What This Guide Covers and Who It Is For
This guide teaches you exactly how to brush your teeth when you have fixed braces (brackets and wires). It covers the right angles, the correct sequence, and which tools make the biggest difference.
Braces create dozens of small spaces where food and plaque collect. A standard brushing routine is not enough. A cross-sectional study comparing patients with fixed braces to those using clear aligners found that gingival health (the health of your gums) tends to decline during treatment with fixed appliances, largely because brackets make cleaning harder. [5]
This guide is for anyone wearing traditional metal or ceramic braces, as well as parents helping children brush. If you wear clear aligners instead, your brushing routine is simpler because you remove the trays before brushing. You can learn more about different appliance types on the orthodontics page.
Every step below is based on recommendations from professional orthodontic and dental organizations. [7] [8] The goal is to help you finish treatment with healthy teeth and gums, free of preventable damage.
Why Brushing with Braces Requires Extra Care
Braces change the landscape of your teeth and make thorough cleaning significantly harder. Understanding why this matters helps you stay motivated throughout treatment.
How Braces Trap Plaque and Food
Each bracket bonded to your tooth creates ledges where plaque (a sticky film of bacteria) collects. The archwire running across your teeth adds another barrier. Food particles wedge between the wire and your gumline, and a normal brushing stroke often misses these areas completely.
A cross-sectional study comparing patients with fixed braces to those using clear aligners found that braces wearers had significantly higher plaque index scores and more gingival bleeding. [5] This difference was linked directly to the difficulty of cleaning around bonded brackets.
When plaque stays on a tooth surface for more than a few hours, the bacteria begin producing acid. That acid dissolves the minerals in your enamel. Around braces, this process can start surprisingly fast because the brackets shield the plaque from your saliva's natural rinsing action.
White Spot Lesions: The Most Common Braces Complication
White spot lesions are chalky, opaque patches on the enamel surface. They form when acid from plaque pulls calcium and phosphate out of the tooth, a process called decalcification. These spots typically appear around the edges of brackets where plaque was not removed consistently.
White spot lesions are one of the most frequently reported complications of fixed orthodontic treatment. According to the American Association of Orthodontists, maintaining excellent oral hygiene throughout treatment is the primary way to prevent them. [7] Once these spots form, they are very difficult to reverse and are often permanent.
The risk is highest in patients who skip brushing after meals, consume sugary drinks frequently, or do not use interdental cleaning tools. Teens and younger patients tend to be at higher risk because their brushing habits may be less consistent.
Gum Inflammation During Orthodontic Treatment
Swollen, bleeding gums are common during braces treatment, but they are not inevitable. Gingival inflammation (gingivitis) happens when plaque accumulates along the gumline. Braces make this worse because the wire prevents the toothbrush from sweeping cleanly across the gum margin.
Research has shown that patients with fixed braces tend to have poorer gingival health parameters compared to those using removable appliances. [5] Improved oral hygiene practices, including proper brushing and the use of interdental tools, are generally associated with measurable reductions in gum inflammation. Good plaque control is the most reliable way to keep gums healthy during orthodontic treatment.
Bad breath (halitosis) is another common concern during braces treatment. Plaque buildup and food trapped around brackets are frequent contributors to unpleasant odor. As a general principle supported by clinical experience, improving oral hygiene is typically the most effective first step for reducing bad breath associated with braces. If bad breath persists despite consistent cleaning, talk to your dentist to rule out other causes.
Healthy gums also help your teeth move more predictably during treatment. Chronic inflammation can slow treatment and, in severe cases, contribute to bone loss around the teeth.
Tools You Need for Brushing with Braces
The right tools make cleaning around brackets faster and more effective. Here is what to keep in your kit.
Manual vs. Electric Toothbrushes
Both manual and electric toothbrushes can clean teeth with braces effectively. The most important factor is technique, not the type of brush. That said, electric toothbrushes with small, round orthodontic-specific heads can make it easier to reach around brackets and along the gumline.
If you use a manual brush, choose one with soft bristles and a compact head. Hard bristles can damage your gums and bend the wires. Replace the brush every three months, or sooner if the bristles start to fray. Braces wear out toothbrush bristles faster than normal.
If you prefer an electric brush, look for one with a pressure sensor. Pressing too hard against a bracket can pop it off. Oscillating-rotating heads tend to fit well around individual brackets. Sonic-style brushes work too, but you still need to angle the bristles deliberately around each bracket.
Interdental Brushes (Proxy Brushes)
An interdental brush is a tiny, cone-shaped or cylindrical brush on a small handle. It slides under the archwire and between brackets to clean surfaces that a regular toothbrush simply cannot reach. The American Dental Association recommends interdental cleaning as part of a complete oral hygiene routine. [8]
Use the smallest size that fits snugly between your brackets and teeth. Push the brush gently under the wire, then move it up and down a few times against each tooth surface. Do this for every gap between brackets.
Many orthodontists consider the interdental brush the single most valuable additional tool for braces wearers. It removes food and plaque from the areas most likely to develop white spots.
Water Flossers
A water flosser uses a pressurized stream of water to flush debris from around brackets, under wires, and along the gumline. It is especially helpful for removing large food particles quickly after a meal.
However, a water flosser does not replace brushing or interdental brushing. The water stream alone does not scrub away the sticky biofilm of plaque. Think of it as a useful first step before you brush, or as a supplement afterward. The American Dental Association recognizes certain water flossers with its Seal of Acceptance for plaque removal. [8]
Floss Threaders, Orthodontic Floss, and Fluoride Rinse
Traditional flossing with braces requires a floss threader, a small flexible loop that helps you feed the floss under the archwire. Orthodontic floss products have a stiff, built-in threader tip that makes this faster. Plan to spend about two to three minutes flossing with braces versus one minute without them.
A fluoride mouth rinse used once daily, typically before bed, adds a protective mineral layer to your enamel. This helps counteract the acid produced by any plaque you may have missed. Your orthodontist may also recommend a prescription-strength fluoride toothpaste if you are at high risk for white spots.
Step-by-Step Brushing Technique for Braces
Follow these steps every time you brush, ideally after every meal and before bed. The full routine takes about four to five minutes.
- Step 1: Rinse your mouth. Swish water vigorously for 10 seconds to dislodge large food particles. A water flosser can help here if you have one.
- Step 2: Apply fluoride toothpaste. Use a pea-sized amount on a soft-bristled or electric toothbrush.
- Step 3: Brush above the brackets. Angle the bristles at 45 degrees downward so they point toward the top edge of each bracket and the gumline. Use small, gentle circular or back-and-forth strokes. Move tooth by tooth across the entire upper arch, then repeat on the lower arch.
- Step 4: Brush below the brackets. Tilt the brush so the bristles angle upward at 45 degrees, reaching the bottom edge of each bracket and the tooth surface below the wire. Again, work tooth by tooth.
- Step 5: Brush the brackets directly. Hold the brush straight against the bracket face and scrub gently. This removes plaque from the front surface of each bracket and the tooth enamel immediately surrounding it.
- Step 6: Brush the chewing surfaces and tongue side. Clean the biting surfaces of your molars and premolars with the brush held flat. Then brush the tongue-facing side of every tooth using the same 45-degree angle technique.
- Step 7: Use an interdental brush. Slide it under the archwire between each pair of brackets. Move it up and down several times to clean the sides of adjacent teeth and the area just under the wire.
- Step 8: Floss. Thread floss under the wire using a floss threader or orthodontic floss. Curve the floss into a C-shape around each tooth and slide it gently up and down below the gumline. Repeat between every pair of teeth.
- Step 9: Rinse with fluoride mouthwash. Swish for 30 to 60 seconds, then spit. Avoid eating or drinking for 30 minutes afterward to let the fluoride absorb.
Common Brushing Mistakes to Avoid
Brushing too hard is one of the most frequent errors. Excessive pressure can detach brackets, irritate gums, and wear down enamel. Let the bristles do the work. If your toothbrush bristles splay outward within a few weeks, you are pressing too hard.
Rushing is another problem. Many people brush for less than two minutes total. With braces, you need closer to four minutes to clean every surface around each bracket. Set a timer or use an electric brush with a built-in timer.
Skipping the gumline is a third common mistake. The area where the tooth meets the gum is where gingivitis starts. Always angle the bristles toward the gumline, not just at the bracket.
How Often to Brush with Braces
Brush after every meal and before bed. That typically means three to four times per day. If you eat a snack, at least rinse your mouth thoroughly with water if you cannot brush right away.
The American Association of Orthodontists recommends brushing after every time you eat when wearing fixed appliances. [7] Carrying a travel toothbrush and a small tube of toothpaste makes this easier at school or work. Even a quick two-minute brush after lunch is far better than waiting until evening.
Cost of Oral Hygiene Tools for Braces
Most braces-specific hygiene tools are inexpensive, and the investment is small compared to the cost of treating preventable damage. Costs vary by location, provider, and case complexity.
A pack of interdental brushes typically costs $3 to $8 and lasts about one month. Orthodontic floss or floss threaders range from $3 to $6 per package. A quality electric toothbrush with an orthodontic-compatible head runs between $30 and $200, depending on the brand and features. Replacement heads cost $5 to $15 each and should be swapped every three months.
Water flossers range from $30 to $100 for countertop models, with portable versions starting around $20 to $50. Fluoride mouth rinse is typically $4 to $8 per bottle. Costs vary by location, provider, and case complexity.
Many orthodontic offices provide a starter hygiene kit when your braces are placed. Ask your orthodontist which specific products they recommend for your situation. Some dental insurance plans cover a portion of hygiene supplies, so check your benefits.
When to Contact Your Orthodontist or Dentist
Contact your orthodontist if you notice signs of damage or problems that home care alone cannot fix. Certain symptoms require professional attention.
See your orthodontist if a bracket comes loose or a wire breaks. Broken hardware creates new areas where plaque accumulates and can injure your cheeks or gums. Also schedule a visit if you notice white, chalky spots forming on your teeth near the brackets. Early professional intervention, such as applying prescription fluoride varnish, may help limit the damage.
Contact your general dentist or periodontist if your gums bleed heavily every time you brush despite consistent good technique, if you develop persistent bad breath that does not improve with better hygiene, or if you see signs of a cavity such as a dark spot or sensitivity to hot and cold. Improving your oral hygiene routine is generally the most effective first step for reducing bad breath associated with braces.
Continue seeing your general dentist for regular cleanings every six months during braces treatment, or more often if your dentist recommends it. Professional cleanings remove hardened plaque (calculus) that even perfect brushing at home cannot eliminate. You can find a qualified orthodontist through the orthodontics page on this site.
Find an Orthodontist Near You
If you have questions about your brushing technique or notice early signs of white spots, gum swelling, or other concerns during braces treatment, an orthodontist can evaluate your situation and recommend adjustments. Use the orthodontics page on My Specialty Dentist to search for a board-certified orthodontist in your area who can guide your home care routine and monitor your oral health throughout treatment.
Search Orthodontists in Your Area