Crooked teeth, cleaning and gum health

Adults who ask about straightening their teeth are usually assumed to be doing it for appearance. Often they are. But a fair number come to it from the other direction: they have been told, appointment after appointment, that they have bleeding gums in the same two or three places, and those places are always where the teeth overlap.

Why crowding makes cleaning harder

Gum disease is caused by plaque left sitting at the gum line. Removing it every day is what keeps the gums healthy.

Where teeth are crowded, rotated or overlapping, that becomes genuinely difficult. An interdental brush will not pass through the gap, floss will not sit flat against a rotated surface, and the toothbrush cannot reach the face of a tooth that is tucked behind its neighbour. Plaque stays where it is, and the gum in that spot stays inflamed. It is not a matter of trying harder, and patients in this position are often already trying very hard.

What straightening can and cannot do

Straightening the teeth removes the obstacle. Once the teeth are in line, the brush and the interdental brush can reach the surfaces they could not reach before, and daily plaque control becomes achievable rather than a losing battle.

What that means in practice is worth being precise about. Alignment does not treat gum disease and it does not cure it. It makes the cleaning you do more effective, and there is evidence that crowding is associated with more plaque and more gum inflammation. If you already have gum disease, it needs to be treated and stabilised by the hygienist before any orthodontic treatment begins, not instead of it. Moving teeth through inflamed, unstable gums is not something we will do.

Gum disease has also been linked with a number of general health conditions. Those associations are real but frequently overstated, and straightening teeth is a long way from being a treatment for any of them. The reason to straighten crowded teeth is that you will be able to clean them.

Whether it applies to you

Not all crooked teeth are hard to clean. Plenty of people have teeth that are visibly not straight and gums that are perfectly healthy, and there is no case for treatment there on gum health grounds. The question is whether there are specific spots you cannot get into, and whether those same spots bleed. Your hygienist will usually be able to tell you.

Where it does apply, Invisalign is the option most adults choose, because the aligners are removable, which means brushing and cleaning between the teeth carry on as normal throughout treatment. Treatment starts from £2,200, and you can see the full price list on our fees page.

If you want an honest answer about whether straightening would help your gums, ask at your next hygiene appointment or get in touch.