporting structures.

Risks of Orthodontic Treatment with Periodontal Disease

1. Exacerbation of Gum Disease

Orthodontic appliances can make it more challenging to maintain oral hygiene, potentially leading to a worsening of gum disease if proper care is not taken.

2. Bone Loss

Patients with periodontitis already have compromised bone support. Orthodontic treatment can put additional stress on the bone, potentially leading to further bone loss if not carefully managed.

3. Gum Recession

The movement of teeth can cause the gums to recede, particularly in areas where bone support is already weak. This can lead to increased tooth sensitivity and aesthetic concerns.

4. Prolonged Treatment Time

Orthodontic treatment may take longer for patients with periodontal disease due to the need for gentler forces and close monitoring.

Managing Periodontal Health During Orthodontic Treatment

Oral Hygiene Practices

1. Brushing

Frequency: Brush at least twice a day, preferably after every meal.
Technique: Use a soft-bristled toothbrush and fluoride toothpaste. Brush at a 45-degree angle to the gums and around each bracket.
Orthodontic Toothbrush: Consider using an orthodontic toothbrush designed to clean around braces more effectively.

2. Flossing

Frequency: Floss at least once a day to remove plaque and food particles between teeth.
Technique: Use floss threaders or orthodontic flossers to navigate around the wires and brackets.
Water Flossers: Water flossers can be a helpful addition to your oral hygiene routine, making it easier to clean around braces.

3. Mouthwash

Antibacterial Mouthwash: Use an antibacterial mouthwash to help reduce plaque and prevent gum disease.
Fluoride Mouthwash: A fluoride mouthwash can help strengthen tooth enamel and prevent cavities.

Dietary Considerations

Foods to Avoid

Certain foods should be avoided to prevent damage to the braces and maintain oral health:

Hard Foods: Foods like nuts, hard candies, and raw vegetables can damage brackets and wires.
Sticky Foods: Sticky foods like caramel, taffy, and chewing gum can get stuck in the braces and are difficult to clean.
Chewy Foods: Foods like bagels, licorice, and tough meats can put excessive pressure on the braces.
Sugary Foods: Foods high in sugar can increase the risk of cavities and gum disease.

Foods to Enjoy

There are plenty of braces-friendly foods that are both nutritious and safe to eat:

Soft Fruits: Bananas, berries, and peaches are easy to chew and won’t damage braces.
Dairy Products: Yogurt, cheese, and milk are excellent sources of calcium and are gentle on braces.
Soft Grains: Pasta, rice, and soft bread are easy to eat and can be included in a balanced diet.
Protein: Soft-cooked meats, poultry, fish, tofu, and eggs are good sources of protein that are safe for braces.
Vegetables: Cooked vegetables like spinach, zucchini, and mashed potatoes are nutritious and braces-friendly.

Regular Dental Visits

Orthodontist Appointments: Regular visits to the orthodontist are essential to monitor progress and make necessary adjustments.
Periodontist Visits: Regular check-ups with the periodontist are crucial to ensure the gums remain healthy and free of inflammation.
Dental Cleanings: Professional cleanings every three to four months are important to maintain oral health and catch any issues early.

Alternatives to Braces for Patients with Periodontal Disease

For patients with severe periodontal disease who are not candidates for traditional braces, there are alternative orthodontic treatments available:

1. Clear Aligners

Clear aligners, such as Invisalign, offer a less invasive option for straightening teeth. These removable aligners make it easier to maintain oral hygiene and reduce the risk of gum disease. However, clear aligners may not be suitable for all orthodontic issues.

2. Limited Orthodontic Treatment

In some cases, limited orthodontic treatment can address specific alignment issues without the need for full braces. This may involve using partial braces or other orthodontic appliances to achieve the desired results.

3. Orthognathic Surgery

For patients with severe bite issues and periodontal disease, orthognathic surgery may be an option. This surgical procedure realigns the jaws and teeth, improving both function and aesthetics. Orthognathic surgery is typically considered for adults with complex orthodontic and periodontal needs.

Conclusion

The question of whether you can get braces with periodontal disease depends on the severity and management of the condition. While periodontal disease poses challenges, it does not necessarily preclude orthodontic treatment. Proper management of gum health, close monitoring, and a customized treatment plan are essential for successful orthodontic outcomes in patients with periodontal disease. By working closely with both an orthodontist and a periodontist, individuals can achieve a healthy, beautiful smile while maintaining optimal oral health.

can you get braces with periodontal disease