Oral Hygiene

Having a clean mouth is important. It gives you fresh breath and a nicer-looking smile. However, it also helps to keep your mouth healthy. And, since your mouth is connected to the rest of your body via the bloodstream, a clean mouth will lead to a healthier body.

During orthodontic treatment, it is exceptionally important that you continue to see your dentist at least every 6 months for regular dental exams and cleanings. Dentists and hygienists can remove the calculus (tartar) that builds up on the teeth. Brushing and flossing do not remove tartar.

Brushing and flossing do remove a thin sticky film that grows on your teeth. This sticky film, called plaque, is the main cause of decalcification (white scarring), tooth decay (cavities), gum inflammation (gingivitis), and gum disease (periodontitis).

Plaque is made up of:

  • Bacteria (i.e. germs)
  • The food that you leave behind when you eat (especially carbohydrates)
  • Saliva
  • Acid: the toxic byproduct of the bacteria
When you eat carbohydrates (foods made of sugar or starch), you feed the bacteria in your mouth. The bacteria then produce acid, which mixes with the bacteria, food, and saliva, to form plaque.

If plaque remains on the teeth for too long, it can attack the enamel and leave a permanent, white scar on the surface. The process that causes the white scar is called decalcification, where calcium is leeched out of the enamel (outer layer) of the teeth by the acid in the plaque. Braces and expanders do not cause this white scarring -- plaque does. If the plaque continues to be present, the acid will ultimately leech enough calcium out of the enamel to form a cavity on the tooth.

Additionally, plaque acts like a poison to the gums. The gums react by becoming inflamed (gingivitis). If left too long, that inflammation will cause the body to protect itself by breaking the bone down underneath the gums, causing permanent gum disease (periodontitis), which if left untreated, can cause loss of teeth.


You will notice that it is harder to keep your teeth clean while wearing braces or expanders because there are extra nooks and crannies to clean. Food becomes caught in the appliances and between your teeth. Brushing after meals and flossing will help to prevent plaque from forming and should become part of your daily schedule. An electric toothbrush, such as the Rota-dent® or Oral-B®, is the most effective method of brushing. However, a manual toothbrush can work well too, with excellent brushing technique. Always use a soft toothbrush, and brush with Colgate Total® toothpaste.

When wearing braces, plaque loves to hang out by the gumline and under the archwires. To clean braces, brush in small circles above and below the brackets, making sure to reach the areas between the brackets and the gumline. Additionally, brush under the archwires of the braces, and use a proxibrush every time you brush, in order to clean thoroughly under the archwires faster and more easily.

When wearing expanders, plaque sticks to the plastic and the metal, as well as to where the plastic and metal join, so extra cleaning is important. Additionally, plaque loves to get caught underneath the plastic in the roof of your mouth (palate). To clean expanders, brush around the bands, plastic, and support arms of your expander, and along the gumline. Additionally, use a proxibrush every time you brush to get into the small, narrow areas. Every time you brush, at least 3 times per day, you should also use the l’il palates™ cleaner and Monoject® Syringe or Waterpik®. The l’il palates™ cleaner will dislodge the food & plaque stuck underneath the plastic. Then, use the Monoject® Syringe or Waterpik® to spray the dislodged food away, like a mouth shower.

Your toothbrush will wear out faster because of your appliances, so be sure to replace it whenever the bristles start to fray.

After you finish brushing, plaque will start to form again on your teeth in 2 hours, which is why Dr. Held recommends brushing 3 times per day: once in the morning, once after lunch or when you get home from school or work, and once at night. If it’s possible to brush at lunch, you can use a travel toothbrush for convenience. However, if you can’t brush after lunch, at least rinse out with water until you get home and can brush.


Flossing with braces takes some practice to master, but is well worth the effort. The first step is to get the floss under the archwire that connects the braces together. A floss threader will help you to accomplish such. Dental floss with a stiff end (Threader Floss) is also available. It is pre-cut and is very easy to insert underneath archwires.

Once the floss is under the archwire, it can be wrapped around the tooth on one side, like the letter "C". The floss is then pushed gently underneath the gum papilla (triangle), and then pulled back gently toward the wire. This action should be repeated four to five times to ensure that all of the plaque is removed. Be careful not to put too much pressure on the wire as you pull the floss back toward it. Then, wrap the floss around the neighboring tooth, again like the letter "C", but in the opposite direction, and push the floss gently underneath the other side of the gum papilla. Once both teeth are done, the floss is pulled out, and the process is repeated for the next two teeth. Use a new, clean position on the floss for each papilla.

Flossing with expanders can be challenging when working around the support arms and bands. Use a floss threader to thread under the expander support arm on one side of the palate, and floss as described above. Then move to the other side of the palate. When flossing close to bands, after flossing, pull the floss out on the cheek side, instead of back down through the contact between the teeth. That way, you will avoid catching the floss on the band and loosening it.

When you are first getting used to flossing with braces or expanders, we recommend that you set a time limit of flossing 1 time per day for 5 minutes, whether you have finished flossing your entire mouth or not, so that flossing does not become too big of a chore. With practice, as you become a master flosser, the number of teeth that you should be able to floss in 5 minutes will increase until eventually, you will be able to floss your entire mouth with braces or expanders in 5 minutes. Remember, the germs in your mouth will not give you a break just because you have braces or expanders. In fact, they are happy that flossing is more challenging. So, it is your job to show them who is boss.

Hygiene Kit

When you start orthodontic treatment with us, we will provide you with a Hygiene Kit, which includes several cleaning aids that you can use at home to help you to maintain excellent oral hygiene while wearing orthodontic appliances:

If you are wearing an expander, there are 2 additional and essential cleaning aids for you to use:

To protect the tooth enamel, you should also use a daily, over-the-counter fluoride rinse (such as ACT®). Additionally, Dr. Held recommends that you use mouthwash and a Waterpik®.

If you purchase a Waterpik® and you have an expander, you may use the Waterpik® instead of your Monoject® Syringe to clean under your expander.

Additionally, in your Hygiene Kit, we include orthodontic wax for your comfort.

Descriptions of Each Cleaning Aid & Accessories

Manual Toothbrush

When using a manual toothbrush, ALWAYS use a soft toothbrush. Medium and hard bristles are too hard on the gums and over time, can cause the gums to recede. It is wise to use a manual toothbrush in conjunction with an electric toothbrush, such as a Rota-dent® or an Oral-B®. Studies have shown that manual toothbrushes alone are significantly less effective for oral cleaning than electric toothbrushes are, though manual toothbrushes can still do a reasonable job with excellent brushing technique. When using your manual toothbrush alone or in conjunction with an electric toothbrush, use a circular motion, as a back and forth motion will miss plaque. Dr. Held recommends that you use Colgate Total® toothpaste with your manual toothbrush. You should replace your manual toothbrush every three or four months – or sooner if the bristles become frayed. A worn toothbrush will not do a good job of cleaning your teeth.


Flossing is an exceptionally important part of keeping your teeth clean and should be performed at least 1 time per day for 5 minutes. It is important to work the floss gently underneath the unattached gingiva (gum) on both sides of each papilla (gum triangle), moving the floss along both teeth adjacent to each papilla, so that each side of every tooth is flossed, as plaque sticks to the teeth, not to the gums. Use a new, clean position on the floss for each papilla. Removing the plaque from underneath the gums is a vital part of excellent oral hygiene.

Floss Threader

Many people think that they can't floss while wearing braces or an expander, but that is ABSOLUTELY FALSE! It just takes a bit more work to get the job done properly. To floss with braces or an expander, a floss threader is an excellent aid. To use a floss threader, simply thread the floss into the eye of the floss threader, and maneuver the threader under the archwire between two brackets (for braces) or support arm (for expanders), right over a papilla. Once the floss is threaded under the archwire or support arm, you can then floss normally. Then, just unthread the floss, and move to the next papilla. Use a new, clean position of the floss for each papilla that you floss.

Oral-B® Threader Floss is an alternative to a floss threader. It is a “one-time use” piece of floss with a stiff end – like a built-in floss threader. Oral-B® Threader Floss can be found in most pharmacies and grocery stores.


Dr. Held recommends that you use Colgate Total® toothpaste, due to this toothpaste's 12 hour antibacterial protective shield. Colgate Total® toothpaste is approved by the Food and Drug Administration (FDA) and accepted by the American Dental Association (ADA) to fight gingivitis.

Travel Toothbrush

A travel toothbrush is an excellent cleaning aid to carry with you throughout your day. Ideally, you should brush after every meal. Your travel toothbrush will easily allow you to do so.

Proxibrush (“Christmas Tree Brush”)

This small brush is also more commonly known as the "Christmas Tree Brush." It is a small, cone-shaped brush that easily fits under the archwires to clean away the plaque that builds up there. When using the proxibrush, rinse the brush as you clean, so that plaque is removed from the brush. The proxibrush is very useful to carry with you and to use after meals throughout your day. Replace your proxibrush when it becomes frayed.

L'il palates™ cleaner

The l'il palates™ cleaner is an essential cleaner to use while wearing an expander. It has a flexible arm with a soft, plastic hook that can fit between the expander acrylic (plastic) and the roof of your mouth. Gently slide the l’il palates™ cleaner under the expander plastic, from the front of your mouth to the very back, and use a sweeping motion to dislodge food and plaque. Remember to sweep the sides of your palate, as it is curved like a rainbow. You should use your l'il palates™ cleaner along with your Monoject® Syringe or Waterpik® 3 times per day, after you brush your teeth.

Monoject® Syringe

The Monoject® Syringe is fantastic for cleaning food and plaque out from under your expander, using water pressure. Simply pull back on the plunger with the tip of the syringe dipped in a cup or bowl of water. Then, while leaning over the bathroom sink, aim the syringe tip just under the front of the expander plastic, and push the plunger inward. Repeat until the water is clear of food and plaque. It's like giving the roof of your mouth a shower. For even better results, you may use a Waterpik® instead of the Monoject® Syringe. You should use your Monoject® Syringe or Waterpik® along with your l'il palates™ cleaner 3 times per day, after you brush your teeth.

Fluoride Rinse

Fluoride can help to slow down the deleterious effects of plaque. Fluoride is kind of like a vitamin for your teeth. Because of the positive effects that fluoride provides, Dr. Held recommends that you purchase an over-the-counter, daily use fluoride rinse (such as ACT®).

How Fluoride Works: For those of you familiar with chemistry, fluoride helps to strengthen teeth by replacing the OH- molecule in the enamel with an F- molecule. The F- molecule is stronger than the OH- molecule and thus, acts like armor against plaque.


It is wise to use mouthwash to kill bacteria and to freshen your breath. We use Listerine® in our office. Please remember that mouthwash is not a substitute for fluoride.


The Waterpik® is an excellent accessory cleaning aid for removing the large pieces of food and debris from around your braces and from under the gums. Please remember that it should not replace brushing and flossing. Use your Waterpik® 3 times per day, after brushing your teeth (or after flossing, if it is time to floss).

If you purchase a Waterpik® and you have an expander, you may use your Waterpik® instead of your Monoject® Syringe for cleaning under your expander. Just place the tip of the pointed Waterpik® attachment under the front of the expander plastic. Then, while leaning over the bathroom sink, turn your Waterpik® on. Rinse until the water is clear of food and plaque. It's like giving the roof of your mouth a shower massage.

Orthodontic Wax

Orthodontic wax is used to stop your braces or expanders from irritating your lips, cheeks, or gums. If a part of your braces or expander is causing discomfort, you can take a ball of wax (pea-sized or grape-sized), dry off the offending part of your appliances, and place the wax on the part that is irritating. Make sure to embed the irritating part totally within the wax. When drying off your appliances, use a cotton swab, a cotton ball, or a tissue to dry the area first, as wax does not stick well in a wet environment. Covering the irritating area of the braces or expander with wax will smooth the area and soothe the adjacent region of the lips, cheeks, or gums. Orthodontic wax is non-toxic, but it is easier to manage if you remove it prior to eating, brushing, and flossing.

Meet Dr. Held

Originally from Northern California, Dr. Cheryl L. Held began her orthodontic residency at the Saint Louis University Department of Orthodontics.
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  • 9979 WingHaven Blvd., Suite 200
  • O'Fallon, MO 63368
  • ph. 636.561.5550