Orthodontic Emergencies and Other Problems

Many common orthodontic “emergencies” can be handled easily at home.  To help you accurately describe an emergency situation to the orthodontist, use the diagram at the end of this section, which illustrates and names each part of a typical set of braces.  A list of supplies to keep on hand is also posted at the bottom of this section.

True Emergencies

Trauma to tooth – tooth came out

If a tooth has been knocked out, do not clean off the tooth.

• Call your orthodontist or your dentist immediately to inform them of what has happened.
• Upon locating the tooth, hold the enamel end of the tooth, not the pointed end/root. 
• Do not rinse the tooth in water.  Do not scrub the root.  You may remove large debris.  If possible, put tooth back in socket where tooth was and hold in place with gauze or washcloth.  If it is not possible to replace the tooth in its socket, put the tooth into cup of milk or saline solution, or put the tooth between the cheek and gum.  Do not put the tooth in plain water.
• Apply an ice pack to the affected soft tissue area to reduce swelling
• Do not let the tooth dry out.  A tooth can sometimes be saved if cared for properly and reimplanted within an hour. 

Broken tooth

• Clean the injured area and apply an ice pack to the effected soft tissue area to reduce swelling.
• Save the tip of the tooth (for possible reattachment) and call your dentist right away. 

Piece of the Orthodontic Appliance is Swallowed or 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 the patient harm.

Encourage the patient to remain calm.  If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated (drawn into the lung).

If there is no coughing or difficulty in breathing, and you suspect the piece has been swallowed, call the patient’s orthodontist for advice and instructions.

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) and the orthodontist immediately.  The patient 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.

 

Other Problems

A Bracket is Knocked Off

Brackets (see diagram below) 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 your orthodontist, who will determine the 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 your orthodontist and inform them of the circumstance.  If you are not in pain, this is not a true emergency.  Please call the orthodontist 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 the orthodontist 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.

“Ligature Wire” is Poking Lip or Cheek

Use a Q-tip or pencil eraser to push the wire (see diagram) 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” below for instructions on applying relief wax.)  Make the orthodontist aware of the problem.

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.

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.

Mouth Sores

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.

Discomfort

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.

Lost Ligature (Rubber or Wire)

Tiny rubber bands known as alastic ligatures (see diagram), are often used to hold the archwire into the bracket or brace.  If an alastic ligature is lost, contact the orthodontist, who can advise you whether the patient should be seen.

The same holds true for wire ligatures.

What if the Lip Gets Caught on a Brace?

• Call your orthodontist immediately.

Apply ice to the affected area until you have the opportunity to been seen by your orthodontist or family dentist.

I Can’t Open My Mouth

Potential causes – problems with lower jaw joint or swelling around the soft tissues in the mouth.

• Call your orthodontist or dentist and inform them of your symptoms.

Food Caught Between Teeth

This is not an emergency.  It can be resolved 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 to dislodge food caught between teeth and braces.

 

Diagram of Braces

To help you accurately describe an emergency situation to the orthodontist, 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.

Supplies

With these supplies on hand, you will be prepared to handle the most common problems with braces.

• Non-medicated orthodontic relief wax
• Dental floss
• Sterile tweezers
• Small, sharp clippers suitable for cutting wire (such as a fingernail clipper)
• Q-tips
• Salt
• Interproximal brush
• Non-prescription pain reliever (acetaminophen or ibuprofen or any over-the-counter medication typically used for a headache)
• Oral topical anesthetic (such as Orabase or Ora-Gel)

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