TOOLS AND SUPPLIES:

Non-medicated orthodontic relief wax

Dental floss

Sterile tweezers

Small, sharp clipper

Q-tips

Salt

Non-prescription pain reliever

Topical anesthetic such as Orabase or Ora-Gel

FOOD CAUGHT BETWEEN TEETH

This is not an emergency, but can be a little uncomfortable or embarrassing for the 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.

LOST WIRE OR LIGATURE

Tiny rubber bands ("circles") or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber or wire ligature is lost, notify the office so we may advise you whether the patient needs to be seen immediately.

LIGATURES COME OFFIf a rubber ligature ("circle") should come off, you may be able to put it back in place using sterile tweezers. If a wire ligature comes loose, simply remove it with sterile tweezers. If the wire ligature is sticking out into the lip but is not loose, it may be bent back down with a Q-tip or clean pencil eraser to eliminate the irritation. When on ligature pops off or breaks, others may follow. Be sure to examine all ligatures before calling the office to schedule a "fix-it" appointment.

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. Reassure the patient that the discomfort is both normal and temporary. Encourage soft foods and cool fluids. Have the patient rinse the mouth with warm salt water. If the patient is not allergic or sensitive, they may take over-the-counter pain relievers.

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 the 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 directly to the ulcerated surface using a cotton swab. Reapply as needed per the instructions that come in the package, or as directed by the orthodontist.

IRRITATION OF LIPS AND CHEEKS

Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of non-medicinal 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 causing irritation. The patient may then ear more comfortable. If the wax is ingested accidentally it’s not a problem. This wax is harmless.

PROTRUDING WIRE

Occasionally the end of a wire will work itself out of place and irritate the patient’s mouth. Use a Q-tip or clean 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. Call the office to notify us of the patient’s problem.

In a situation where the wire is extremely bothersome and the patient will not be able to see the orthodontist anytime soon, as a last resort, you may 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 office should be notified as soon as possible to determine the appropriate next steps.

A BRACKET IS KNOCKED OFF

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 student has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is truck while at play. (ALL orthodontic patients should wear a protective mouth guard while playing sports).

If the bracket is off center, the adhesive may have failed. Notify the orthodontist, who 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 further damage. But take care to prevent swallowing or other injury.

To put the bracket back in place, use sterile tweezers to slide the bracket along the wire unti it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the center of the tooth.