Orthodontic emergencies occasionally happen, sometimes when you are away from our office. If you are on vacation or out of the area, have the local orthodontist do what is necessary to relieve the discomfort, save any parts of the appliance that were removed, and call our office for an emergency appointment. If you are at home and an emergency occurs, call our office to schedule an appointment. Listed below are possible solutions to help before you arrive, in addition to routine home care and food ideas for tender mouths.
Headgear or Removable Appliance (retainer, bite plate, expander) Does Not Fit
Stop wearing the appliance and call the office immediately for an emergency appointment. Please bring the loose fitting appliance with you to the appointment.
Ligatures (o-rings) are the tiny colored rings which hold the archwire to the brackets. Power chain is simply a series of ligatures (o-rings) that are connected together and stretched between adjacent teeth. If you notice that a bracket is missing an o-ring or that a piece of power chain has detached from a bracket, please schedule an emergency appointment so we can regain control of the tooth or teeth. Sometimes, the doctor does not attach a ligature or power chain to a specific tooth for a reason, but it is best to call and check if you think something is not right.
Poking Tiewires ("Pig-Tails")
Occasionally the doctor will tie one or more teeth to the archwire with a very thin metal wire. The end of this wire will create a small "pig-tail" which the doctor or assistant will tuck next to the bracket so that it does not protrude into the lips, cheeks or gums. Sometimes, during eating or brushing, this "pig-tail" of wire will be dislodged and will start to poke the soft tissues of the mouth. If this occurs, try to push the "pig-tail" of the tiewire back towards the bracket with a fingernail, pencil eraser or end of a toothbrush. If the wire comes loose or is still protruding after several attempts, cover area with wax and contact our office for an emergency appointment so we can correct the problem.
Food Caught Between the Braces, Teeth and/or Other Fixed (Cemented) Appliances
Patients, especially those with new braces, may find that their cheeks and lips are sore and irritated from the brackets on their teeth. This is especially true for the teeth at the back of the mouth and for teeth that are significantly out of place. Be assured that this is a common and usually temporary problem which resolves over time as the lips and cheeks get used to the braces. Until the tissues adjust, patients can use relief wax and over the counter topical anesthetics (Orabase or Ora-Gel) for relief of the discomfort.
It is normal for teeth to have soreness/discomfort within hours of an orthodontic adjustment appointment. Due to varying pressures on the teeth and varying levels of pain tolerance between patients, some patients will experience more discomfort than others throughout their orthodontic treatment. At no time should orthodontic discomfort be severe enough to merit prescription pain medication. If discomfort cannot be managed with over the counter pain relievers, time, and a soft diet, please call our office for an emergency appointment.
Swallowing/Aspiration of a Bracket, Band or Piece of the Braces
Fortunately, this is a very rare occurrence. Most parts of the braces are designed with smooth edges so that, if they are swallowed, they will pass easily through the digestive tract. Therefore, if a part of the appliance is swallowed, remain calm and contact our office so we can replace the part as necessary. In extremely rare cases, a piece of the orthodontic appliance could act as a choking hazard, similar to a chicken bone or other foreign object. If a piece of the appliance has lodged in the throat, attempt to cough it out or dislodge it with the Heimlich maneuver. If airway obstruction is suspected, do not delay and get immediate emergency medical attention (dial 911). Once medical intervention is completed, please contact our office for follow up care.
Routine Home Care
Toothbrushing
Our office will provide you with two types of toothbrushes to help keep your braces, teeth and gums in tip-top shape. The first brush is similar to a traditional toothbrush except the bristles are contoured to help reach above and below the brackets. The second brush is an interproximal toothbrush which looks like a little Christmas tree or bottle brush. This brush is used after a general scrubbing with the larger toothbrush to get at places the bigger brush cannot reach. Just as brushing without braces, it is best to use small, circular motions to remove food and plaque from the teeth and to gently massage the gum tissues around the brackets. Ideally, each arch (upper and lower) should be brushed about two minutes for a total brushing time of about four minutes. Before leaving the sink, check the braces and teeth in a mirror to be sure all food and debris has been removed. If you need a replacement for either of these types of toothbrush, please ask us.
Toothpaste
An over the counter type of toothpaste with fluoride is generally all that is needed in a toothpaste. Toothpastes with an anti-gingivitis ingredient such as Triclosan (Colgate Total) are also useful. Toothpastes with whitening chemicals are not recommended while in braces as they may not change the shade of the tooth underneath the braces. It is acceptable to brush without toothpaste, if necessary, to mechanically remove food and plaque from the teeth.
Fluoride Rinses
If you find yourself in situations where it is not possible to brush after a meal or snack, it is helpful to carry a small bottle of an over the counter fluoride rinse (such as ACT, Fluoriguard or Phosfluor). Plax is not a fluoride rinse and is actually less effective than fluoridated water. If possible, try to swish several times with water to remove food and debris before using a fluoride rinse. Then take a small amount of fluoride rinse (2oz or less) and swish it around the mouth for at least 30 seconds before expectorating (spitting it out). Do not swallow the excess fluoride rinse. Once you have used the fluoride rinse, try not to eat or drink anything for 30-60 minutes to let the rinse be effective.
Flossing
Our office will provide you with floss threaders to help you floss between the braces and we will also demonstrate how they are used. Flossing with braces takes time but is essential for keeping the gum tissues from becoming inflamed. Floss threaders can be used numerous times but we do provide replacements to our patients who ask.
Stains
There are certain foods which easily stain portions of the braces and which are best to avoid. These include coffee, tea, chicken broth, curry, saffron and red wines. Colas and tomato based products may also stain some of the plastic portions of the braces.
Sports
For any contact sport, it is essential to wear mouth protection. While in braces, it is not possible to have a custom fitted mouthguard which prevents tooth movement. Our office can provide a generic type of mouthguard which fits loosely over the braces while the patient is in active treatment. There is a company called ShockDoctor which markets an athletic mouthguard for patients with braces that is sold in many sports stores. This mouthguard can be used provided that it is not adapted too closely to the patient's teeth.
Musical Instruments
Patients who play wind instruments, especially trumpet, trombone and other instruments which require lip pressure may have some difficulty adapting their technique to work with the braces. Our office can provide soft lip bumpers and wax upon request to minimize discomfort while playing such instruments. It has been our experience that the discomfort is temporary and most of our patients who play these instruments, in time, adapt to playing without any special coverings over the braces.
