The following orthodontic concerns and their treatments are listed in the order from the most common to the least common. The majority of these concerns are easily treated over the phone or by scheduling a repair appointment. Only a few of these are true emergencies that may require attention by the orthodontist.
If the patient is coughing excessively or having difficulty breathing, a piece of their retainer could have been aspirated (drawn into the lung), call 911 and seek medical attention immediately! A physician may request an x-ray be taken to locate the piece in order to determine the best way to remove it. Call our office after seeking medical attention.
Food Caught Between Teeth:
This can be a little uncomfortable or embarrassing. 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:
Small, fine wires, known as ligatures, hold the wire to the bracket. If a wire ligature comes loose, simply remove it with sterile tweezers. If the wire ligature is sticking out toward the lip but is not loose, it may be bent back down with a Q-tip or pencil eraser to eliminate the irritation.
Occasionally, when one ligature loosens or breaks, others may follow. Be sure to examine all of the ligatures. If a ligature breaks or is removed, please call our office to determine if a repair appointment is necessary.
Discomfort:
It’s normal for a patient to have mild discomfort for a day or two after braces are put on or when retainers are adjusted. It can make eating a bit uncomfortable but reassure the patient that this is both normal and temporary. Encourage soft foods, warm saltwater rinses and over-the-counter pain relievers may be used.
Mouth Sores:
Some patients are susceptible to episodes of mouth sores. While braces do not cause them, they may be brought on 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. Instruct the patient to reapply as needed. Warm salt water rinses are also very soothing.
Irritation of Lips or Cheeks:
Sometimes new braces can be irritating to the lips or cheeks, especially when the patient is eating. A small amount of non-medical relief wax makes an excellent buffer between the braces and mouth. Simply pinch off a small piece and roll into a ball the size of a small pea. Flatten the ball and place it completely over the the brace that is causing the irritation. The patient may then eat more comfortably. Let the patient know that if the wax is accidentally swallowed, it’s okay, the wax is harmless.
Protruding Wire:
Occasionally, the end of a wire will work itself out of place and irritate the patient’s cheek. You can use a Q-tip or pencil eraser to push the wire flat against the tooth but 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.) and call our office for a comfort appointment.
In the situation where the wire is extremely bothersome and the patient cannot schedule a timely appointment, you may 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 call the office to schedule a repair appointment.
Brackets are the parts of braces attached to tooth 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 any hard or crunchy foods they are asked to avoid, or if the mouth is struck while at play. We encourage all patients, especially those with braces, to wear a protective mouth guard while playing sports.
If the bracket is off center, and is sliding on the wire, the adhesive may have failed. Please call and schedule a repair appointment.
If the loose bracket has rotated on the wire and is sticking out, you can do a temporary fix to alleviate discomfort and prevent further damage. To put these 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, and then slide it back to the center of the tooth. Please call the office to schedule a repair appointment.
Piece of Appliance is Swallowed:
This is rare, but when it does happen, it can be fairly alarming to the patient. Encourage the patient to remain calm. If there is no coughing or difficulty breathing, and you suspect a piece has been swallowed, please call our office for further instructions. 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 the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated (drawn into the lung), call 911 and seek medical attention immediately! A physician may request an x-ray be taken to locate the piece in order to determine the best way to remove it. Call our office after seeking medical attention.
Trauma:
Tooth is knocked out:
- Do not clean it off.
- Call your dentist immediately to inform them of what has happened.
- After locating the tooth, hold it on the enamel end, not by the root.
- Do Not Rinse the tooth in water or scrub the root. You make carefully remove any large debris. If possible, place the tooth back in the socket and hold it in place with gauze or a washcloth. If it is not possible to replace the tooth in the socket, put the tooth in a cup of milk or saline solution, or hold it between your cheek and gum.
- Apply an ice pack to the affected soft tissue area to reduce swelling
Broken Tooth:
- Call your dentist immediately!
- Save the piece of the tooth and apply an ice pack to the affected area to reduce swelling.
Supplies
With these supplies on hand, you will be prepared to handle most of the concerns listed above:
- Orthodontic relief wax
- Dental Floss
- Sterile tweezers
- Small, sharp clipper (such as a fingernail clipper)
- Q-tips
- Regular table salt
- Interproximal brush
- Non-prescription pain reliever (acetaminophen or ibuprofen)
- Oragel numbing gel