Emergency Care

Orthodontic Emergency?

During treatment, you may encounter one of the following scenarios that possibly causes temporary discomfort. Here are some solutions you can implement at home to alleviate the discomfort.

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, which can be purchased at most drug stores) directly to the ulcerated surface using a cotton swab. Reapply as needed.

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 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 brace.

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 sterile tweezers. If the wire ligature is sticking out into the lip but is not loose, it may be bent 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. Let Dr. Rob or Dr. Frank know of any missing or broken ligatures.

Discomfort

It’s normal for a patient to have discomfort for a day or two after braces or retainers are adjusted. But it can make eating uncomfortable. Discomfort is both normal and temporary. Try eating soft foods until the discomfort resolves, or have the patient rinse their mouth with warm saltwater.

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-medical 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 irritating. The patient may then eat 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 the patient’s mount. 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 section above for instruction on applying relief) and let our office know, so we can help alleviate the problem.

In a situation where the wire is extremely bothersome and the patient will not be able to see the orthodontist anytime soon, you may, as a last resort, clip the wire. 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 parent or guardian needs to be notified, and they should call the orthodontist to determine appropriate next steps.

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 has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play. We encourage patients with braces to wear protective mouthguards while playing sports.

If the bracket is off-center, the adhesive may have failed. Give us a call and notify us and we 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 swallowing or other injuries. 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 Appliance is Swallowed

This is rare, but when it does happen, it can be fairly alarming to the patient. If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated.

If you can 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 patient’s 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 have been aspirated, notify the orthodontist immediately.

If you have any problems occurring after hours, please call our office at (334) 277-6690 or (334) 358-6411. You will receive an on-call phone number where an orthodontic assistant can be reached.