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How to handle Orthodontic (Braces) Emergencies

This post is provided by Dr. Matthew Wirig of Wirig Shaw Orthodontics in Henderson, NV.

One of the benefits of Invisalign is most of these emergencies do not apply to Invisalign treatment and the amount of things that could go wrong is significantly less when being treated with Invisalign.

Remember, these are listed in least to greatest severity. Only the most severe problem needs to be seen immediately by an orthodontist or one of his or her staff members. The majority of these smaller problems can be addressed at the patient’s next scheduled appointment. Orthodontic offices are equipped to instruct patients on the urgency of a specific problem.

Remember, orthodontic movement of teeth is a slow process that takes time. It is rare that something would ever be urgent and require immediate attention. Just give your office a call and ask, if you have any questions.

If it is a life threatening emergency, you should call 911 immediately.

Food Caught Between Teeth

Having food caught in your braces and between teeth is inevitable for every patient. This is not a true emergency, but can be annoying and frustrating to deal with until you have learned how to manage it. It can be both uncomfortable and embarrassing to have food caught in between teeth and in the braces. Effective use of floss and using a good flossing technique is effective in fixing this problem.

Other devices that may help in these cases are floss threaders, orthodontic/braces specific flossers, super floss, interproximal brushes, and toothpicks, which can be effective in helping solve this problem. Instead of saving your dinner in your braces for later, clean it out and smile more comfortably and confidently.

Ligatures Come Off

The word ligature means the little colored rubber bands or small fine wires that hold the wire into the individual brackets. It takes a finely skilled hand to place the colored rubber bands on the braces as well as a good, sterile pair of tweezers. If, instead of a rubber band, a small fine wire is tied around the brace and an end is poking out, use the end of a pencil with its eraser to push the wire out of the way and so that it is not poking anymore.

Of course, if either comes loose or is lost, it may need to be replaced; feel free to call your orthodontist and inquire about the issue. A staff member should be able to tell you if it needs to be seen soon or if it can wait till your next appointment.

Bite Feels Strange or Teeth Feel Loose

It is a completely normal thing for patients to become frustrated with how their bite works or doesn’t work anymore while in the middle of treatment. When I did my Invisalign treatment, I was frustrated that my teeth did not function the same way as they did prior to treatment. One of the reasons for this was that my bite was not perfect. I was used to functioning with a bad bite. So, that takes some getting used to.

At one point, as my teeth were moving, my front teeth couldn’t touch when I tried to bite down.

As it was changing, I was also frustrated that some teeth felt loose or tender as well. I couldn’t bite through that tough piece of beef jerky anymore with my front teeth. Then a few weeks later, I was able to bite with my front teeth, but my back teeth didn’t work together quite right and I had the opposite problem. The reality is that we are creatures of habit and get used to doing things a certain way. During treatment, teeth are moving and the bite is changing. It may take time to get used to the changes. In fact, things may seem worse or seem as though they are not getting better. Don’t worry, your smile and bite will be better after treatment is completed.

We often advise patients who are concerned about this. Sometimes it may get or look worse before it gets better. This is perfectly normal. Orthodontists are highly trained in what we do. Just leave it to me and my trusted team of skilled professionals. We will get you the results you want if you follow the course of treatment to the end.

Think of it similarly to repainting your car. The first step is to remove the previous paint and/or put a coat of primer on. If you were to judge the paint job at this point, it would not be fair. The priming is necessary for a good result in the end. However, at that point, it does not look good. The point at which you should judge the paint job is when it is completed. This is the ideal time to judge the results.

Spaces Appear In Places They Never Have Before

When we begin orthodontic treatment, sometimes we will create spaces in places where they never existed before. This can be most frustrating if it happens in between the two front teeth. This is a normal part of braces for some people. It is not an indication of the final results, and although frustrating, it does mean progress is being made. Be assured that as easily as the space opens up, it is just as easy to close it. Sometimes we will wait to close the space; this may be necessary so that it is closed correctly and with good results.

Consult with your orthodontist if you have concerns like this. He or she will be able to explain the process and plan for your specific case.

Discomfort

It is normal to have discomfort for a day or two after an adjustment of the braces or when putting in a new Invisalign aligner. The teeth themselves may become tender to the touch and experience sensitivity to hot and cold, temporarily.

Any discomfort that is lingering and does not subside in a few days to a couple of weeks should be discussed with your orthodontist. Softer foods are a way to avoid some of the discomfort as well as rinsing with warm salt water. Over-the-counter pain medications can be very helpful as well, these would include acetaminophen (Tylenol) and ibuprofen (Motrin/Advil). There have been some really good studies that show a significant decrease in pain when these are used. The best results are often seen using ibuprofen. Just take the recommended amount for your age and size, as instructed on the bottle.

Most orthodontists like myself don’t have the legal ability to prescribe medications. The strongest thing we would ever recommend would be over-the-counter ibuprofen. This can be obtained at any drug store, pharmacy, and many other places.

Irritation of Lips or Cheeks

The mouth is a really incredibly tough place. When you think about it, we are pouring really strong acids into our mouths with sour candies, hot sauces, and soda. We pour scalding hot and freezing cold liquids into our mouths. We also mash up crunchy foods and some of us crush ice in our mouths (by the way, chewing ice is not good). I’m amazed we don’t cause far more damage to our mouths and teeth than we already do.

Almost everyone has been a victim of a canker sore on the lip. Who hasn’t burned themselves by drinking hot cocoa/coffee? Or tore up the roof of their mouth on some cereal? It’s not terribly uncommon for your mouth to develop little sores from the braces or Invisalign trays as well.

I was a victim of an Invisalign tray constantly irritating the side of my tongue. Or if I slept on my stomach, my face and cheek would become pressed into the side of the Invisalign edge. Or I would find my tongue playing with the edge of the tray, and then I would get a sore on my tongue from the habit. It is inevitable. Our mouths will find ways to be annoyed by what we put in it. So, this shouldn’t come as a surprise. I can tell you it will all go away with time. Your body will adapt to the annoyance and it will get better on its own most of the time.

If, however, you can remove the irritation without damaging the appliances, then it can speed up the process. We give every patient who gets braces a little package of wax. Wax can be useful when applying to the offending area on the braces or Invisalign. When it is put on repeatedly, it allows the area to heal up. When the offended area is healed, it is less likely to be damaged again. The mouth is similar to our hands. When working in a garden or with hand tools, your hands will toughen up and develop calluses that protect them from the rigors of the work. Our mouths will toughen up in the same way. This means you should only rely on wax when you have an open sore which has developed and not for other minor annoyances.

You should be able to wean yourself off of wax and only need use of it occasionally.

A small amount of relief wax can be an excellent buffer between the braces and your cheeks.

Simply pinch off a small piece and roll it into the size of a small pea. As best as you can, dry off the area on your braces where you intend to apply it. Then, flatten the small ball of wax over the dried area on your braces. You will then be able to eat more comfortably and the area will heal easier. Everything in the mouth takes only a few days to heal, although some sores take up to two weeks. If you accidentally swallow or eat the wax, it is ok. The wax will not hurt you if ingested. It is harmless.

With Invisalign, we have the added advantage of being able to trim the aligner so that the offending edge does not cause the same irritation. I often instruct my Invisalign patients to use sterile, disinfected fingernail clippers to clip off an edge that is causing a sore. It’s a fast and easy fix for patients with Invisalign. Don’t clip off too much though!

Check with your orthodontist before making any major modifications to your aligners. Wax can be used to great effect with Invisalign as well, although we see far less irritation in the mouth from patients using Invisalign.

Protruding Wire

When you start wearing braces, the wires zig and zag in and out in order to conform to a patient’s crooked teeth. As the teeth straighten, the wire itself does not need to bend as much. When this happens, the wire will start to creep out the back of the braces and become extended. When a wire is protruding out of the back of the braces, it can sometimes be irritating because it may catch the cheek or embed itself in the gums. The good thing about this is it is an indication of progress; the teeth are moving and getting straighter. The bad thing is, of course, it can be uncomfortable.

At other times, the wire may protrude from different circumstances. When this happens, it may need to be clipped by the office staff or be seen by the orthodontist. Notify the office if it cannot be resolved by methods discussed previously.

Those methods mentioned previously involve using a pencil eraser to move the wire, or a pair of tweezers to reinsert it into a brace, or placing wax to temporarily solve the problem. If the situation is extremely bothersome and it is impractical to be seen soon for an appointment, you may try clipping the wire yourself with sterile/disinfected nail clippers. The main thing to be careful of is to not allow the clipped wire to be swallowed or lost after clipping! This can be helped by using gauze or cotton balls to stabilize the wire while it is being cut.

This can be scary to do, and you don’t want to break the wire, so call your orthodontist if you have questions.

You can avoid this issue with Invisalign. For most patients, the protruding wire is not noticeable nor a problem, as it is usually trimmed and accounted for at each appointment.

Loose Brackets, Wires, Bands, or Attachments

If any fixed part of the braces such as a bracket, wire, band, or in the case of attachments on Invisalign, come loose, or break off, you should notify the orthodontic office. This is especially important if you were just seen recently for an appointment and don’t have an appointment for a while.

Broken or loose parts can mean longer overall treatment times. The faster something is fixed, the better your treatment will stay on track. If your appointment is coming up soon, it would still be good to let us know beforehand what is possibly wrong, but we may advise you to be seen at your regular appointment.

The average patient breaks two brackets during the entire course of his or her treatment. This is normal and unavoidable because our mouths are such active places. Multiple things can cause excessive breakage of brackets. The rarest cause is improper bonding technique or faulty materials.

This does happen, but for most orthodontists, it is extremely rare. The most common cause of breakage is careless management of the braces or improper diet – eating foods that will break the braces. Certain types of bites can also cause breakages. Some people with strong jaw muscles or deep bites are more prone to having braces break off. Another cause may be malformed enamel. Enamel is the hard outer layer of teeth. At times, it may form in an abnormal way and may be difficult for the braces’ adhesives/glues to work.

A really conscientious patient who follows the rules and is careful will have the fewest problems and the fastest treatment times.

Piece of Appliance is swallowed

With so much in the mouth and so much on the teeth with braces, sometimes, as much as we work to avoid it, something may come loose and get swallowed. This is rare, but when it does happen, it can be fairly alarming to the patient. If something is swallowed, most of the time it is harmless. The most common thing swallowed is wax or rubber bands. Neither of these things will cause a problem.

Most other things will not cause a problem either. If you are worried about having swallowed anything, you should contact your orthodontist’s office.

Most of these events are not even true emergencies. The true orthodontic emergency is really very rare. It would only be considered a true emergency if it is required to be sent to an emergency room. This is most often the case when someone has had a severe accident and has broken teeth and/or the jawbones. In these cases, it is much more important to be seen by a general dentist, physician, and/or oral surgeon before being seen by an orthodontist.

One of the advantages to wearing braces or Invisalign is that if there is a true emergency and some damage has been done to the teeth or jaw, the amount of damage caused is often severely lessened by wearing braces. Meaning, it is much harder to get a tooth knocked out when wearing braces or Invisalign. It is still a good idea to wear athletic mouth guards while wearing braces. If nothing else, it will prevent your cheeks from getting torn up by the braces if you get an impact to the face.

I recently saw a patient who came in after being hit with a baseball at a practice. The baseball had dislodged his tooth and it was only being held in by the braces themselves. He was really fortunate because the bone was damaged around the front teeth also and was broken. Because he was wearing braces, everything was stabilized and not falling out. This sounds rather gruesome, but he was pretty fortunate.

The advantage of Invisalign when someone receives trauma is that it serves much in the same way as mouth guard and protects the mouth and teeth.

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