Emergency

Discomfort

It is normal to experience some discomfort at the start of your treatment and after some adjustment appointments. We recommend using over-the-counter pain relievers and eating soft foods for a few days.

Irritation of lips or cheeks

Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of 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. You may then eat more comfortably. if the wax is accidentally ingested, it’s not a problem. The wax is harmless.

Photo courtesy of the Canadian Association of Orthodontists

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.

Photo courtesy of the Canadian Association of Orthodontists

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 of Lips or Cheeks above for instructions on applying relief wax.) In a situation where the wire is extremely bothersome and you will not be able to see the orthodontist anytime soon, you may, as a last resort, clip the wire. Reduce the possibility of 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.

Photo courtesy of the Canadian Association of Orthodontists

Loose brackets, wires or bands

Call our office as soon as you notice a loose band or braces and, together, we will evaluate whether it is necessary to schedule an additional appointment to repair it or whether it can wait until your regularly scheduled appointment.

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 eats 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.)

If the loose bracket has rotated on the wire and is sticking out and you cannot come to the office, 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.

Photo courtesy of the Canadian Association of Orthodontists

If a fixed or bonded appliance, such as a palatal expander, becomes detached on one side, press the loose side back in place temporarily. If both sides detach, remove it altogether to avoid swallowing it.

In either case, cease activations if your treatment is still in its active phase and call our office to schedule an appointment.

Removable appliances

A removable appliance that does not fit properly in the mouth or that cause some discomfort must be adjusted. Call our office as soon as possible to schedule an appointment.

Ligatures that come undone/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 may be bent back down with a Q-tip or pencil eraser to eliminate the irritation. Be sure to examine all ligatures. Please call our office to inform us. We will advise you if you should be seen before your regular appointment.

Photo courtesy of the Canadian Association of Orthodontists

Food caught between teeth and/or braces

This is not an emergency, but can be a little uncomfortable or embarrassing for the braceswearing 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.

Photo courtesy of the Canadian Association of Orthodontists

Forsus

If the spring and lower arm are coming apart, compress the spring and, keeping your mouth wide open, re-insert the lower arm.

If you are having difficulty re-engaging the spring or if something is broken, temporarily secure the spring to the arch wire with dental floss.

If the spring and lower arm become completely detached, remove both pieces to avoid swallowing them.

Accident

If you sustain a direct injury to the mouth or teeth during your orthodontic treatment, you should see us or your dentist as soon as possible. In the meantime, here is some infos that could help to manage the situation.

Broken teeth

• Clean the injured area and put an ice pack on the lip or gum.
• Cover any exposed area with sterile gauze.
• Save the tip of the tooth (for possible reattachment) and call your family or pediatric dentist right away.
• Store the tooth fragment in water.

Loosened teeth

An accident can cause a tooth to come loose from the socket. A tooth can be:

• Pushed into the socket (intruded)
• Knocked part way out of the socket (extruded)
• Pushed sideways, but still in the socket (luxated)

What to do:

• Apply an ice pack to the injury.
• You may attempt to gently push an extruded tooth back into the socket.
• Call your family or pediatric dentist for immediate attention. Early stabilization is the best chance for the tooth to reattach itself.

Intruded tooth

Extruded tooth

Luxated tooth

Knocked out permanent tooth – Time is critical

A tooth might be saved if cared for properly and reimplanted as soon as possible. Timely treatment may improve the chances of reattaching an injured tooth.

• Call your family or pediatric dentist for immediate attention.
• Locate the tooth; hold it by the crown, don’t touch the root.
• Remove large pieces of debris, but avoid rubbing or touching the root.
• Rinse the tooth. Do not scrub.
• Attempt to gently put the clean tooth back in its socket. Cover with gauze or tissue and bite down to stabilize it, if possible, or hold the tooth in its socket until seen by the dentist.
• If the tooth cannot be put back into its socket, store the tooth in liquid until you see the dentist. Put the tooth in milk or sterile saline solution (contact lens solution with no preservatives). Do not soak or store the tooth in water because water will kill the cells on the root that are vital for successful reimplantation. If milk or saline solution are unavailable, the tooth can be stored in the cheek where saliva will help provide vitality to the root surface. If stored in the cheek, be careful not to swallow the tooth.
• Do not let the tooth dry out.

Jaw injury

If teeth appear to fit together properly when the mouth is closed:

• Apply ice to control swelling.
• Restrict diet to soft foods and if no improvement occurs within 24 hours, seek dental care to rule out subtle injuries.
• If in doubt at any time, contact your dentist or seek medical attention.

If teeth do not fit together properly when the mouth is closed:

• Seek emergency medical attention.