Orthodontic emergencies are not very common and very few occasions require an unexpected visit to the office that will take you away from your planned daily schedule, but if you do have one Dr. Rodriguez and Dr. Marrecau are available to you 24/7 by direct contact line.
To help you accurately describe an emergency situation to Dr. Rodriguez and Dr. Marrecau use the diagram below that 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.
Diagram of Braces
The arch wire is held to each bracket with a ligature, which can be either a tiny elastic ring or a twisted wire.
B. Arch wire
The arch wire is tied to all of the brackets and creates force to move teeth into proper alignment.
Brackets are connected to the bands, or directly bonded on the teeth, and hold the arch wire 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.
Trauma to tooth – tooth came out If a tooth has been knocked out; do not clean off the tooth. Call 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 often be saved if cared for properly and re-implanted within an hour.
Injury: Orthodontic appliances can be damaged when a patient sustains injury to the face or mouth. Call for an appointment if the teeth feel loose or if the appliance is broken. If you choose, we can create a customized mouth guard to protect your teeth and appliances during contact sports.
Broken tooth: Clean the injured area and apply an ice pack to the effected soft tissue area to reduce swelling. 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 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.
What if the Lip Gets Caught on a Brace? Call our office immediately; Dr. Rodríguez or Dr. Marrécau will guide you through. Apply ice to the affected area until you have the opportunity to been seen by your orthodontist or family dentist.
Other Concerns not necessary considered emergencies
Loose band, wires or bracket: Brackets (see diagram above) are the parts of braces attached to teeth with a special adhesive. They are generally positioned on each tooth. If the bracket is off center and moves along the wire, the adhesive has likely failed. Call our office during regular business hours and schedule a repair appointment to have it reattached. If the loose bracket has rotated on the wire and is sticking out, attempt to turn it back into its normal position. 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 Dr. Rodríguez and Dr. Marrécau and inform them of the circumstance. Dr. Rodríguez and Dr. Marrécau will determine the course of action and appropriate next steps to make you confortable at all times. If you are not in pain, this is not a true emergency. Please call our office at your earliest convenience to schedule an appointment to reattach the bracket to the tooth. Remember to brush very well around the loose appliance, as it may tend to trap plaque.
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 and obtain immediate relief. Call our office to schedule an appointment and have the wire clipped. If you are uncomfortable, make sure you inform us. In a situation where the wire is extremely bothersome and the patient will not be able to see Dr. Marrécau or Dr. Rodríguez 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.
Broken Arch wire: Call our office during regular business hours to schedule a visit. Place wax or a piece of wet cotton over the area if the wire is poking.
“Ligature Wire” is Poking Lip or Cheek: If a wire tie begins to scratch your lip, you can gently tuck it under the main archwire with the tip of an eraser. Call our office for an appointment if the discomfort persists. 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 our office, Dr. Rodríguez or Dr. Marrécau aware of the problem so that we can make sure that you are always comfortable.
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 with a Q-tip applicator 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 or Sore spots: Occasionally patients may develop canker sores while wearing braces. There is no cure for canker sores, but to help relieve any discomfort we recommend placing wax on the problematic area of the braces and use Orabase or Oragel on the sore spot. Canker sores generally heal within 7 – 10 days. Please call us if you do not experience relief after this time period. 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.
General Soreness and Discomfort: It is common and normal to experience some soreness during orthodontic treatment. This can last three to four days after an adjustment. To alleviate discomfort, we recommend that patients eat softer foods and rinse with warm salt water after each meal. Pain relievers may also help. Parents can give children the recommended dosage of Ibuprofen or Tylenol if there is no history of adverse reactions or contraindications to these medications. 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.
Missing or broken ties / Ligature (Rubber or Wire): Tiny rubber bands known as Alastic ligatures (see diagram: letter A in the diagram), are often used to hold the arch wire into the bracket or brace. If an Alastic ligature is lost, contact our office and we will schedule an appointment to check everything, who can advise you whether the patient should be seen. The same holds true for wire ligatures. Call our office during regular business hours and schedule an appointment to have missing or broken ties replaced. If the tie is missing or broken, the tooth can drift away from the arch wire. This is particularly a problem if you are wearing rubber bands.
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 inter proximal brush to dislodge food caught between teeth and braces.
Loose teeth: Do not be surprised if teeth feel loose during treatment. Teeth need to loosen before they can move into their new positions. It is very common to experience some tooth mobility while undergoing orthodontic treatment. However, if you have any concern, always feel free to bring it to the attention of Dr. Rodríguez and Dr. Marrécau.
Lip bumper causing sores: Remove the lip bumper by pulling it forward. If the lip bumper is tied in with elastic, cut the elastic first and then remove it. Call our office during regular business hours to schedule an appointment so we can adjust the bumper to a more comfortable position. Do not wear the lip bumper until we can see you for an adjustment.
Separator/Spacer is out: If a separator (spacer) falls out a day or two before your next appointment you do not need to have it replaced. If it falls out before then, call our office during regular business hours to schedule a quick appointment to replace the missing separator.
Rubber bands: Rubber band wear will cause sore teeth when you first begin wearing them (approximately the first 3 – 4 days). Once the teeth begin to move, this soreness will go away. Continue to wear the rubber bands during this initial period of soreness and take pain relievers if necessary. Do not continue wearing the rubber bands if you are unsure how they are to be worn. Call our office during regular business hours and we will let you know how to wear your elastics.
An APPLIANCE THAT DOES not fit: Call our office during regular business hours and schedule an appointment to have the appliance or headgear adjusted. Do not try to force the appliance or headgear into place.
Supplies To Have at Home
With these supplies on hand, you will be prepared to handle the most common problems with braces.
Marrecau & Rodriguez Orthodontic Specialist * 3934 SW 8th Street 206 * Coral Gables FL 33134 T: (305) 448 4616 F:(305) 446 0858 http://orthodonticspecialist.webs.com/