Emergency Treatments

The following orthodontic emergencies and their treatments are listed in the order of the least sever to the most severe. Only the most severe emergencies may require immediate attention by an orthodontist. The majority of these is easily treated with a follow-up by the patient’s orthodontist.

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 bay 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 orthodontists.

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

It’s normal for a patient to have discomfort for a day or two after braces or retainers are adjusted. But it can make eating uncomfortable. Reassure the patient that the discomfort is both normal and temporary. Encourage soft foods. Have the patient rinse the mouth with warm salt water.

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 by 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.

Irritation of Lips or Cheeks

Sometimes new braces can be irritating to the mouth, especially when a patient is eating. A small amount of non-medicinal relief wax makes an excellent buffer between metal and mouth. Simply pinch of fa 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. Let the patient know that 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 was 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 the appropriate next steps.

Brackets are the parts of the braces attached to the 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 in play. (Encourage all patients, especially those with braces, to wear a protective mouth guard while playing sports.)

If the bracket if 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 make it 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 difficult breathing, the piece could have been aspirated.

If you are able to see the pieces, you may carefully attempt to remove it. But do not make the attempt if you could cause harm.

If you are unable to see the piece and believe it may have been aspirated, notify the parent/guardian and the orthodontist immediately.

Initial Soreness

After the initial placement of braces or following an adjustment, the teeth may be tender for three to five days. This occasionally happens and will pass. An over the counter pain reliever such as Advil, Motrin or Tylenol may be helpful in alleviating this initial soreness. This, of course, is the protocol only if there are no known allergies to these medications. Rinsing your mouth with Peroxyl or a cup of warm water and teaspoon of salt can also be soothing. The lips, cheeks and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. You can put wax on the braces to lessen this. If the soreness does not lessen after 3-4 days, you are advised to phone for an appointment so that an adjustment may be made.

Loosening of Teeth

This is to be expected throughout treatment. Don't worry! It's normal. Teeth must loosen first so they can be moved. The teeth will again become rigidly fixed in their new – corrected – positions.

Bleeding when brushing or flossing

If you experience any bleeding when brushing or flossing, that usually means there is a local area of inflammation. Continue to keep the area clean by brushing, flossing and rinsing with Listerine. If a particular area is painful or you notice a bump of any sort, you should report this to your orthodontist as soon as possible.

Wire Poking

If wire protrudes and is irritating, use a blunt instrument (back of spoon or the eraser end of a pencil) and carefully, gently push the irritating wire under the archwire. Simply get it out of the way. You can also try to solve this problem by taking a nail clipper and snipping the wire as close as possible to the brace. If irritation to the lips or mouth continues, place some wax on it to keep you comfortable.

Broken Wire

If the main wire breaks, take a pair of nail clippers and cut the wire as close as possible to the next brace it is attached to. You may also need to place wax over the cut end of the wire. Please call our office so we can schedule an appointment to repair the wire.

Wire out of a Brace

If the main wire has come out of the tube on the back molar tooth, you may attempt to reinsert the wire with a pair of needle-nosed pliers or tweezers. If you are having a difficult time and the wire is not sticking you, place a piece of wax over the area. If the wire is sticking you and wax does not help, the wire can be cut with a small wire cutter or toenail clipper close to the back of the last brace.

Poking Wire Tie

Sometimes to secure the brace to the wire we twist a very small stainless steel ligature around it. Infrequently it is possible for the twisted end of the ligature to move and start to feel sharp. If this happens simply use the eraser end of a pencil or a Q-tip to gently push it into a comfortable position.

Broken Brace

If a bracket (the small rectangular brace) is loose, it usually will remain connected to the main wire and is not cause for an emergency visit. You may use a pair of tweezers to reposition the brace if it flips around the wire and becomes a source of irritation. Please let our office know you have a loose brace, so we can be prepared at your next visit to repair the brace. It may be necessary to schedule a separate visit to repair the loose brace(s), since repairs of this nature usually take additional time.

Tie has come off of a Brace

If the "O-tie" has come loose, see if the wire is attached to the brace with a small wire thread or ligature. If so, it should be fine until the next appointment. If there is no ligature on the tooth, please call our office to schedule an appointment to place a new "O-tie" on the brace.

Expander is Loose

If an expander becomes loose we do not want you to activate it until you are seen. Usually the expander can be pushed back onto the tooth until you can get back into our office. Please call the office as soon as possible. Sticky foods are usually the cause of this.

Lost Spacer

If a rubber spacer falls out, take two pieces of dental floss and insert them through the spacer. Then pull on both pieces of floss to stretch the spacer back and forth between the two teeth where it belongs. When the bottom half of the spacer slips under the tight spot between the teeth, release and remove the floss. The spacer should now be back in place. Please call the office the next morning if you have any questions.

Headgear does not fit

This is sometimes caused by not wearing it as prescribed. If face bow is bent call our office.

Lost or Broken Retainer

If you lose or break a removable appliance or retainer, please call our office during office hours or leave a message. Save the piece and we will schedule an appointment for you to make a new one.

We are here to not only give you a great smile, but also to keep you comfortable. If you or your child is uncomfortable and you cannot correct the problem yourself, please call our office at 708-799-0060 or 815-462-3232.