The following is intended to provide general information regarding some of the more common orthodontic emergencies. Emergencies for patients in braces tend to be relatively infrequent and fortunately are not usually severely debilitating. Nevertheless, discomfort from a problem with the braces can occur. Listed below are some of the more common problems and some possible solutions to deal with the situation on a temporary basis. If you have concerns after attempting these repairs, please feel free to contact our office for further instructions.
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 our office when the problem occurs. When a bracket comes off of a tooth, it is still normally attached to the wire with an elastics tie.
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.
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 a period of time (3-4 weeks), saliva and bacteria may enter into the crevice between the tooth and the band. The result could be a decalcification (white spot) on the tooth surface. It can form rather quickly, causing damage to the enamel, so a phone call to our office is recommended.
Many times as the teeth move in the early phase of treatment, the wire used to straighten the teeth has no place to go except out the back of the molar band area. Also, if spaces are being closed or if the bite is being corrected, the wire will begin to get longer at the back of the braces. Fortunately, most times this can be handled at home very simply with some orthodontic wax. 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 tissue from getting caught on the end. If wax does not resolve the pain, please contact our office.
Orthodontic pain and discomfort
Pain and discomfort is a normal part of orthodontic treatment. The pain tends to occur about 4-6 hours after the braces are placed 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. We recommend over the counter pain medication (preferably Tylenol) 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.
Significant dental injuries while in braces can be traumatic to the patient. Immediate care should be sought from an emergency physician and dentist in these cases. Often the braces have been known to actually prevent loss of teeth, since the braces and wires had provided stability.
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. However, every patient may differ with the potential amount of relapse. 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. Please call our office if your retainer is lost or broken to discuss your options.
Poking metal tie
Occasionally, metal wires are used to tie the archwire to the brackets or bands. Sometimes during eating or brushing, this metal wire tie can accidentally be redirected and start to cause irritation to your lips or cheeks. You can try to push the poky wire back into place by using the end of a pencil eraser.
If that is not possible, you can place wax on the area causing the irritation until you can be seen at our office.
The braces have a tendency to feel rough against the cheeks, lips, and tongue, especially soon after the braces are placed. 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 anesthetics (i.e. Orabase®).