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Can I wear braces when I have bleeding gums?

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Orthodontic treatment can still be beneficial for individuals whose gum disease is well controlled (Quang Tri Nguyen - Unsplash)

By: Assoc. Prof. Dr. Saritha Sivarajan, Dr. Cheah Chia Wei, Dr. Norhidayah@Nor Zahidah Mohd. Tahir

Periodontal disease, or commonly known as gum disease affects 90% of the population, with 35% of these cases being the severe form. This silent and often painless condition damages the tissues and bone supporting your teeth, eventually leading to shaky teeth, unwanted teeth migration/repositioning, and tooth loss.

The effects of severe gum disease can have a great social impact on the sufferer. The unwanted teeth movement, such as splaying, excessive downward growth, and tilted position because of lost neighbouring teeth, can compromise a person’s appearance. Fortunately, this can be corrected using orthodontic treatment, also known as braces treatment, provided that the gum disease has been treated and controlled.

Orthodontic treatment can offer several benefits for patients with gum disease, but it’s crucial to coordinate care between braces and gum treatment to ensure the best outcomes. Crooked teeth can be challenging to clean properly, leading to the accumulation of plaque and tartar, which can worsen gum disease. Orthodontic treatment can align teeth, making it easier for patients to maintain effective oral hygiene. Additionally, it can reduce stress on supporting tissues, such as gums and bone, contributing to improved gum health by minimizing factors that exacerbate gum disease.

Not only did orthodontic treatment enhance the alignment and appearance of teeth, it also boost a patient’s confidence and overall satisfaction with their smile, potentially motivating them to maintain better oral hygiene and adhere to periodontal treatment.

For individuals with gum disease, the transformative journey towards achieving a straighter, healthier smile might seem challenging. Orthodontic treatment involves the use of various appliances to correct misalignments and enhance oral function. While these interventions primarily focus on tooth movement, they can significantly impact the health of surrounding gum tissues. Individuals with a history of gum disease will still experience a recurrence of inflammation and gum bleeding. Orthodontic appliances can exacerbate these issues, making oral hygiene practices more challenging. Thus, it is of utmost importance to continue regular reviews of the gum conditions.

Next, braces and other orthodontic appliances can create additional nooks and crannies where bacteria may accumulate, leading to plaque formation and worsening gum disease. In patients with significant bone loss around certain teeth, orthodontic movement might be unsuitable. Gum disease can affect the supporting structures of teeth. Orthodontic forces need to be gentle to prevent further damage during orthodontic treatment. Thus, addressing active gum disease before starting orthodontics is crucial.

An uneven bite can put extra stress on teeth and gums, contributing to gum disease progression. Orthodontic treatment can adjust the bite for a more balanced distribution of forces. In patients with gum disease, it is common to see teeth appearing longer than normal, and sometimes, it occupies the space of the missing lower teeth. In this situation, orthodontic treatment can be undertaken to push back the teeth to allow prosthesis replacement. While this procedure is undertaken, the control

of dental plaque has to be kept to the minimum possible so it will not be pushed into the gum and worsen/reignite gum inflammation.

Despite these challenges, orthodontic treatment can still be beneficial for individuals whose gum disease is well controlled when approached with caution by the experts. By collaborating closely with periodontists and implementing comprehensive oral care strategies, orthodontists can minimise risks and optimise outcomes for their patients.

Dr Saritha and Dr Norhidayah are from the Department of Paediatric Dentistry and Orthodontics; while Dr Cheah is from the Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya. They may be reached at saritha@um.edu.my

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