Emergency
What to do when you have an Orthodontic 911!
Braces are delicate and must be taken care of in order to prevent damage to them. Always be careful with what you eat and your activities to keep from breaking any of your appliances. Sometimes, however, things happen and something breaks. It is important to know what to do. The following are some of the common problems that occur and what to do about them. The following orthodontic emergencies and their treatments are listed in the order of the least severe to the most severe. Only the most severe emergencies may require immediate attention by an orthodontist. The majority of these are easily treated with a follow-up to our office.
| Food Caught Between Teeth |
 This is not an emergency, but can be a little uncomfortable or embarrassing for the braces wearing patient. It is easily fixed with a piece of
dental floss. Try tying a small knot in the middle of the floss to help remove the food, or use an interproximal brush or toothpick to dislodge
food caught between teeth and braces.
|
| Ligatures Come Off |
 Tiny rubber bands or small, fine wires, known
as ligatures, hold the wire to the bracket. If a
rubber ligature should come off, you may be
able to put it back in place using sterile tweezers.
If a wire ligature comes loose, simply remove it
with sterile tweezers. If the wire ligature is sticking
out into the lip but is not loose, it may be
bent back down with a Q-tip or pencil eraser to
eliminate the irritation.
Of course, when one ligature pops off or breaks, others may follow. Be sure to examine all ligatures. Missing or broken ligatures should be rought to the attention of the patient’s parent/guardian, who should then inform the orthodontist.
If a rubber or wire ligature is lost, notify the parent/guardian so that the orthodontist may advise
whether the patient should be seen. |
Discomfort |
| Mouth Sores |
 Some patients are susceptible to episodes of
mouth sores. While braces do not cause them,
they may be precipitated or exacerbated by an
irritation from braces. One or several areas of
ulceration of the cheeks, lips or tongue may
appear. This is not an emergency, but may be
very uncomfortable for the patient. Prompt relief
may be achieved by applying a small amount of
topical anesthetic (such as Orabase or Ora-Gel)
directly to the ulcerated surface using a cotton
swab. Reapply as needed. |
| Irritation of Lips or Cheeks |
 Sometimes new braces can be irritating to the
mouth, especially when the patient is eating. A
small amount of non-medicinal relief wax makes
an excellent buffer between metal and mouth.Simply pinch off a small piece and roll it into a
ball the size of a small pea. Flatten the ball and
place it completely over the area of the braces
causing irritation. The patient may then eat more
comfortably. If the wax
is accidentally ingested, it’s not a problem. The
wax is harmless. |
|
Protruding Wire |
 Occasionally, the end of a wire will work itself
out of place and irritate the patient’s mouth. Use
a Q-tip or pencil eraser to push the wire so that
it is flat against the tooth. If the wire cannot be
moved into a comfortable position, cover it with
relief wax. (See Irritation of Lips or Cheeks
above for instructions on applying relief wax.)
The patient’s parent/guardian will need to make
the orthodontist aware of the problem.
In a situation where the wire is extremely
bothersome and the patient will not be able to
see the orthodontist anytime soon, you may, as
a last resort, clip the wire.
Reduce the possibility of the patient swallowing
the snipped piece of wire by using folded tissue
or gauze around the area. Use a pair of sharp
clippers and snip off the protruding wire. Relief
wax may still be necessary to provide comfort
to the irritated area. |
|
Loose Brackets, Wires or Bands |
 If the braces have come loose in any way, the
parent/guardian needs to be notified, and they
should call the orthodontist to determine appropriate
next steps.
Brackets are the parts of braces attached to
teeth with a special adhesive. They are generally
positioned in the center of each tooth. The
bracket can be knocked off if the patient has
eaten one of those hard or crunchy foods orthodontic
patients are instructed to avoid, or if the
mouth is struck while at play. (All
patients, especially those with braces, should wear
a protective mouth guard while playing sports.)
If the bracket is off center, the adhesive may have
failed. Call the parent/guardian, and recommend
that they immediately notify the orthodontist, who
will determine the course of action.
If the loose bracket has rotated on the wire
and is sticking out and the patient cannot
immediately be taken to the orthodontist, you
can do a temporary fix to alleviate discomfort
and prevent further damage. But take care to
prevent swallowing or other injury.
To put the bracket back in place, use sterile
tweezers to slide the bracket along the wire
until it is between two teeth. Rotate the bracket
back to the proper position, then slide it back to
the center of the tooth. |
|
Piece of Appliance is Swallowed This is rare, but when it does happen, it can be fairly alarming to the patient. Encourage your patient to remain calm. If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated. If you are able to see the piece, you may carefully attempt to remove it. But do not make the attempt if you could cause harm. If appropriate under the circumstances, examine the patient’s braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above. If you are unable to see the piece and believe it may have been aspirated, notify the parent/ guardian and the orthodontist immediately. If you lose one of the colored rubber bands on your braces, all you need to do is notify your orthodontist at your next visit. Unless it becomes uncomfortable, you do not need to see your orthodontist before your next scheduled appointment. If your headgear doesn’t fit, it may be because you are not wearing it as your orthodontist prescribed. Follow your orthodontist’s instructions and the discomfort should diminish. If the face bow is bent, call your orthodontist at once. When you lose any appliance or your retainer, call your orthodontist’s office as soon as you can so that treatment will not be delayed for too long. It is important to pay attention to the condition of your appliances and take immediate action when there is a problem. That way your treatment time can be kept to a minimum and you will be smiling with beautiful teeth as soon as possible. Paying attention and doing your part will bring great rewards with a sparkling smile. This includes the essentials of brushing and flossing every day, eating a balanced diet, and visiting your dentist regularly. Click here to download a flyer of how to handle orthodontic emergencies. |