Emergencies

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, scissors and snip off the protruding wire.  Relief wax may still be necessary to provide comfort to the irritated area.

Tiny colored 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 clean tweezers. If a wire ligature comes loose, simply remove it with clean 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 brought to the attention of the patient’s parent/ guardian, who should then inform the orthodontist, who will advise whether the patient should be seen.

Broken or loose braces are generally not considered an urgent problem in most cases. There are times when a loose brace may cause some problems, however, so it is best to call the orthodontic office when the problem occurs and ask for their recommendation. When a bracket comes off of a tooth, it is still normally attached to the wire with an elastics tie. This will prevent the bracket from being swallowed, but it may move or spin around on the wire. 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 clean 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. If this is a problem for the patient, a little wax pressed against the bracket will keep it from moving  around.

When a band (ring around the back teeth) comes loose, the patient is in no immediate harm. However, the band is normally cemented on the tooth with an adhesive that seals the inner portion of the band from saliva and plaque. If the band is left loose for a period of time (3-4 weeks), saliva and bacteria may enter into the crevice between the tooth and the band. The bacteria produce an acidic byproduct, which then eats away at the enamel (demineralization). The result is decalcification (white spot) or a cavity on the tooth surface. It can form rather quickly, causing damage to the enamel, so a phone call to the orthodontist is recommended. If you are able to remove the band, please do so, save it and bring to the appointment with you.

A rapid maxillary expander is an appliance used in some patients to help widen the upper jaw and teeth. If the appliance becomes loose, it may be more urgent to see the orthodontist, since the appliance may become quite uncomfortable for the patient. Also, if the appliance is not in its proper position, or if it falls out completely, the correction that has already been achieved may be lost. It would be best to call the orthodontist and follow their recommendations.

Do not wear retainer, call the orthodontist within 2-3 days so your teeth do not shift.

Call the orthodontist within 2-3 days so your teeth do not shift, use a removable retainer if you have one every night until the permanent retainer is repaired.

Do not wear the headgear until the next appointment.

Swallowing braces or other appliances used during orthodontic treatment tends to occur relatively infrequently. This is because the braces and bands are normally still attached to the wire if they become loosened from a tooth. However, if it does occur, it is best to seek advice from the orthodontist and physician right away. Fortunately, the braces and rubber bands used for orthodontic treatment are quite small, and the patient will usually pass them without difficulty.

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. The orthodontic wax may also be placed on the appliances next to the mouth sore to prevent any future irritation.

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.