Orthodontic Emergencies
Many common orthodontic “emergencies” can be handled easily at home. To help you accurately describe an emergency situation to Dr. Frank, use the diagram at the end of this section, which illustrates and names each part of a typical set of braces. A list of supplies to keep on hand is also posted at the bottom of this section.
True Emergencies
Trauma to tooth - tooth came out
If a tooth has been knocked out, do not clean the tooth. Call Dr. Frank or your dentist immediately to inform them of what has happened. Upon locating the tooth, hold the enamel end of the tooth, not the pointed end/root. Do not rinse the tooth in water. Do not scrub the root. Large debris may be carefully removed. If possible, put tooth back in socket where tooth was and hold in place with gauze or washcloth. If it is not possible to replace the tooth in its socket, put the tooth into cup of milk or saline solution, or put the tooth between the cheek and gum. Do not put the tooth in plain water. Apply an ice pack to the affected soft tissue area to reduce swelling. Do not let the tooth dry out. A tooth can often be saved if cared for properly and replaced within an hour.
Broken tooth
Clean the injured area and apply an ice pack to the affected soft tissue area to reduce swelling. Save the tip of the tooth (for possible reattachment) and call your dentist right away.
Piece of the Orthodontic Appliance is Swallowed or Aspirated
If you are able to see the piece, you may carefully attempt to remove it. But do not make the attempt if you would cause the patient harm. Encourage the patient to remain calm. If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated (drawn into the lung). If the patient is not coughing or does not have difficulty in breathing, and you suspect the piece has been swallowed, call Dr. Frank for advice and instructions.
If you are unable to see the piece and believe it may be have been aspirated, call 911 (or the appropriate emergency number for your area) and Dr. Frank immediately. If possible have someone take you to an urgent care facility for an x-ray to determine the location of the piece. A physician will determine the best way to remove it.
Other Problems
Definitions:
To help you accurately describe an emergency situation to Dr. Frank, use the definitions below to name the parts of your braces.
A. Ligature: The archwire is held to each bracket with a ligature, which can be either a tiny elastic or a twisted wire.
B. Archwire: The archwire is tied to the brackets and creates force to move teeth into proper alignment.
C. Brackets: Brackets are connected to bands, or directly bonded (cemented) to the teeth, and hold the archwire in place.
D. Band: The band is the cemented ring of metal which wraps around the tooth.
E. Spurs, Hooks & Circles: Spurs, Hooks and Circles are used to attach rubber bands in many different directions.
F. Elastic (Rubber) Bands: Elastic Bands provide the forces used to move teeth in many different directions.
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. If the bracket is off center and moves along the wire, the adhesive has likely failed. Call Dr. Frank, who will determine the course of action to take.
If the loose bracket has rotated on the wire and is sticking out, attempt to turn it back into its normal position and call Dr. Frank’s office to schedule an appointment to have it reattached. You may wish to put orthodontic wax around the area to minimize the movement of the loose brace. If you are in pain, please call Dr. Frank and inform him of the circumstance. If you are not in pain, this is not a true emergency. Please call Dr. Frank’s office at your earliest convenience to schedule an appointment to reattach the brace to the tooth.
Remember, brackets can become loose as a result of chewing on hard, sticky or chewy foods or objects as well as from physical contact from sports or roughhousing. Be sure to wear a protective mouth guard while playing sports!
The Archwire is Poking
If the end of an orthodontic archwire is poking in the back of the mouth, attempt to put wax over the area to protect the cheek. Call Dr. Frank’s office to schedule an appointment to have the archwire clipped. If you are uncomfortable, make sure you inform them.
In a situation where the wire is extremely bothersome and you will not be able to see Dr. Frank immediately, as a last resort, the wire may be clipped with an instrument such as a fingernail clipper.
Reduce the possibility of swallowing the snipped piece of wire by using folded tissue or gauze around the area to catch the piece you will remove. 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.
"Ligature Wire" is Poking Lip or Cheek
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 Cheeks or Lips” below for instructions on applying relief wax.) Make Dr. Frank’s office aware of the problem.
Irritation of Lips or Cheeks
Sometimes new braces can be irritating to the mouth. A small amount of orthodontic wax makes an excellent buffer between the braces and lips, cheek or tongue. 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. If possible, dry off the area first as the wax will stick better. This will allow you to eat more comfortably. Accidentally swallowing the wax is not a problem, since wax is harmless.
Mouth Sores
People who have mouth sores during orthodontic treatment may gain relief by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the sore area using a cotton swab. This may be reapplied as needed.
Discomfort
It’s normal to have discomfort for a few days after braces or retainers are adjusted. Although temporary, it can make eating uncomfortable. Eating soft foods is encouraged. You may rinse your mouth with warm salt water. Over-the-counter pain relievers, acetaminophen or ibuprofen, may be effective.
Lost Ligature (Rubber or Wire)
Elastic ligatures (see definitions above) are often used to hold the archwire into the bracket. If an elastic ligature is lost, contact Dr. Frank, who can advise you whether you should be seen. The same holds true for wire ligatures.
What if the Lip Gets Caught on a Brace?
Call Dr. Frank immediately. Apply ice to the affected area until Dr. Frank or your family dentist has the opportunity to see you.
Can’t Open Your Mouth
Potential causes may come from problems with lower jaw joint or swelling around the soft tissues in the mouth. Call Dr. Frank or your dentist and inform them of your symptoms.
Food Caught Between Teeth
This is not an emergency. It can be resolved 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 to dislodge food caught between teeth and braces.
Supplies
With these supplies on hand, you will be prepared to handle the most common problems with braces:
- Non-medicated orthodontic (relief) wax
- Dental floss
- Sterile tweezers
- Small, sharp clippers suitable for cutting wire (such as a fingernail clipper)
- Q-tips
- Salt
- Interproximal brush
- Non-prescription pain reliever (acetaminophen or ibuprofen or any over-the-counter medication typically used for a headache)
- Oral topical anesthetic (such as Orabase or Ora-Gel)
The above information was adapted from Orthodontic Emergencies©2006 American Association of Orthodontics 401 N.Lindbergh Blvd., St. Louis, MO 63141-7816 Phone: 314.993.1700 | Fax: 314.997.1745 | Contact AAO
