Marissa Bell advises dental professionals on how to help patients maintain oral health and hygiene while undergoing orthodontic treatment.
For many people, embarking on orthodontic treatment represents an exciting step towards the smile they’ve always dreamed of. Yet it’s also a time when established oral care routines need to evolve significantly in parallel. Specialist orthodontist Dr Marissa Bell has witnessed how patients of all ages adapt to the demands of braces or aligners relatively fast because they are motivated to achieving good results, however their adherence to oral health routines sometimes take longer to adapt to.
‘The most common hurdle patients face is that oral hygiene routines suddenly become far more complex,’ she explains. ‘With fixed braces, I recommend patients brush three times daily and incorporate additional cleaning tools beyond their standard toothbrush. Aligner wearers may manage with twice-daily brushing, but they must also maintain their aligners meticulously.
‘Whichever treatment modality, the routine becomes considerably more demanding, and establishing these new habits requires an understanding of the rationale and patience to establish.’
What is the best cleaning tool during orthodontic treatment?
Dr Bell has observed marked differences in outcomes based on patients’ choice of cleaning tools. ‘There’s simply no contest between manual and powered brushes when it comes to orthodontic care. Fixed braces create countless small spaces where plaque can accumulate, whilst aligners sit flush against every tooth surface. You need dynamic cleaning action to reach these areas effectively.’
Her clinical experience has consistently shown superior results with sonic technology. ‘The sweeping bristle action and fluid dynamics of Sonicare brushes create the ideal cleaning forces. Since recommending the brushes, I’ve documented significantly lower plaque levels and healthier gum tissue in patients who use this technology compared with those relying on manual brushing.’
What particularly appeals to Dr Bell is the intuitive nature of sonic brushing. ‘It’s not technique-dependent in the way manual brushing can be. Patients can maintain their familiar brushing motions without learning entirely new methods. This proves especially valuable for younger children still developing dexterity, and older adults who may find complex techniques challenging. The ergonomic design also makes it accessible across all age groups.’
She typically schedules initial orthodontic assessments around age seven. ‘By this stage, children have their first permanent molars and several adult anterior teeth, allowing us to evaluate growth patterns and determine whether early intervention might be beneficial. When treatment is indicated for this age group, I favour clear aligners. Children can continue their normal brushing routine whilst parents take responsibility for aligner maintenance. This division of labour reduces stress for the whole family.’
How can parents help children’s orthodontic treatment succeed?
Parental involvement, she emphasises, often determines treatment success. ‘For children under 10, I suggest parents supervise at least one of the twice daily brushing sessions. Evenings work best as there’s no morning school rush, and thorough cleaning before sleep is crucial. Two minutes feels lengthy even for adults, so parental guidance helps ensure adequate cleaning time.
Having a brush with an in-built sextant timer as featured in the Sonicare brush is a real bonus. I also recommend parents handle aligner cleaning themselves. Sonic brushes excel at this task, removing biofilm and debris from the aligner that would otherwise remain in contact with teeth throughout the day. To do this a tiny amount of toothpaste is reapplied to the brush after cleaning the teeth, and the Sonicare cleans deep into every aligner scallop.’
Interproximal cleaning presents particular challenges during orthodontic treatment. ‘Traditional flossing becomes nearly impossible with fixed braces, and even interdental brushes can prove difficult to manoeuvre. This is where powered irrigation devices like the PowerFlosser become invaluable. They provide an effective alternative when conventional methods fall short. Aligner patients have the advantage of removable appliances, yet many still appreciate the efficiency and simplicity of powered interproximal cleaning to make sure every tooth surface is thoroughly cleaned.’
The challenge of teenagers
Teenagers, she notes, require special consideration. ‘Adult patients typically maintain excellent aligner hygiene, and parents manage cleaning for younger children. Teenagers represent our biggest challenge. They may brush their teeth diligently but neglect their aligners, perhaps assuming it doesn’t matter since they’ll receive new ones weekly. However, wearing contaminated aligners over clean teeth completely undermines their efforts. I always emphasise that aligner cleaning with a sonic brush and minimal toothpaste is non-negotiable.’
Adult patients frequently express concerns about tooth staining. ‘Tea, coffee, red wine, and heavily spiced foods pose the greatest risks. Rather than asking patients to further restrict their already limited diet, I encourage awareness and proactive management. Powered brushes help combat surface staining more effectively than manual alternatives. Simple modifications, like adding milk to hot beverages, can also reduce the risk of discolouration.’
Consistency underpins all her recommendations. ‘My approach is straightforward: three daily brushing sessions for brace wearers, twice daily for aligner patients. Powered brushing enhances outcomes in both scenarios. This simple framework gives patients the best foundation for maintaining excellent oral health throughout treatment.’
The future
Looking ahead, Dr Bell is optimistic about technological advances in oral care. ‘Each innovation that simplifies home care represents genuine progress.’
Her philosophy extends beyond achieving straight teeth. ‘My goal is for every patient to complete treatment with not only an attractive smile, but also with healthy teeth and supporting tissues that will serve them for decades. The right combination of technique and technology, including sonic brushing and powered interdental cleaning, makes this possible. These improvements in daily practice are what make our specialty so rewarding.’
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This article is sponsored by Philips.
