The Need for Good Oral Health and Hygiene with Invisalign Treatment by Dr Camilla Morrison

“How many times do you brush a day?” “Twice”

“With an electric toothbrush or manual?” “Electric”                    

“Okay great, and do you floss?” “Well, I try to but not as often as I should!”                  

How many times do we have this conversation with our patients?

It’s probably one of the most common conversations we have! For our general patients it is likely quite automatic for us to go through the process of education and motivation, but can the same be said for our Invisalign patients the whole way through their treatment?

It is important to do a full oral health examination for all your Invisalign patients prior to treatment. We are oral health providers first and foremost. Any health-related dental work should be completed before we start the Invisalign treatment. We can then ensure we have a baseline of health before embarking on the Invisalign journey. I find some patients can be a little unwilling and want to jump straight into their aesthetic-focused treatment. To help satisfy this desire to get started, I discuss that we can still start the planning process of the Invisalign whilst we (or their normal general dentist) address the oral health issues. After the restorative/periodontal work has been carried out we will then take a new scan and substitute this into the ClinCheck using the modification text box with the scan ID or tracking number if using dental impressions.

Not only does this ensure that we have a good oral health base when starting treatment, but it will also reduce the risk of problems occurring during treatment. It is important to ensure we have the best fit possible of the aligners onto the teeth. If we do need to do restorative work mid-way through treatment this can lead to additional aligners needing to be ordered as the tooth or teeth will inevitably have changed shape.

Once we have achieved dental health we can move forward to ordering and fitting of the aligners.

When we talk to our Invisalign patients I’m sure we all say our mantra of “22 hours a day taking out to eat or drink anything but water. After eating make sure you brush and floss before putting your aligners in.” We may even give out little survival packs with Chewies, a toothbrush and travel-sized toothpaste.

We likely tell them what we want them to do but do we tell them why? This can be the point of disconnect in the communication and lead to patients not taking the role of their oral hygiene during Invisalign treatment as seriously as we would like them to. Let’s explore some of the reasons why good oral hygiene is so important during Invisalign treatment.

  • Clean aligners. I find it obvious when a patient has been eating with their aligners in. The aligners look sorry for themselves and there is food debris stuck in the crevices, especially around attachments. This makes the aligners more obvious in the mouth, they take on an almost cloudy appearance. It can also make the aligners smell which can in turn lead to our patient’s breath smelling.
  • Dental decay. If patients don’t remove the food from around the teeth prior to putting the aligners in, the aligners will hold the food debris against the teeth for extended periods of time (if compliance is good!) Coupled with the aligners also reducing the saliva flow over the teeth, we know this is likely to lead to caries forming if this goes on over a period of time. A similar scenario occurs when acidic/sugary drinks are consumed with the aligners in place. In fact, I have seen white spot lesions around the attachments from daily drinking of full sugar fizzy drinks on an almost daily basis for the duration of treatment!
  • Periodontal disease. To move teeth, we put forces through the teeth and subsequently the bone. It is imperative that historic periodontal disease is stabilised prior to treatment and kept under review throughout. If the periodontal disease becomes active during treatment, we will need to pause and stabilise the periodontal disease again before moving on to further aligners. If the periodontal disease is not stable this can lead to accelerated bone loss and ultimately can reduce tooth/teeth long-term prognosis.
  • Calculus build-up. Without daily removal of plaque, calculus will inevitably build up. Aside from causing health problems, the calculus build-up can occur interdentally and where IPR has been carried out, reducing the space the teeth have to move. This can reduce tooth movement efficiency and increase treatment time.

Ensuring our patients maintain good oral hygiene throughout their treatment is crucial for success not only in the alignment of the teeth but most importantly for the patient’s long-term oral health. I like to have a team approach whereby the patient attends appointments with our therapist who sets the recalls throughout treatment. I find this increases the value on the whole team and the patient’s focus on their oral care.

Article by Dr Camilla ‘Millie’ Morrison


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