What to do in an Emergency
As a patient or the parent of a patient, you may occasionally face an orthodontic emergency. Most of these, though a little upsetting, are actually fairly simple to handle. In most cases, with the right tools and a little “tender loving care,” the patient will be able to return to normal activities until their next scheduled appointment. For some emergencies, you may need to contact us however, and please don't hesitate to do so. The diagram below will help you to identify the brace components referred to in our guide:
Food Caught Between Teeth
This is not an emergency, but can be a little uncomfortable or embarrassing for the 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.
Lost Wire or Ligature
Tiny rubber bands or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber or wire ligature is lost, notify us so that Dr. Coups Smith may advise whether the patient should be seen.
Ligatures Come Off
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 to be sure. Missing or broken ligatures should be brought to our attention. Please go ahead and call us.
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. If the patient is allowed to have over-the-counter pain relievers, Advil™ used as directed may be effective.
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. Instruct the patient to reapply as needed.
Irritation in Mouth
Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of non-medicinal relief wax (which we provide all our patients) 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 in Mouth above for instructions on applying relief wax.) Please make us aware of the problem telephonically.
In a situation where the wire is extremely bothersome and the patient will not be able to see Dr. Coups Smith anytime soon, as a last resort, you may clip the wire.
Reduce the possibility of the student 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 Wires, Brackets or Bands
If the braces have come loose in any way, we need to be notified. Please call our office to determine appropriate next steps.
A Bracket is Knocked Off
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. (Please encourage your child to wear a protective mouth guard while playing sports.)
If the bracket is off center, the adhesive may have failed. Call our office immediately and we'll notify Dr. Coups Smith, 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.