Given the fact fixed orthodontic appliances increase the surface area within the mouth and subsequently cause the accumulation of plaque, it is no wonder the orthodontic patient struggles to maintain good oral hygiene. Studies have shown it is important to perform rigorous home care during orthodontic treatment to prevent excessive plaque accumulation creating caries and periodontal disease. The increased amount of retentive plaque surfaces from fixed appliances causes an acidic pH and increased bleeding of tissues.2
Considering orthodontic appliances consist of wires, hooks, and tubes positioned about 1-2 millimeters above the tooth surface creating just enough space to harbor thousands of species of bacteria within plaque, it is no wonder plaque removal is so difficult. Finding devices with the ability to reach into these tiny locations can be difficult, but not impossible. Sometimes modification of existing tools is necessary. This can be done by either changing the device to suit the need better or by redefining the use of a product. For instance, to change an existing device, one could heat up a toothbrush handle and bend it to create better angulation for placement in a specific area. In order to redefine the use of a product, the dental professional could recommend using a device in a way that was not part of the original intent of the product.