Emergencies

At first, having orthodontic treatment may take a little getting used to. It isn't uncommon to experience a bit of soreness when appliances are first put on, or some minor aches as teeth begin moving into new positions. Yet it's comforting to know that genuine orthodontic emergencies are rare.

If you think you may have an emergency, however, the first step is to determine the severity of the problem: Is it an urgent situation that requires immediate attention, or a minor problem that you can take care of yourself, temporarily, until you can come in to our office?

Please understand that most emergencies will need to be seen during school time.

Orthodontic Emergencies

The following information is compiled by the Australian Society of Orthodontists and reproduced for the information of Straight Orthodontics patients.

Orthodontic emergencies occur occasionally and, although they may be a little concerning for the patient and parents, they are usually fairly simple to treat. For some emergencies, you may need to contact your orthodontist. To help you accurately describe an emergency situation to your orthodontist, look at the component parts of a typical set of braces in the picture below:

emergency-braces.jpg

Brackets - Brackets are bonded directly onto each tooth or attached to the tooth via a metal band.

Archwire - The archwire is tied to all of the brackets and creates force to move teeth into proper alignment.

Ligatures - Ligatures (or “o-rings”) are tiny rubber rings used to tie the archwire to each bracket. Brackets with self-locking mechanisms do not require ligatures.

Metal Band - Metal bands are flat metal rings cemented around a tooth to provide a stronger means of attaching a bracket (or any other type of fitting).

Hooks & Rubber Bands - Hooks are used for the attachment of rubber bands (elastics) which help move teeth toward their final position.

Tools & Supplies

With these tools and supplies on hand (most of which you will already have), you will be prepared to handle the most common orthodontic emergencies.

  • Non-medicated orthodontic relief wax
  • Dental floss
  • Sterile tweezers
  • Small, sharp clipper
  • Salt
  • Inter proximal brush
  • Toothpicks
  • Non-prescription pain reliever
  • Topical Anaesthetic (such as SM-33)

Emergency Treatments

The following orthodontic emergencies and their treatments are listed in the order of the least severe to the most severe. Only the most severe emergencies will require immediate attention by an orthodontist or medical doctor. The majority of these are 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 patient. It is easily fixed with a piece of dental floss or use an inter proximal 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, are used in some cases to hold the wire to the bracket. If a rubber or wire ligature is lost, notify the orthodontist who will 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 to eliminate the irritation.

Missing or broken ligatures should be brought to the attention of the orthodontist at your earliest convenience.

Discomfort

It is 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, these 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 anaesthetic (such as SM-33) 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 the patient is eating. A small amount of non-medicinal relief wax 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 lunch more comfortably. Let the patient know that if the wax is accidentally ingested it is 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 suitable implement 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 above for instructions on applying relief wax.) The orthodontist should be notified 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, as a last resort, you may clip the wire if it is a light and flexible archwire, used in the first few months of orthodontic treatment.

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 orthodontist should be notified, at your earliest convenience, however it is not a dental “emergency”.

A Bracket is knocked off

Brackets are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the centre 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 the patient, especially if he or she is wearing braces, to wear a protective mouth guard while playing sports.)

If the bracket is off center and is movable, it has most likely been broken off. 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 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 centre of the tooth.

Even though this is not an “emergency” as such, we do ask that you call and let us know about the breakage ahead of your next appointment.  This allows us to determine if we should make you an additional (sooner) appointment.  It also allows us to be prepared and ready with the correct equipment required to repair the breakage when you come in.

Piece of the appliance is swallowed or aspirated

If a piece of the appliance it is swallowed, there should be no coughing or difficulty in breathing. Usually the conservative approach is taken and the piece is allowed to pass naturally. Notify your orthodontist and follow his or her advice.

Very rarely, a piece of the appliance can be aspirated (caught in the airway). If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated. When this happens, it can be fairly alarming to the patient. Encourage the patient to remain calm.

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 harm.

If you are unable to see the piece and believe it may be have been aspirated, call the appropriate emergency number for your area, then notify the parents and the orthodontist immediately. The patient should be taken to an urgent care facility for an x-ray to determine the location of the piece. A physician will have to determine the best way to remove it.