The following orthodontic complications and their treatments are listed in the order of the least severe to the most severe. Only the most severe emergencies may require immediate attention by one of our orthodontists. The majority of these are easily treated with the following helpful hints. An index of helpful terms is also included to help you understand the complication.
Food Caught Between Teeth:
This is not an emergency, but can be a little uncomfortable or embarrassing for the braces-wearing patient. It is easily fixed with a price 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 and braces
Ligatures Come 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 tweezers. If a wire ligature comes loose, simply remove it with tweezers. If the wire ligature is sticking out into the lip or cheek 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. Missing or broken ligatures should be brought to the attention of the office. This will ensure that treatment remains on schedule.
It’s normal to have discomfort for three to five days after braces or retainers are adjusted. Although temporary, it can make eating uncomfortable. Encourage soft foods. Have the patient rinse the mouth with warm salt water. Over-the-counter pain relievers, acetaminophen or ibuprofen, may be effective.
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. Reapply as needed.
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. The patient may then eat more comfortably. If the wax is accidentally swallowed it’s not a problem. The wax is harmless.
Loose Brackets, Wires or Bands:
If the braces have come loose in any way, call the orthodontist to determine appropriate next steps. Save any pieces of your braces that break off and bring them with you to your repair appointment.
Brackets (see diagram) 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 the office so that we may be able to determine the proper course of action.
If the loose bracket has rotated on the wire and is sticking out, attempt to turn it back into its normal position and call your orthodontist 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 the ofice to inform us of the circumstance. If you are not in pain, this is not a true emergency. Please call the 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 rough housing.
Be sure to wear a protective mouth guard while playing sports!
The Archwire is Poking:
If the end of an orthodontic archwire (see diagram) is poking in the back of the mouth, attempt to put wax over the area to protect the cheek. Call the orthodontist to schedule an appointment and have that clipped. If you are uncomfortable, make sure you inform the orthodontist.
In a situation where the wire is extremely bothersome and the patient will not be able to see one of our orthodontists immediately, as a last resort, the wire may be clipped with an instrument such as fingernail clippers.
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.
Piece of Appliance is Swallowed/Aspirated:
This is rare, but when it does happen, it can be fairly alarming. Remain calm. If the incident is followed by excessive coughing or breathing difficulty, the piece could have been aspirated.
If you are able to see the piece, you may carefully attempt to remove it. But do not make the attempt if you could cause harm.
If appropriate under the circumstances, examine the braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above.
If you are unable to see the piece and believe it may be have been aspirated, please contact our office immediately.
If the piece has been swallowed, normal digestive functions should pass the piece out of the body in time.
©2006 American Association of Orthodontists