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Gaps or irregularly placed can occur naturally or as a result of gum disease. Braces are the best choice for correcting this problem. This article will explore the possibility of getting braces after having been diagnosed with gum disease.

Gum disease also called as periodontal disease, is extremely common around the world [1]. Gum disease progresses slowly and affects the gums, the ligament attaching the tooth to the bone, and the underlying bone of the jaw.

Symptoms of gum disease include bleeding from the gums, bad breath, shifting of the teeth due to the loss of bone, teeth becoming loose and shaky, and maybe even falling out. Since pain is not one of the symptoms, the diagnosis of gum disease often occurs incidentally during a check-up or during treatment of some other complaint [2].

Braces or orthodontic treatment to shift the teeth into a more favorable position requires the presence of a healthy amount of bone support. Teeth which are already shaky and do not have the necessary support can actually become worse with orthodontic treatment [3].

Luckily, there is a solution for people that are suffering from gum disease and are looking for braces.

Can people with gum disease get braces?

The answer to this question is a yes, provided the gum disease is bright under control and a steady dentition with no active infection can be achieved.

If gum disease is suspected or detected by an orthodontist then the patient will first need to be referred to a periodontist for evaluation. The level of the gum disease will dictate whether the teeth are strong enough to withstand the forces of orthodontic movement [4].

For a patient who is detected to have gingivitis only, the treatment is relatively simple. Scaling, or bleeding gums treatment, has to be carried out to bring down the level of gingival inflammation. Normally, a visible difference in the state of the gums is noticeable only a couple of days after the completion of treatment. In such a situation, the patient could be given the go-ahead for getting braces a week or so after the completion of the scaling. The same treatment is necessary for patients the develop gingivitis during orthodontic treatment [5].

If, however, the gum disease has progressed to a point where around the bone around the teeth has started to become compromised then things become a lot more complex. The treatment will now likely involve gum surgery and increases the waiting time before which orthodontic treatment can begin [6].

It requires a minimum of three months to be sure that gum disease has been arrested and that the remaining teeth are strong enough to bear the load of the orthodontic forces. 

If the chief reason for the appearances of spaces in between the teeth is due to gum disease, then it indicates that the loss of bone around the teeth may be quite significant. It is highly unlikely in such a condition that a patient will be able to get an orthodontic treatment done.

Simply put, if the teeth are unable to withstand the normal forces during chewing then they are not going to be able to be strong enough to get braces. There are case reports of successful treatment done in patients with severe gum disease but those instances are rare [7].

Can braces worsen gum disease?

There are a couple of ways in which braces can affect pre-existing gum disease.

The presence of external attachments on the teeth makes them more likely to accumulate plaque on their surfaces and end up increasing the inflammation of the surrounding gums [8]. The patients must be made aware of this possibility and the need for a stricter oral hygiene regimen must be reinforced.

There is no point in having the teeth in the right positions if they are going to be decayed or rife with gum disease by the time the treatment is over.

There is also an upside to orthodontic treatment. The movement of the teeth into their proper positions can help reduce any excessive loads on the teeth and increase their lifespan. It is also easier to maintain good oral hygiene when the teeth are properly arranged without any crowding or overlaps [9].

There is also a condition in which improper orthodontic forces end up compromising the integrity of the teeth. There is only a certain range of forces which should be applied on the teeth to bring about their movement in the jaw. An attempt to accelerate this process by applying more than recommended forces can lead to the destruction of bone around the teeth, make them shaky, and even lead to the loss of teeth from the jaw [10].

Can gum treatment be provided after getting braces?

Sometimes gum disease may be diagnosed after the orthodontic treatment has already been started. Depending on the condition, gum treatment can be provided at that time as well. The periodontist may need the braces to be removed until the treatment has been completed or for the braces to be kept in a neutral position until the problem can be taken care of.

The likelihood of gum treatment being successful does not change with the presence of braces. The underlying factors determining the success of gum treatment remain the same: Current destruction, the ability of the patient to maintain oral hygiene, and forces which the affected teeth are being put under on a daily basis.

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