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  • Emergencies

    While Dr. Nalbandian makes every effort to minimize them, you may occasionally face an orthodontic emergency. Most orthodontic emergencies, though a little upsetting, are actually fairly simple to treat and can often be handled by the patient or their loved ones.

    For some emergencies, you may need to contact our office. To help you accurately describe an emergency, use the diagram below, which illustrates and names and parts of a typical set of braces.

    braces_components2

    Tools & Supplies

    With these tools and supplies on hand (most of which you already have), you will be prepared to handle the most common orthodontic emergencies.

    • Non-medicated orthodontic relief wax
    • Dental floss
    • Sterile tweezers
    • Small, sharp clipper
    • Q-tips
    • Salt
    • Interproximal brush
    • Toothpicks
    • Non-prescription pain reliever (acetaminophen or ibuprofen supplied by the student’s parent/guardian—use only with written permission of Dr. Nalbandian and parent/guardian)
    • 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. 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. You can also use an interproximal brush or toothpick to dislodge food caught between teeth and braces.

    Lost Wire or Ligature

    Tiny rubber bands or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber or wire ligature is lost, notify your parents so we can advise whether the patient should be seen.

    Ligatures Come Off

    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 your parents, who should then inform our office.

    Discomfort

    It’s normal to have discomfort for a day or two after braces or retainers are adjusted. You also may find that eating is uncomfortable. This discomfort is both normal and temporary. Be sure to eat soft foods. You can also try rinsing your mouth with warm salt water. If you are allowed to have over-the-counter pain relievers, acetaminophen or ibuprofen may be effective.

    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 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. 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. Reapply as needed.

    Irritation in Mouth

    Sometimes new braces can be irritating to the mouth, especially when 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. This will help to make eating a bit more comfortable. The wax is harmless, so don’t be alarmed if you accidentally ingest some.

    Protruding Wire

    Occasionally the end of a wire will work itself out of place and cause irritation in your 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 Cheeks or Lips above for instructions on applying relief wax). You will need to call the office to make us aware of the problem.

    In a situation where the wire is extremely bothersome and you will not be able to see the orthodontist anytime soon, you may clip the wire. But, this should be a last resort.

    In order to reduce the possibility of swallowing the snipped wire, be sure to use 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 Wires, Brackets or Bands

    If the braces have come loose in any way, call our office to determine 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 you have eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play (Please remember to wear a mouthguard when playing sports, especially if you have braces).

    If the bracket is off center, the adhesive may have failed. Notify our office, and we will determine the appropriate course of action.

    If the loose bracket has rotated on the wire and is sticking out, and you 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 until it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the center of the tooth.