swollen gums with braces--help!

[m2w&l]

Hello!

My son has had braces for a year and a half now.  After his appointment this last January, the gums in the back of his mouth began to swell (before that he never had issues).  After his dental cleaning in January, the hygenist told us he has areas of decalcification on his teeth. The ortho tech said he needed to to a better job brushing his teeth, and showed us what she wanted him to do.  Since that time it has been a big struggle.  His gums in the back of his mouth are now right on top of his brackets, in spite of a great deal of effort on his part.  The ortho office isn't a whole lot of help; they just tell him he's not doing it good enough.  We even bought a sonic toothbrush that the office sells with the idea that it would help.  It hasn't.  Here is his routine:

In the morning and after school:

He brushes his teeth in tiny circles with a regular toothbrush wetted with water, and then brushes away from his gumline, as the ortho tech showed him to do.

He brushes his teeth with the sonic toothbrush on the "gum care" setting with fluoride toothpaste for 3 minutes.

He has me or his dad check to see if we see any spots he missed.

He rinses with salt water to help with the swelling.




Before bed he does the following routine:

Uses the proxa brush to get in between his teeth and braces (can't use it on back teeth because of swelling)

Flosses

Brushes his teeth in tiny circles with wetted regular toothbrush, then away from gums as ortho tech showed him

Rinses mouth with Closys (an antiseptic rinse), swishing vigorously to dislodge any missed food particles

Brushes his teeth with the sonic toothbrush and fluoride toothpaste on "gum care" setting  for 3 minutes

Has his dad or me look to make sure he didn't miss any spots

Rinses mouth with Listerine to kill plaque germs

Rinses mouth with fluoride rinse to help reduce decalcification


It's very frustrating for him to put so much effort into it only to be told he isn't doing a good job.  It's very difficult to see if he's getting the food out of his brackets in the back due to the swelling.  I can totally understand his frustration, and I share it.  Why go to all this effort only to go into the ortho to have them tell us he's not working hard enough on his teeth?  The ortho tech said he can brush his teeth all day but if he doesn't get the food out it won't make a difference.  When I asked her if she would watch him brush his teeth so she could show him where he's doing it wrong, she just took him over to the chair and showed me (and him, holding a mirror) what he needs to be doing--little circles on each tooth and then brushing away from gumline).  It's very difficult to keep him motivated.  I never had braces, so I never had to deal with this.  Hubby says he didn't take near as good care of his teeth when he had braces (he never flossed and drank tons of Pepsi) and doesn't remember having this issue.  

I made an appointment with them to look at his teeth in two weeks to see how he's doing (he's not due for an adjustment for another 5 weeks), and if they say he isn't doing well, I am going to insist the tech WATCH him brush his teeth so she can correct his mistakes, and SHOW me where the food is, because I can't see it on the back teeth with his gums so swollen.  

Have any of you had experience with this?  

[turkee23]

yea procedure sounds painful but the patients said it wasnt that bad, they stay awake, they just take a machine called electrosurge and it literally "burns" off the excess gum. of course the patient is very numb and doesnt feel a thing. sometimes a suture or 2 is required.

the way you explain he was brushing sound like the right way to me, and it is the way we also teach our patients to do it in the office. yes i agree make them watch him brush and have them tell you what they think he is doing wrong. good luck and keep updated!

[m2w&l]

Thank you.  They haven't mentioned anything about needing a procedure; and they don't sound concerned by it--they just tell him he's not brushing properly (which it may be, but if so then take the time to help him learn to do it properly!).  They haven't x-rayed.  I'm not really concerned about appearance, since it's just the back teeth--the gums in front look great.  He has a dentist appointment in July--I may ask about it then if he's still having issues.  That procedure sounds painful, and after all the pain in the butt we've had with the braces, I want to make sure it's medically necessary before I do any more procedures on him.  

I understand what you're saying about the Listerine; the reason I was having him do the Listerine was to kill plaque germs and also because I read that using it right before using fluoride might help the teeth absorb more of the fluoride since the enamel is slightly softened by the Listerine.  I got that info from the blog "Ask Dr. Ellie."  I'll look into it a bit more though; thanks for mentioning it.  

I'm glad to know that this can be fairly common in teens.  They never mention THAT at the ortho.  It's always just, "You're not brushing good enough."  And that very well might be true, but Heaven forbid they actually take ten minutes to watch him doing it and correct his mistakes.  All I know is that he's working harder on his teeth as a teen than his dad or I ever did.  Grrr.  I'll be choosing a different ortho if our daughter needs braces.

[turkee23]

oops i meant to say we DID many procedures just for this same problem.....
have they xrayed the back teeth?....possible wisdom teeth coming early?

[turkee23]

sounds like he needs a gingivectomy, sometimes the gum tissue grows more then normal (gingival hyperplasia).

in my dental office i saw this many times on teenagers. we didnt many procedures to reduces the gums giving a better appearence to the teeth. and times we had to do it more then once cause the gums will gro back....

ps i wouldnt use listerine, is full of alcohol and bad for the enamel on your teeth

[m2w&l]

Just an additional bit of info:  his gums don't bleed when he brushes, but they are "squishy" in the back.  He says they don't hurt.