Braces First Aid
Handling Orthodontic Emergencies
The following orthodontic emergencies and their treatments are listed in the order of the least severe to the most severe. Only the most severe emergencies may require immediate attention by our office. The majority of these are easily treated with a follow-up office visit.
Irritation of Lips or 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 eat more comfortably. If the wax is accidentally ingested, it’s not a problem. The wax is harmless.
Ligatures Come Off
Tiny rubber bands or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber ligature 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 pencil eraser to eliminate the irritation.
Of course, when one ligature pops off or breaks, others may follow. Be sure to examine all ligatures. Missing or broken ligatures should be brought to the attention of our office. Our friendly staff will advise whether the patient should be seen.
If a rubber or wire ligature is lost, please notify our office to determine whether the patient should be seen.
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. This discomfort is both normal and temporary. We recommend that the patient eat soft foods and rinse the mouth with warm salt water.
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 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 (such as Orabase or Ora-Gel) directly to the ulcerated surface using a cotton swab. These are usually available at a local pharmacy. The patient can reapply as needed.
Food Caught Between Teeth
This is not an emergency, but can be a little uncomfortable or embarrassing for the braces- wearing 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, or use an interproximal brush or toothpick to dislodge food caught between teeth and braces.
Occasionally, the end of a wire will work itself out of place and irritate the patient’s mouth. Use a Q-tip or 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. (See Irritation of Lips or Cheeks above for instructions on applying relief wax.) Please contact our office to make us aware of the problem.
In a situation where the wire is extremely bothersome and the patient will not be able to present to our office anytime soon, the wire, as a last resort, may be carefully clipped.
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, please call our office to determine the appropriate next steps.
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 patient has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play. (We encourage all of our patients, especially those with braces, to wear a protective mouth guard while playing sports.)
If the bracket is off center, the adhesive may have failed. Please contact our office to determine the most appropriate course of action.
If the loose bracket has rotated on the wire and is sticking out and the patient cannot immediately visit our office, a temporary fix may be performed to alleviate discomfort and prevent further damage. Please 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 until it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the center of the tooth.
Piece of Appliance is Swallowed
This is rare, but when it does happen, it can be fairly alarming to the patient. Please remain calm. If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated.
If you are able to see the piece, you may carefully attempt to remove it. But do not make the attempt if you could cause harm.
If appropriate under the circumstances, examine the patient’s braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above.
If you are unable to see the piece and believe it may be have been aspirated, monitor the patient and notify our office immediately. You may be requested to promptly call 911 and/or bring the patient to the emergency room for medical care. If the patient is not breathing or has lost consciousness, call 911 without delay.