Objective To explore the effect of the "five-step" problem-solving nursing model on tooth glossiness and smile aesthetic score in orthodontics patients. Methods A total of 108 patients who received orthodontics treatment at the School of Stomatology, Anhui Medical University (Afffliated Stomatological Hospital) from January to December 2024 were selected as the research subjects, and they were divided into the basic group and the study group by the coin-ffipping method, with 54 patients in each group. The basic group received conventional nursing, and the study group received the "ffve-step" problem-solving nursing model. The tooth glossiness, smile aesthetic score, plaque index and satisfaction were compared between the two groups. Results The tooth glossiness of the study group at 6 and 12 months after nursing was higher than that of the basic group (P<0.05). The smile aesthetic score indicators of the study group at 12 months after nursing were higher than those of the basic group (P<0.05). The plaque indexes of the study group at 6 and 12 months after nursing were lower than those of the basic group (P<0.05). The satisfaction rate of the study group (96.30%) was higher than that of the basic group (85.19%) (P<0.05). Conclusion The "five-step" problem-solving nursing model helps to improve the tooth glossiness and smile aesthetic score of orthodontics patients, reduce the plaque index, and enhance their treatment satisfaction.