Every year, around 200,000 young people undergo NHS-funded orthodontic treatment.[i] On top of this, a 2024 survey found that more than 70% of orthodontists observed an increase in adults seeking treatment in the previous three years.[ii] This comes at a time when the popularity of clear aligners is excelling, often owing to improved aesthetics and oral hygiene capabilities.[iii]
However, many patients are still undergoing treatment with fixed braces. This could be because they are more suited to this treatment modality, especially in complex cases, or prefer enhanced predictability – fixed braces will always apply the forces planned by a professional, whereas clear aligners rely upon patient compliance to see results.
Fixed orthodontic appliances can have an impact on oral health through their presence in the oral cavity. Clinicians should understand the potential effects they may have on patient health, and offer support to mitigate the risk of irritation, pain and infection.
Managing periodontal health
Periodontal diseases are common, with almost half of UK adults having periodontitis.[iv] Complications with the soft tissue are reported to be a common side effect of orthodontic care, including gingivitis, periodontitis, gingival recession, and hypertrophy.[v] This is in part due to the increased build-up of plaque around the appliance and orthodontic brackets, which can be difficult to remove without diligence.[vi]
As mentioned, clear aligners are beneficial here, as they can be removed prior to the oral hygiene routine for improved access to all sites. Patients with clear aligners have better results in oral and periodontal health indices compared to those with traditional solutions,[vii] which typically produce a higher plaque index and an increasing bleeding on probing score over time.[viii]
Clinicians need to ensure patients are engaged with a diligent oral hygiene regimen, using effective solutions to debride plaque from the appliance with care. Specially designed orthodontic toothbrushes – with a unique arrangement of bristles to optimise cleanliness around orthodontic brackets – have been shown to improve tooth cleanliness compared to standard and electric solutions, and thus could be recommended to patients.[ix]
Individuals who begin to display signs of periodontal infection, including inflammation, bleeding when brushing and upon probing, and localised pain, should be supported appropriately throughout their orthodontic treatment.
Tackling white spot lesions
White spot lesions (WSLs) are typically the first stage of caries development, and are an understood side effect of orthodontic treatment with ill-maintained oral hygiene.[x] Once again, this is in part due to plaque build-up around the orthodontic brackets, requiring effective oral hygiene intervention.
Patients will typically present with small lines around the brackets, or large decalcified areas with or without cavitation, and this can be discouraging for patients after lengthy treatment timelines.[xi] One meta-analysis found that across 14 studies, 45.8% of patients had new WSLs develop during orthodontic treatment, and the prevalence of WSLs in all patients undergoing such care was 68.4%.[xii]
A 2023 study had lower prevalence rates, with 46.57% of total patients having WSLs at 12 months.[xiii] However, its patient group experienced a significant increase WSLs after beginning treatment – only 11.86% of patients were affected when beginning treatment.xiii
Whilst it may simply be an aesthetic problem for many patients, timely intervention is necessary to prevent the development of damaging carious tissue that requires more invasive restoration. Effective oral hygiene is paramount, and clinicians can provide advice on effective toothbrushes and toothpaste that will meet their clinical needs.
Irritation of the mucosa
One possible issue that cannot be solved with oral hygiene, however, is discomfort and pain caused directly by an appliance to surrounding soft tissue. This includes the periodontium and the buccal mucosa. These difficulties are thought to decrease patient co-operation and can lead to the discontinuation of treatment.[xiv] Oral mucosa ulcers may even develop following mechanical stress and the introduction of oral bacteria.[xv]
Whilst regular tooth brushing can displace harmful bacteria, additional support is required to avoid pain caused by the abrasive properties of loose wires and brackets. Such intervention is especially vital in the early stages of treatment.
The Orthodontic Relief Wax from Kemdent is designed to support patients, ensuring a simple, soft gum protector can be applied over irritating appliances in an instant. The wax is simply warmed in a patient’s hands, and moulded over a bracket or wire to minimise pain in the oral mucosa. Plus, the Orthodontic Relief Wax is stored in a small, pocket-sized tin, which is also completely recyclable to minimise plastic waste.
Patients beginning orthodontic treatment will require support from professionals to minimise sources of pain, from both common causes of infection and fixed appliances themselves. Recommendations of effective oral health and orthodontic adjuncts can make a significant difference to the course of treatment, and the overall experience of care.
For more information about the leading solutions available from Kemdent, please visit www.kemdent.co.uk or call 01793 770 256
Author: Alistair Mayoh Marketing Director Kemdent
[i] British Orthodontic Society, (2024). Claims about Orthodontics. (Online) Available at: https://bos.org.uk/news/claims-about-orthodontics/ [Accessed January 2026]
[ii] British Dental Journal, (2025). The demand for tooth straightening among adults continues to rise. (Online) Available at: https://www.nature.com/articles/s41415-025-8300-8 [Accessed January 2026]
[iii] Liu, F., Wang, Y., Luopei, D., Qu, X., & Liu, L. (2024). Comparison of fixed braces and clear braces for malocclusion treatment. BMC Oral Health, 24(1), 941.
[iv] Department of Health & Social Care, NHS England, (2025). Delivering better oral health: an evidence-based tootlkit for prevention, Chapter 5: periodontal diseases. (Online) Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-5-periodontal-diseases [Accessed January 2026]
[v] Cerroni, S., Pasquantonio, G., Condò, R., & Cerroni, L. (2018). Orthodontic fixed appliance and periodontal status: an updated systematic review. The open dentistry journal, 12, 614.
[vi] Annamalaisamy, S., Malthesh, B. S., Shashikumar, G. M., Shantharam, S., & Kumar, P. K. (2024). Comparative Study of Periodontal Health in Patients with Fixed Braces Versus Clear Aligners. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 4), S3790-S3792.
[vii] Cenzato, N., Occhipinti, C., D’amici, E., Savadori, P., Baldini, B., & Maspero, C. (2024). Microbiological Analysis of Plaque and its composition in three patient groups under different orthodontic treatments. Dentistry Journal, 12(6), 168.
[viii] España-Pamplona, P., Bernés-Martínez, L., Andrés-Castelló, C., Bolás-Colveé, B., Adobes-Martín, M., & Garcovich, D. (2024). Changes in the oral microbiota with the use of aligners vs. braces: a systematic review. Journal of Clinical Medicine, 13(23), 7435.
[ix] Rebekah, R., & Navaneethan, R. (2023). Cleaning Efficacy of Regular, Orthodontic and Electric Toothbrushes around Orthodontic Brackets: An In-vitro Study. Journal of Clinical & Diagnostic Research, 17(5).
[x] Lopes, P. C., Carvalho, T., Gomes, A. T., Veiga, N., Blanco, L., Correia, M. J., & Mello-Moura, A. C. V. (2024). White spot lesions: diagnosis and treatment–a systematic review. BMC Oral Health, 24(1), 58.
[xi] Khoroushi, M., & Kachuie, M. (2017). Prevention and treatment of white spot lesions in orthodontic patients. Contemporary clinical dentistry, 8(1), 11-19.
[xii] Sundararaj, D., Venkatachalapathy, S., Tandon, A., & Pereira, A. (2015). Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: A meta-analysis. Journal of International Society of Preventive and Community Dentistry, 5(6), 433-439.
[xiii] Jha, A. K., Chandra, S., Shankar, D., Murmu, D. C., Noorani, M. K., Tewari, N. K., … & kumar Tewari, N. (2023). Evaluation of the prevalence of white spot lesions during fixed orthodontic treatment among patients reporting for correction of malocclusion: a prevalence study. Cureus, 15(7).
[xiv] Namdar, P., Karkhi, H., Rezaeikalantari, N., Hosseinnataj, A., Namdar, M., Arab, S., … & Shiva, A. (2023). Incidence of mucosal lesions and pain during orthodontic treatment with fixed versus removable orthodontic appliances. Iranian Journal of Orthodontics, 18(2), 1-9.
[xv] Chang, J., & Li, X. (2024). Multivariate analysis of oral mucosal ulcers during orthodontic treatment. World Journal of Clinical Cases, 12(26), 5868.
