Emergencies

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The following orthodontic emergencies and their treatments are listed in the order of mild to severe. Interestingly only the most severe emergencies require immediate attention by an orthodontist. The majority of these problems are easily treated during future follow-up appointments.


Food Caught Between Teeth

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This is not an emergency, but can be a little uncomfortable or embarrassing for a patient wearing braces. 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 (Christmas tree shaped brush) to dislodge food caught between teeth and braces.


Color Ties Come Off

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Tiny rubber bands known as ligatures, hold the wire in the bracket. If a color tie 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.


Discomfort

It’s normal for a patient to have discomfort for a day or two after braces or retainers are new inserted or adjusted. This 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 or diluted Listerine to keep the mouth clean.


Mouth Sores

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Some patients are susceptible to episodes of mouth sores. While braces do not cause them, they may be exacerbated by irritation from braces. Common areas of ulceration include the lips, cheeks or tongue. 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.


Irritation of Lips or Cheeks

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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 cushion between the braces 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. Let the patient know that if the wax is accidentally ingested, it’s not a problem. The wax is harmless.


Protruding Wire

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Occasionally, the end of a wire will work itself out of place and irritate the patient’s mouth. The wires are flexible and can be moved by gum chewing. 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 should call the office for an appointment to clip the wire. 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 with a sterilized nail clipper. 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

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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. (Encourage all patients, especially those with braces, to wear a protective mouth guard while playing sports.)

A broken bracket will stay attached to the wire. If the bracket is sliding on the wire the parent / guardian should call the office immediately.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 into the patient’s lung. This requires an immediate visit to the ER. The ER doctors will take an Xray to determine the location of the appliance and treat accordingly. It is unlikely that the piece goes into the lung and more likely that it is swallowed. Broken appliances that are swallowed usually pass naturally, A high fiber diet is encouraged along with evaluation of the stool. In either case the orthodontist should be notified immediately.

The information and photos above are courtesy of the American Association of Orthodontists.