The following is intended to provide general information regarding some of the more common orthodontic emergencies. They are designed to get you comfortable until your next appointment. If you unable to get yourself comfortable, please seek follow-up care with Dr Semaan, your dentist, or physician for more specific instructions.
Emergencies for patients in braces tend to be relatively infrequent and fortunately are not usually debilitating. Nevertheless, the discomfort from a problem with the braces can be upsetting and can usually be fixed quite easily.
Listed below are some of the more common problems and some possible solutions to deal with the situation on a temporary basis until you can come in for an appointment.
Pain and discomfort is a normal part of all orthodontic treatment. Some patients will be surprised by this fact, even though they have been warned of the possibility. The pain tends to occur about 4-6 hours after the braces are put on or after an adjustment appointment. Over the next day or two, the pain will progressively become worse. Then, after days 3-5, the pain will begin to subside. Most orthodontists recommend over the counter pain or anti-inflammatory medication just prior to and after the adjustment appointments. This allows the medication to already be in the system before the pain begins, improving the effectiveness.
The braces have a tendency to feel rough against the cheeks, lips, and tongue, especially soon after the braces are put on. This will sometimes lead to soreness and cause discomfort. The tissues will develop a callous over time, so this becomes less of a problem while treatment progresses. In the initial stages of treatment, wax can be used in areas that are particularly painful. However, limiting the use of wax will help the patient build up the callous tissues. Temporary pain relief can also be obtained with topical anaesthetics like the brace relief gel provided at the beginning of treatment. For any minor cuts or sores on the lips, cheeks or tongue, rinse your mouth with a mixture of warm water and a teaspoon of salt.
Significant dental injuries while in braces can be traumatic to the patient. Immediate care should be sought from a physician and dentist in those cases. In some cases, the braces have been known to actually prevent loss of teeth, since the braces and wires had provided stability. Home care is generally not recommended in these cases. Contact the office if you are unsure about the severity of an injury.
Many times as the teeth move in the early phase of treatment, the wire used to straighten the teeth or close gaps, has no place to go except out the back of the braces. Fortunately, most times this can be handled at home very simply with some orthodontic wax provided to you at the beginning of treatment. It is important to try and dry the area first (with a paper towel), then roll up a piece of wax into a ball. Place the ball of wax into the area of the poking wire. The wax will smooth the area and keep the inside of the mouth from getting caught on the end.
It is very important to keep your teeth and gums free of plaque and food debris during orthodontic treatment and have regular dental check-ups and cleans by your family dentist. Poor oral hygiene may result in swollen and bleeding gum tissue. Please contact your family dentist should you experience swollen gums. Gentle and thorough brushing, rinsing with warm salt water and mouthwash will help temporarily before you see your dentist. Also, using dental floss to check the swollen area to see if food debris may be trapped under a band or bracket is helpful.
Bleeding of gums indicates that the gums are swollen and more than likely due to poor oral hygiene. Many people find that their gums bleed when they floss, so they avoid flossing. This usually just makes it worse. Gentle brushing and consistent flossing can help reduce gum inflammation and bleeding. If it does not, contact your dentist for check-up.
Broken or loose braces are generally not considered an urgent problem in most cases. There are times when a loose brace may cause some problems, however, so it is best to call the orthodontic office when the problem occurs and ask for their recommendation. When a bracket comes off of a tooth, it is still normally attached to the wire. This will prevent the bracket from being swallowed, but it may move or spin around on the wire. If this is a problem for the patient, a little wax pressed against the bracket will keep it from moving around.If the bracket comes off, keep it in a zip lock bag ready for your next appointment.
Contact the office and let them know as they may need to have you come in sooner or allow more time to fix the bracket at your next appointment. In some cases, broken brackets can delay treatment so it is important to let the office know as soon as you can.
When a band (ring around the back teeth) comes loose, the patient is in no immediate harm. However, the band is normally cemented on the tooth with an adhesive that seals the inner portion of the band from saliva and plaque. If the band is left loose for too long it can allow bacteria to build up and damage the surface of the tooth. It is recommended that you contact the office as soon as you are aware of it.
We want to keep your teeth straight and retention is the only way. There are a number of variables that determine whether this is an urgent situation or not. For example, if the braces had recently been removed, there is a greater chance that the teeth will shift and move if a retainer is not replaced relatively quickly. Also, certain types of tooth movements may have a greater tendency for relapse than others. For example, a space between the upper front teeth may have a greater tendency to reopen in some patients, so it may be important to replace the retainer sooner. If a patient has been out of braces for a long period of time, and the teeth are in a relatively stable position, the chance of significant shifting may be low.
A widening plate or RPE is an appliance used under the roof of a patient's mouth to help widen the upper jaw and teeth. If the appliance becomes loose, it may be more urgent to see the orthodontist, since the appliance may become quite uncomfortable for the patient. Also, if the appliance is not in its proper position, or if it falls out completely, the correction that has already been achieved may be lost. It would be best to call the office and follow their recommendations.
Swallowing braces or other appliances used during orthodontic treatment tends to occur relatively infrequently. This is because the braces and bands are normally still attached to the wire if they become loosened from a tooth. However, if it does occur, it is best to seek advice from the orthodontist and physician right away. Fortunately, orthodontic appliances are rather small and the patient will usually pass them without difficulty.
In case a rubber spacer falls out, take two pieces of dental floss and insert them through the spacer. Pull on both pieces of floss to stretch the spacer, then slide the spacer back and forth between the two teeth where it belongs. Once the bottom half of the spacer slips under the tight spot between the teeth, release and remove the floss and the spacer will fit back properly. If you cannot place the spacers back in your mouth, please call the office for an appointment. You can usually avoid losing spacers by avoiding sticky foods and temporarily avoiding flossing between the teeth that has the spacers.
While it is rare, you may lose a set of aligners. Please call us immediately so we can give you instructions. This is urgent as your teeth are moving and we don’t want them going off track. Getting things back on track takes work and will usually mean your estimated finish date will be delayed and further charges may apply (From $595).
After Hours, please move back to your previous aligner. If for some reason you do not have your previous aligner, go to your next aligner and email us at firstname.lastname@example.org and let us know the following information:
- What aligner you lost. (upper 13)
- How long you wore the aligner before losing it. (3 days full-time)
- What aligner you moved onto (previous/next)
Next, use your chewies more often. Each spot for 2 minutes, 3 times per day.
1. You will need to get a friend/family member to help take these photos. Please use your flash.
2. WEARING YOUR ALIGNERS - Slightly open your mouth so we can see the edges of your aligners. Take your index finger AND middle finger and hook your cheeks to the side.
3. Center – Hook both cheeks and take a photo from the front on showing all front teeth upper and lower as clearly as possible. See fig A.
4. Left Side (B) and Right Side (C) – hook just one cheek and take a photo from the side showing as many teeth as possible including the molars at the back.