Orthodontic Emergencies

Most orthodontic emergencies, though a little upsetting, are actually fairly simple to treat. Please review the following information for suggestions on what to do if you have a problem with your braces. These tips may be helpful if your problem develops after hours or on weekends. If you have an emergency and need to speak to Dr. Baker when the office is closed, please call the office and follow the instructions on our telephone system. Dr. Baker will be paged and will contact you. During regular business hours, please call the office and we will schedule a time for you to come in for a repair appointment. To help you accurately describe an emergency situation, use the diagram below, which illustrates and names each part of a typical set of 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 all of the brackets and creates force to move teeth into proper alignment.

C. Brackets
Brackets are connected to the bands, or directly bonded on the teeth, and hold the archwire in place.

D. Metal Band
The band is the cemented ring of metal which wraps around the tooth.

E. Elastic Hooks & Rubber Bands
Elastic hooks are used for the attachment of rubber bands, which help move teeth toward their final position.

Tools & Supplies

With these tools and supplies, you will be prepared to handle the most common orthodontic emergencies.

• Non-medicated orthodontic relief wax
• Dental floss
• Sterile tweezers
• Small, sharp clipper
• Q-tips
• Salt
• Interproximal brush
• Toothpicks
• Non-prescription pain reliever (acetaminophen or ibuprofen)
• Topical Anesthetic (such as Orabase or Ora-Gel)
• 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 Dr. Baker.

Food Caught Between Teeth

This is not an emergency, but can be a little uncomfortable or embarrassing. 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 the Dr. Baker so he may advise whether you 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. Missing or broken ligatures should be brought to the attention of Dr. Baker.

Discomfort

It’s normal to have discomfort for a day or two after your braces or retainers are adjusted. But it can make eating uncomfortable. Try soft foods, and rinse your mouth with warm salt water. If pain persists you may consider taking pain relievers such as acetaminophen or ibuprofen.

Mouth Sores

Some people 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. 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. Reapply as needed.

Irritation of Lips or Cheeks

Sometimes new braces can be irritating to the mouth, especially when 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. You may then eat lunch 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 your 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 Cheeks or Lips above for instructions on applying relief wax.) Notify Dr. Baker of the problem.

In a situation where the wire is extremely bothersome and you will not be able to see the Dr. Baker or an orthodontist anytime soon, as a last resort, you may 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.

Loose Brackets, Wires or Bands

If the braces have come loose in any way, Dr. Baker should be notified, 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 you have eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play.

If the bracket is off center, the adhesive may have failed. Immediately notify Dr. Baker, who will determine the course of action.

If the loose bracket has rotated on the wire and is sticking out, and you cannot immediately be taken to Dr. Baker's 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.

Piece of the Appliance is Swallowed or Aspirated

This is rare, but when it does happen, it can be fairly alarming. Remain calm. If you are coughing excessively or having difficulty breathing, 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 would cause yourself harm.

If there is no coughing or difficulty in breathing, call 911 (or the appropriate emergency number for your area) for advice or instructions, and inform Dr. Baker.

If appropriate under the circumstances, examine your 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, call 911 (or the appropriate emergency number for your area), then notify Dr. Baker immediately. You 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