If you have braces and you notice your gums are puffy or swollen, it’s worth getting it checked out. However, not all swollen gums are a sign that something is wrong. Many orthodontic patients experience minor gum issues that end up being nothing to worry about.
But for others, braces are the perfect breeding ground for bacteria and the build-up of plaque. If dental hygiene is lacking, it can lead to gum problems.
The Relationship Between Braces and Swollen Gums
The placement of fixed braces normally make it more difficult to clean the teeth.This often results in an increase in the number of bacteria around the appliances that can cause changes in the gingivae (gums).
Orthodontic treatment can cause gum overgrowth without any clinical signs of gingival inflammation or poor oral hygiene by tissue bunching up as teeth are pushed together. It may also lead to loss of gum tissue and recession formation in some patients if the gum tissue is thin and the teeth are moved off the supporting bone. In some situations, the gum tissue may improve if an extremely displaced tooth is returned into the supporting tissue. A study found up to 10-12% of orthodontic treatment patients exhibited gingival recession.
Swollen gums should not be ignored as it may be a sign of gum (periodontal) disease where bacteria infect the soft tissue leading to gingivitis (infection of the edges of the gum) and the more serious progression towards periodontitis (infection deeper into the gum towards the surrounding bone). The gum infection can cause long-term damage to the soft tissue and, if not treated, can destroy the bone that surrounds your teeth. Once this bone is destroyed, it can’t provide adequate support for your teeth, causing them to become loose and even fall out.
The infection is usually caused by poor brushing and flossing habits and some people may also have weaker resistance to bacterial build-ups, resulting in a more pronounced infection. When bacteria are allowed to accumulate on teeth and gums, inflammation occurs. In the early stages, your gums recede away from your teeth creating small pockets between the gums and teeth. These pockets allow more bacteria to accumulate and your immune system works to fight the infection.
You may notice your gums look red and swollen. Bleeding during brushing and flossing is another sign of periodontal disease. In this early stage of the disease, you may experience some bone loss, but it’s possible to seek treatment and stop further damage to the gum and bone.
Moderate periodontal disease means you lose bone support and teeth may become loose. The disease can cause an inflammatory response in the body. If the disease is left to continue without treatment, you may experience more bleeding, pain, bad breath and gum recession.
Swollen Gums Before Braces
Swollen gums and periodontal disease can occur at any time – before, during or after orthodontic treatment.
Orthodontists will look for signs of poor oral hygiene such as a build-up of plaque before braces are fitted. If a patient isn’t looking after their teeth adequately before braces, it’s likely the situation will get worse once the braces are fitted. Your orthodontist will look for signs of gum inflammation, swelling, recession and tooth movement at the initial appointment. X-rays are taken to check for any sign of bone loss.
If there are signs of periodontal disease, a patient will be referred back to their dentist for treatment or to a periodontist, if specialist care is required. Your orthodontist will require your gums to be as healthy as possible before orthodontic treatment begins. Braces move teeth in the gums and if the gums are infected, teeth movement can make any gum problem worse.
It is essential to continue to see your dentist/periodontist regularly during treatment to monitor the health of the gums during orthodontics.
Swollen Gums During Orthodontic Treatment
Your orthodontist will continue to check your gums at each appointment. If your orthodontist or therapist notices a build-up of plaque or minor gum disease, you may need further instructions on brushing and flossing with braces. It may be advisable to increase the number of times you brush your teeth each day until the inflammation clears up. However, the brushing needs to be gentle to ensure you don’t cause further gum damage.
What to Do if You Notice Swelling in Your Gums
If you notice your gums have become swollen or puffy during orthodontic treatment, it’s important to call your orthodontist without delay and make an appointment to have it checked out. It’s common for people who wear braces to suffer from gum inflammation because they make it harder to maintain good oral hygiene.
Your orthodontist will carefully check your gums and tell you if you need to make any changes to your oral hygiene or seek further treatment. Your gum inflammation is likely to be a mild case of gingivitis which is highly treatable.
What if Your Swollen Gums is Periodontal Disease?
In rare cases, the diagnosis for swollen gums is aggressive periodontal disease. Orthodontic treatment may be paused and a referral provided to see a periodontist for specialist treatment. Moving teeth with braces or Invisalign when there are gum issues present becomes more difficult and the outcome is often compromised compared to healthy gums. Receding and swollen gums will be examined, the bacteria may need to be cleaned out from under the gums, and any bone loss is evaluated.
Once the periodontal disease is under control, orthodontic treatment can safely begin again. However you will need to see the dentist/periodontist more regularly than a normal patient to monitor it for the duration of your orthodontic treatment and beyond if there is a risk of a relapse.
Keep Up Appointments With Your Dentist
Many people won’t notice subtle signs of periodontal disease such as swollen gums in its early stage. Keep up with thorough brushing and flossing twice or more per day and see your dentist at least every six months for an examination and professional clean. Your orthodontist will also keep a close eye on your gum health at each appointment.