A Parent’s Guide to Protecting Your Kids’ Teeth with an Appliance
Usually by the time a child has an orthodontic appliance, they are brushing independently. However, any foreign material in the mouth carries with it certain risks and in my practice I have seen several instances where an appliance was directly related to a cavity forming. Therefore I highly encourage parents to understand the appliance being put into their child’s mouth and check it periodically. Here are the most common areas of concern I have seen.
Herbst Appliance
Used to correct a Class II bite (severe overjet), these appliances are hard to clean because there is a lot of metal in the mouth. While this is true, my main concern is the health of the anchor teeth, which are usually covered with a stainless steel crown with a hole in the top and sealed with cement. During a routine dental exam I have found teeth where the cement has washed out from these anchor teeth and the area is trapping food. There is a food trap in the top of a crown which is covering the tooth- it is impossible to clean this area and I have found a cavity growing on the permanent tooth covered by the crown.
Appliances always feel a little strange so kids don’t often say anything. It is important to have a conversation with your child about how everything is feeling and (if it were me) take a peek and make sure the area is sealed well a few times a week
2. Rapid Palatal Expanders or Nance Space Maintainers
For these appliances, there are rings around (usually) the permanent molars on the top jaw. These rings are cemented in. Similar to the Herbst, this cement can wash out and a food trap can form. Additionally, if your child feels the appliance shift or move in any way, they need to tell you immediately. An unstable cementation can lead to demineralization around this molar or even a cavity. If it were me, I’d take a peak at those anchor teeth and make sure there’s no sign of washed out cement.
3. Braces in General
Braces are hard to clean, they just are. I encourage patients to use floss, water piks, electric toothbrushes, anything (including the bathroom sink!) to help keep them clean. I like to brush around each individual bracket with either an end tuft brush or a proxibrush. Help from a parent can be very helpful too because you’re likely to see something they won’t.
I always tell my patients; you’re going through a lot of inconvenience to have these braces, please please please take the best care of them that you can- at the end you’ll get to have literally perfect teeth. You can do it!