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Can You Wear Aligners with Cavities? A Comprehensive FAQ Guide

Orthodontist examines patient with cavities before clear aligner therapy.

Cavities are among the most common oral health problems from which patients will suffer. According to CDC estimates, around 57% of adolescents suffer from cavities, and 90% of adults aged 20 and older have at least one cavity. If you’re a current or prospective clear aligner wearer among that 57% or 90%, you might be wondering what that means for treatment.

Perhaps you’re wondering whether or not cavity problems would affect your candidacy  to receive clear aligner treatment. If either scenario applies to you, then you should refer to this in-depth comprehensive FAQ guide to better understand the relationship between cavities and clear aligners.

Can You Get Aligners If You Have A Cavity?

It’s technically possible, though not advisable, to get aligners with an open cavity. Likewise, it’s technically possible to drive a car with a broken exhaust, but you still wouldn’t want to, lest you risk having corrosive toxins seep through the opening.

That same logic applies to your teeth; if even a single vulnerable opening is present, it will be a far greater priority to address that opening before addressing your teeth alignment.

The good news with clear aligner therapy is that you still can get your cavities treated and, most of the times, your aligners will still fit. In those rare cases, where you already started aligner treatments and after treatment of those cavities you have difficulties fitting aligners, your treating doctor can request replacement of those aligners for little to no additional cost.

Do Clear Aligners Increase Risk of Cavities? Can Aligners CAUSE Cavities?

No. Neither clear aligners, braces, or any other orthodontic treatment will directly cause cavities, nor will they directly exacerbate the risk of them happening. However, clear aligners will demand an extra level of oral hygiene diligence; even though using a trustworthy tool is important, it’s even more important to utilize that tool responsibility.

Cavities can be one problematic nuisance, with or without clear aligners. But that nuisance can be addressed by the "Three Cs":

  • Care
  • Compliance
  • Cleanliness

You should take the utmost care precautions to keep both your teeth intact, and your aligner appliances intact in one piece. Furthermore, you should enforce that care with a loyal, dedicated compliance to maintaining a robust oral hygiene routine. Lastly, you should pay mind to diligently promoting cleanliness.

It could be argued that aligners and braces may indirectly contribute to the exacerbation of plaque, periodontal disease, and cavity-causing decay if you aren’t careful. Even so, it would be a misnomer to say that aligners, or any orthodontic appliance for that matter, could directly cause or prevent cavities. At the end of the day, that responsibility falls on you and you alone.

What Happens If You Get A Cavity with Aligners?

Your orthodontist will want to have any existing, open cavities filled shut before moving forward with clear aligner therapy. But what happens if you get a new cavity, after you’ve moved forward with treatment?

If a cavity occurs in the middle of treatment, then that will be the first and foremost immediate priority to attend to. The first immediate priority will be having that cavity attended to with fillings or restorations.

If the filling or sealant drastically alters the shape of the tooth, then your orthodontist may need to perform a treatment revision, as the original fit may become compromised. If you need revised impressions or scans, then you should get that taken care of ASAP.

How to Avoid Cavities with Aligners?

You would go about avoiding cavities with clear aligners as you would without clear aligners. Keeping your smile healthy and happy is a continuous, ongoing, and lifelong struggle. Adhering to consistent care, compliance, and cleanliness (those 3 C’s we mentioned earlier) will go a long way toward curtailing your risk of developing cavities.

To maintain due oral hygiene diligence, you should:

  • Brush 2-3 times a day, for two minutes a day (per ADA recommendations)
  • Floss each tooth, incorporating a Waterpik or interdental brush for good measure
  • Gargle saltwater and/or mouthwash for at least 30 seconds to promote disinfection

Beyond those basic care routines, the following steps can also help you minimize the risk of developing cavities and tooth decay:

  • Limit sugary/acidic beverages: Sweetened coffee, tea, soda, beer, and processed juice can all force undue wear on the teeth over prolonged, long term exposure. To mitigate that wear, consider moderating or abstaining from these substances.
  • Drinking tap water: Fresh tap is high in enamel-strengthening fluoride that most bottled water brands simply lack. To curtail cavities, consider drinking more tap, and if your region doesn’t have the highest quality drinking water, purify it further using a Brita filter.
  • Stop smoking: Tobacco doesn’t just stain the teeth yellow; it leaves them more vulnerable to decay by receding the gum tissue from your roots! To fully eliminate this cavity risk, it’s ideal to fully eliminate this bad habit.
  • Limit snacking or sipping: Frequent snacking on sugary foods isn’t just problematic to your cavity risks; it’s problematic to your treatment compliance as well. To keep your smile journey moving as smoothly as possible, cut back on the frequent sweets.
  • Switching toothpaste brand: If you’re not already using a brand of toothpaste that contains fluoride, then you should switch to one that does.
  • Brushing your tongue: Billions of bacteria are living in your mouth at any time, and your tongue can be a convenient launchpad for that bacteria to fester. To alleviate bad bacterial buildup, take the extra initiative and brush your tongue.
  • Regular dental visits: Don’t neglect getting your regular deeper cleaning from your dentist, at least once every six months.

If you try all of the above and still find yourself suffering from cavities while wearing aligners, consult your dentist and orthodontist for additional help. Perhaps there’s a missing link you’re yet to uncover, or your cavity issues are emblematic of a deeper underlying problem.

In any case, it’s always good to ask for help, and have access to antibacterial remedies you wouldn’t be able to access otherwise.