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From the time you were small, you’ve been warned about the dangers of plaque. Why? Because:

• It’s an unpleasant film that sticks to your teeth
• It causes cavities
• It causes gum disease
• It can cause extra problems when you wear braces

And really, do we need to know much more than this to motivate us to brush? But if you’re in a curious mood, you might be wondering just how this soft, fuzzy film accomplishes all that damage. Let’s take a closer look at the sticky problem of plaque.

How does plaque form?

We live with hundreds of species of oral bacteria, most of which are harmless, and some of which are actually beneficial. But when our oral ecosystem gets out of balance, problems can occur. For example, without regular and thorough brushing and flossing, we start to build up plaque.

Plaque starts forming within hours of your last brushing. And even though plaque fits the very definition of “seems to appear overnight,” this biofilm is actually a complex microbial community with several different stages of development.

• It starts with saliva.

Saliva is vital to our oral health, because it keeps us hydrated, washes away food particles, neutralizes acids in the mouth, and provides minerals which keep our enamel strong. Saliva also contains proteins, which help form a healthy, protective film on the tooth surface. This film is called a pellicle.

• Bacteria attach to the pellicle.

There are species of oral bacteria that are able to attach themselves to the pellicle film within hours of its formation. As they become more firmly attached, they begin to grow and divide to form colonies, and are known as the early colonizers of the plaque biofilm.

• A complex biofilm forms.

If you’ve skipped brushing for a few days (please don’t!), you’ll notice a fuzzy, sometimes discolored film on your enamel—that’s a thriving plaque community, and it only takes a matter of days to go from invisible to unpleasant.

If you’re not removing plaque regularly, it can harden further and become tartar. And once you have tartar buildup, you’ll need the care of a dental professional to remove it.

• What happens if we ignore plaque and tartar?

We get cavities and gum disease.

How does plaque cause cavities?

• The bacteria in plaque, like all organisms, need nutrients.

Our normal oral environment and the food in our everyday diets provide the nutrients plaque needs. And, as we mentioned above, certain types of oral bacteria convert these nutrients into acids. Foods such as carbohydrates, starches, and sugars are most easily converted into acids, which is why we recommend that you enjoy them in moderation.

• The biofilm promotes acid production.

Within the plaque film, anaerobic bacteria (bacteria which don’t use oxygen) convert sugars and starches into acids. As the plaque film becomes denser, it blocks acid-neutralizing saliva and oxygen from reaching these bacteria close to the tooth’s surface, creating an ideal environment for the bacteria to produce their acid waste products.

• Acids attack enamel.

The sticky nature of plaque keeps these acids in contact with tooth enamel, where, over time, acids dissolve minerals in enamel, weakening the mineral structure of the tooth.

How does plaque cause gum disease?

• Bacteria cause inflammation and gingivitis.

The bacteria in plaque irritate the delicate tissue of the gums, which causes an inflammation response which can leave your gums swollen, red, bleeding, or tender. This early form of gum disease is gingivitis. Fortunately, good dental care and careful brushing and flossing can usually prevent and even eliminate gingivitis.

• Plaque and tartar can lead to periodontitis.

When plaque and tartar build up around and below the gumline, the gums pull away from the teeth, leaving pockets where bacteria collect, leading to infection as well as inflammation. Infections and constant inflammation not only harm gum tissue, they can destroy the bone supporting the teeth. This serious gum condition is periodontitis, and should be treated immediately to avoid further infection and even tooth loss.

How does plaque affect orthodontic patients?

• Plaque collects around your braces.

Braces provide plenty of spots for plaque to hide from your brush. If you aren’t extremely diligent with your brushing and flossing, plaque collects near brackets, wires, and bands—all those spots that a brush and floss find difficult to reach.

• Plaque promotes demineralization

The demineralization process we mentioned above can cause white spots on teeth (decalcification), where minerals have dissolved. Sometimes these spots can be treated, and sometimes they are permanent. They can become quite sensitive, and may lead to cavities.

Careful brushing and flossing around your braces will help eliminate the plaque that can cause demineralization near brackets. Ask Dr. Dennis Johnson about the tools and the brushing and flossing techniques which will give you the best results.

How do we fight plaque?

From the time you were small, you’ve learned how to fight plaque:

• Brush at least twice a day for two minutes, and be sure to brush all of your tooth surfaces and around the gumline.
• Floss to remove plaque from between the teeth and near the gumline.
• See your dentist as recommended for a thorough professional cleaning.

Be proactive. If you have any questions, talk to us at our Columbus, OH office about the best way to keep plaque at bay. We can show you the most effective ways to brush and floss, recommend anti-plaque toothpastes and rinses, even suggest plaque-revealing tablets if you’re missing some trouble spots.

We’ve only brushed up on some plaque basics, because there is a lot more to discover about this complex biofilm. Happily, even with all there is to learn about plaque’s growth and development, it’s reassuring to know that getting rid of it is quite simple—with just a soft-bristled brush, some dental floss, and a few minutes of your time each day, you’re on the way to a healthy, happy, plaque-free smile.

Lingual braces are a lot like regular braces, but they have brackets and wires on the inside of the teeth instead of the outside. Why choose this type of appliance? Because lingual braces offer some benefits other braces don’t.

Lingual braces are almost invisible to the people around you. If you’re involved in a contact sport, they are much less likely to contact your lips and mouth. (But you should still wear a mouthguard!) If you play a reed or brass instrument, they won’t have as much impact on your lips, your mouth, and your performance. And, did we mention they’re almost invisible?

Just like regular braces, lingual braces require careful cleaning to protect your teeth from staining, plaque and cavities. But because the brackets are located on the inside of the teeth, making sure your teeth are their cleanest can be a bit more challenging. Here are some suggestions for making your life with lingual braces a little easier.

• Think Small

Because you will be working on the inside of your mouth, a brush with a smaller head might be more maneuverable (and more comfortable!) in a tighter space. If you use an electric toothbrush, look for a head attachment in a smaller size or one especially designed for orthodontic appliances.

And for the tiniest spaces, use the tiniest brushes. Interdental brushes, also called interproximal brushes, can fit between your wires to clean around brackets as well as removing plaque between teeth.

• Thread Alert

How to get that floss under the wire? Special tools called floss threaders can help get your dental floss where it needs to be. Or try one of the flosses meant for braces wearers, which offer pre-cut strands with a stiff tip at one end to thread between teeth and through wires more easily.

• Top Picks

For removing food particles and plaque between teeth, try interdental soft picks. These have a flexible, textured pick at the tip to fit gently into smaller, tighter spaces. They are also easy to carry on the go if you aren’t able to floss.

• Water Power

Water flossers use a pulsing stream of water to clean between and around teeth. If you find it very difficult to floss around your lingual brackets, this might be a good option. Make sure any model you choose has a seal of approval, and has been tested for safety and effectiveness.

• Keep Current

Remember to keep up with your regular appointments at our Columbus, OH office. It’s especially important to care for your mouth and teeth while you are wearing braces.

No matter what type of appliance you use, get in the habit of cleaning your teeth and braces after every meal and snack.  You will be rewarded with a beautiful and healthy smile when your orthodontic work is completed—and that’s the greatest benefit of all!

It’s normal to be a little self-conscious when you first get your braces. Even though you really want to straighten any crooked teeth, or correct a bad bite, you might still be a bit hesitant about sharing your new orthodontic work with the world. What are some ways to get over those under-confident feelings?

• Keep It Clean

Make sure you brush after every meal to reduce the chance of food particles and plaque sticking to your enamel and brackets. Brushing and flossing is particularly important now, not only to prevent cavities, but because nobody wants to see food stuck in your braces—especially you! If you absolutely can’t brush, rinse with water right after eating.

And carry a small bag filled with all the essentials for gleaming braces: a travel toothbrush, floss, a small tube of toothpaste, an interproximal brush, and a handy mirror to make sure you’re good to go. When you know your teeth and braces are their cleanest, you can’t help but feel more confident.

• Express Yourself

Braces are no longer the one-style-fits-all appliances of the past. Traditional metal braces at our Columbus, OH office are more compact, and now come in different colors and shapes. Metal brackets are typical, but ceramic brackets are an option for an almost unnoticeable look. And don’t forget to accessorize!

You can choose from a rainbow of band colors to make a fashion statement that’s uniquely you. Show your spirit with school colors, celebrate the holidays with festive tones, or choose shades that do wonders for your coloring. Whether you go for bold contrast, mono-chromatic subtlety, or “just because I’m in the mood” quirky combinations, let your braces showcase your style. And remember—you can change that style with every adjustment!

• Smile with Confidence

Nothing looks better on you than a confident smile. If you’re a little unsure, practice! Some mirror or selfie time will get you used to seeing yourself in braces. Break them in with friends and family before you go public. Remember that any difficulties with talking or eating should only last a little while.

Above all, you’re still your unique and valued self. You can wear braces and be a good friend, a student, an athlete, a lovestruck Juliet on the theater balcony, a star at your after-school job. Don’t let wearing braces hold you back from the activities you love.  Act like your old self, and you’ll soon feel like your old self!

It’s normal to feel a little self-conscious when you first get your braces. But when you care for yourself and your braces, good things happen! If you’re having difficulty adjusting, talk to Dr. Dennis Johnson. We want to help make sure your journey to a beautiful, healthy smile is as rewarding and as positive as it can be.

We’re all friends here, so if you sometimes feel a bit nervous before your orthodontic appointments, no judging! Ask us about any worries you might have. We are happy to explain procedures, equipment, and your orthodontic options so you know exactly what is going on during treatment. And if X-rays are a concern, we can put your mind at ease here as well.

What Exactly Are X-rays?

Sometimes patients feel reluctant about the process of imaging because X-rays are a kind of radiation. But the fact is, radiation is all around us. We are exposed to radiation naturally from our soil and water, sun and air, as well as from modern inventions such as cell phones, Wi-Fi, and air travel.

Why is radiation so common? Because matter throughout the universe constantly gives off energy, and the energy that is emitted is called radiation. This radiation takes two forms—as particles (which we don’t need to consider!) and as traveling rays. This second type is known as electromagnetic radiation, created by photons traveling in regular waves at the speed of light.

We are exposed to electromagnetic radiation every day, because, whether we can see them or not, these different wavelengths and frequencies create various forms of light. Radio waves, microwaves, infrared, visible, and ultraviolet light, X-rays, and gamma rays are all part of the electromagnetic light spectrum.

Different types of radiation on this spectrum have different wavelengths and different frequencies, and produce different amounts of energy. Longer wavelengths mean lower frequencies and less energy. Because X-rays have shorter wavelengths and higher frequencies than, for example, radio waves and visible light, they have more energy.

How Do Dental X-rays Work?

An X-ray machine produces a very narrow beam of X-ray photons. This beam passes through the body and captures images of our teeth and jaws on special film or digital sensors inside the mouth (intraoral X-rays), or on film or sensors located outside the mouth (extraoral X-rays). These X-ray images are also known as radiographs.

Why are X-rays able to take pictures inside our bodies? Remember that higher energy we talked about earlier? This energy enables X-rays to pass through the softer, less dense parts of our bodies, which are seen as gray background in a radiograph. But some substances in our bodies absorb X-rays, such as the calcium found in our bones and teeth. This is why they show up as sharp white images in radiographs. 

There are many different types of dental X-rays used in orthodontics, including:

• Occlusal X-rays, which show the entire arch of teeth in the upper or lower jaw.
• Panoramic X-rays, which use a special machine to rotate around the head to create a complete two-dimensional picture of teeth and jaws.
• Cephalometric X-rays, which show the patient’s entire profile, and the position and development of the teeth and jaws.
• Cone Beam Computed Tomography, an external device which uses digital images to create a three-dimensional picture of the teeth and jaws.

Why Do We Need X-rays?

You might have noticed that these X-rays, unlike, for example, typical bitewing X-rays, don’t take images of individual teeth. That is because orthodontists deal with the teeth in relationship to each other and to the structures around them.

Beautifully aligned teeth and a healthy bite are the visible result of your orthodontic work, but there’s a lot going on above and below the surface that needs to be discovered and taken into account before your treatment even begins. X-rays help us evaluate:

• The size, shape, and position of your teeth, including impacted teeth and wisdom teeth
• The size, position, and health of your roots throughout treatment
• The size and shape of your jaw bones, and how they affect your teeth alignment and bite
• Your progress during different phases of treatment

How Do Orthodontists Make Sure Your X-rays Are As Safe As They Can Be?

First of all, the amount of radiation you are exposed to with a dental X-ray is very small. In fact, a typical panoramic X-ray provides roughly the same amount of radiation we are exposed to through our natural surroundings in just one day. Even so, Dr. Dennis Johnson and our team are committed to making sure patients are exposed to as little radiation as possible.

Radiologists, the physicians who specialize in imaging procedures and diagnoses, recommend that all dentists and doctors follow the safety principal known as ALARA: “As Low As Reasonably Achievable.” This means using the lowest X-ray exposure necessary to achieve precise diagnostic results for all dental and medical patients.

The guidelines recommended for X-rays and other imaging have been designed to make sure all patients have the safest experience possible whenever they visit the dentist or the doctor. We ensure that imaging is safe and effective in a number of ways:

• We take X-rays only when they are necessary.
• We provide protective gear, such as apron shields and thyroid collars, whenever needed.
• We make use of modern X-ray equipment, for both traditional X-rays and digital X-rays, which exposes patients to a lower amount of radiation than ever before.
• When treating children, we set exposure times based on each child’s size and age.

And now that we’ve talked about some things you might like to know,

Please Let Us Know If . . .

• You are changing orthodontists and have had previous orthodontic X-rays taken. Ask to have your older X-rays sent to our office so we have a complete record of your orthodontic history. (With digital X-ray technology, this transfer can be accomplished with e-mail!)
• You’re pregnant, or think you might be pregnant. Even though radiation exposure is very low with dental radiographs, unless there is a dental emergency, dentists and doctors recommend against X-rays for pregnant patients.

X-rays play an important part in helping us make sure your orthodontic treatment provides you with a lifetime of beautiful and healthy smiles. If you have any concerns, contact our Columbus, OH office. When it comes to making sure you’re comfortable with all of our procedures, including any X-rays that might be necessary, we’re happy to give you all the inside information!