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How Braces Can Lead to Cavities

When seeking orthodontic treatment, it is important to compare your options. The most common choice is braces, but did you know that braces can cause more problems than they fix?

To understand how this can happen, let us look at how the fixed appliances themselves work.

How do braces work?

Traditional orthodontic metal braces consist of three main components: Brackets, Arch wires, and O-ties (ligatures/clips).

The bracket is a small metal part that is bonded to your teeth. The brackets engage with the arch wire, and this is what moves your teeth into the correct alignment. Before starting treatment, the arch wire is bent into the ideal shape of your teeth. The arch wires are very springy, and they will want to return to their original position even after they are set into place by the bracket. As they slowly return to their original shape, the teeth are pulled along with them into the correct alignment. O-ties (orthodontic ligatures) attach the arch wire to the bracket to facilitate tooth movement.

Tooth movement is caused by the constant application of pressure to the teeth by the arch wire. This causes signals to be sent to special cells in your blood to carry out a process known as bone remodeling where the bone is resorbed from its current position and deposited in the new position. This is a slow and gradual process with orthodontic treatment, typically lasting two years.

So, now that we know how braces work, we will answer the question:

How can braces lead to cavities?

Braces can increase the risk for cavities in the following ways:

  • Food getting stuck

The way braces are designed makes it easy for small pieces of food to become lodged between the wires and teeth. This food is the perfect substrate for bacteria within the oral cavity to act on to produce acids. These harmful acids can cause the demineralization of tooth enamel and cause cavities or small holes to form in your teeth.

  • Oral hygiene is more difficult

While we are all aware that we should be brushing our teeth at least twice daily, brushing with braces requires a special technique and is more time-consuming. Flossing is also essential, and a floss threader or water flosser will be needed to do it properly with braces. It can become tedious trying to maneuver your way around the mouth, and so some patients do not bother. This leads to declining oral hygiene and ultimately poor dental health.

  • Metal braces can help to cause demineralization

When food is acted upon by bacteria, demineralization occurs. During this process, the acid pulls minerals such as calcium and phosphate out of the teeth, and this can cause white spots. Not only are these spots an aesthetic nightmare, but they also weaken the tooth and increase the risk of cavities.

  • Filling cavities with metal braces requires multiple visits and is expensive

The reality is that cavities may form, and the longer you are in braces, the likelihood increases. Cavities are more likely to form around your braces and getting them filled would require removing the wires and brackets on the affected teeth, getting the cavity filled, and then re-affixing the brackets and wires. Not everyone will be willing to go through this tedious process, and so cavities may be left to fester.

What problems can be created by cavities?

When cavities develop during orthodontic treatment, they will become more difficult to treat as time progresses. What was once a small cavity in the enamel could spread to deeper layers of the teeth to involve the dentin and the pulp. If this happens, pulpal involvement means that there is an increased likelihood of pain and the need for more complex treatment when the braces are removed.

When a cavity spreads to involve the pulp of the tooth, root canal treatment, and a crown may become necessary when braces are removed. Both of these treatments are expensive and require multiple visits to be completed.

In patients with poor oral hygiene, where widespread demineralization has occurred and white spot lesions from around the brackets, this poses a serious aesthetic problem that will require multiple restorations to fix-like composite or porcelain veneers on anterior teeth.

So, the truth is that braces cost more than just braces. It's the added stress and time that comes as baggage that many patients are searching for alternatives.

The Good News

The good news is that there are alternatives to teeth straightening. At-home aligners have been proven to be effective and only a fraction of the cost of traditional braces. They can also help you avoid the common problems that come with braces because they are removable. See if you're a candidate today by taking a quick 30-second questionnaire!


  1. Coles, D. (n.d.). How Do Braces Work? Premier Orthodontics.

  1. MiSmile Network. (2017, March 23). 4 Facts about Cavities and Metal Braces.


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