To contact Dr. Smart
for an orthodontic emergency, please see our
"Contact Us"
page.
Many common orthodontic “emergencies” can be handled
easily at home. To help you accurately describe an
emergency situation to the orthodontist, use the
diagram at the end of this section, which
illustrates and names each part of a typical set of
braces. A list of supplies to keep on hand is also
posted at the bottom of this section.
Trauma to tooth –
tooth came out
If a tooth has been knocked out, do not clean off
the tooth.
- Call your orthodontist or your dentist
immediately to inform them of what has happened.
- Upon locating the tooth, hold the enamel end
of the tooth, not the pointed end/root.
- Do not rinse the tooth in water. Do not
scrub the root. You may remove large debris.
If possible, put tooth back in socket where
tooth was and hold in place with gauze or
washcloth. If it is not possible to replace the
tooth in its socket, put the tooth into cup of
milk or saline solution, or put the tooth
between the cheek and gum. Do not put the tooth
in plain water.
- Apply an ice pack to the affected soft
tissue area to reduce swelling
- Do not let the tooth dry out. A tooth can
often be saved if cared for properly and
reimplanted within an hour.
Broken tooth
- Clean the injured area and apply an ice pack
to the effected soft tissue area to reduce
swelling.
- Save the tip of the tooth (for possible
reattachment) and call your dentist right away.
Piece of the
Orthodontic Appliance is Swallowed or Aspirated
If you are able to see the piece, you may
carefully attempt to remove it. But do not
make the attempt if you would cause the patient
harm.
Encourage the patient to remain calm. If
the patient is coughing excessively or having
difficulty breathing, the piece could have been
aspirated (drawn into the lung).
If there is no coughing or difficulty in
breathing, and you suspect the piece has been
swallowed, call the patient’s orthodontist for
advice and instructions.
If you are unable to see the piece and believe it
may be have been aspirated, call 911 (or the
appropriate emergency number for your area) and the
orthodontist immediately. The patient should
be taken to an urgent care facility for an x-ray to
determine the location of the piece. A
physician will have to determine the best way to
remove it.
A Bracket is Knocked
Off
Brackets (see diagram below) are the parts of
braces attached to teeth with a special adhesive.
They are generally positioned in the center of each
tooth. If the bracket is off center and moves
along the wire, the adhesive has likely failed.
Call your orthodontist, who will determine the
course of action.
If the loose bracket has rotated on the wire and
is sticking out, attempt to turn it back into its
normal position and call your orthodontist to
schedule an appointment to have it reattached.
You may wish to put orthodontic wax around the area
to minimize the movement of the loose brace.
If you are in pain, please call your orthodontist
and inform them of the circumstance. If you
are not in pain, this is not a true emergency.
Please call the orthodontist at your earliest
convenience to schedule an appointment to reattach
the brace to the tooth.
Remember, brackets can become loose as a result
of chewing on hard, sticky or chewy foods or objects
as well as from physical contact from sports or
rough housing.
Be sure to wear a protective mouth guard while
playing sports!
The Archwire is Poking
If the end of an orthodontic archwire (see
diagram) is poking in the back of the mouth, attempt
to put wax over the area to protect the cheek.
Call the orthodontist to schedule an appointment and
have that clipped. If you are uncomfortable,
make sure you inform the orthodontist.
In a situation where the wire is extremely
bothersome and the patient will not be able to see
the orthodontist immediately, as a last resort, the
wire may be clipped with an instrument such as
fingernail clippers.
Reduce the possibility of swallowing the snipped
piece of wire by using folded tissue or gauze around
the area to catch the piece you will remove.
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.
“Ligature Wire” is
Poking Lip or Cheek
Use a Q-tip or pencil eraser to push the wire
(see diagram) 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” below for
instructions on applying relief wax.) Make the
orthodontist aware of the problem.
Loose Brackets, Wires
or Bands
If the braces have come loose in any way, call
the orthodontist to determine appropriate next
steps. Save any pieces of your braces that
break off and bring them with you to your repair
appointment.
Irritation of Lips or
Cheeks
Sometimes new braces can be irritating to the
mouth. A small amount of orthodontic wax makes
an excellent buffer between the braces and lips,
cheek or tongue. 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. If
possible, dry off the area first as the wax will
stick better. The patient may then eat more
comfortably. If the wax is accidentally
swallowed it’s not a problem. The wax is
harmless.
Mouth Sores
People who have mouth sores during orthodontic
treatment may gain relief by applying a small amount
of topical anesthetic (such as Orabase or Ora-Gel)
directly to the sore area using a cotton swab.
Reapply as needed.
Discomfort
It’s normal to have discomfort for three to five
days after braces or retainers are adjusted.
Although temporary, it can make eating
uncomfortable. Encourage soft foods.
Have the patient rinse the mouth with warm salt
water. Over-the-counter pain relievers,
acetaminophen or ibuprofen, may be effective.
Lost Ligature (Rubber
or Wire)
Tiny rubber bands known as alastic ligatures (see
diagram), are often used to hold the archwire into
the bracket or brace. If an alastic ligature
is lost, contact the orthodontist, who can advise
you whether the patient should be seen.
The same holds true for wire ligatures.
What if the Lip Gets
Caught on a Brace?
- Call your orthodontist immediately.
Apply ice to the affected area until you have the
opportunity to been seen by your orthodontist or
family dentist.
I Can’t Open My Mouth
Potential causes – problems with lower jaw joint
or swelling around the soft tissues in the mouth.
- Call your orthodontist or dentist and inform
them of your symptoms.
Food Caught Between
Teeth
This is not an emergency. It can be resolved
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 to
dislodge food caught between teeth and braces.
To help you accurately describe an emergency
situation to the orthodontist, use the diagram
below, which illustrates and names each part of a
typical set of braces.
A. Ligature
The archwire is held to each bracket with a
ligature, which can be either a tiny elastic or
a twisted wire.
B. Archwire
The archwire is tied to all of the brackets and
creates force to move teeth into proper
alignment.
C. Brackets
Brackets are connected to the bands, or directly
bonded on the teeth, and hold the archwire in
place.
D. Metal Band
The band is the cemented ring of metal which
wraps around the tooth.
E. Elastic Hooks & Rubber Bands
Elastic hooks are used for the attachment of
rubber bands, which help move teeth toward their
final position.
With these supplies on hand, you will be prepared
to handle the most common problems with braces.
- Non-medicated orthodontic relief wax
- Dental floss
- Sterile tweezers
- Small, sharp clippers suitable for cutting
wire (such as a fingernail clipper)
- Q-tips
- Salt
- Interproximal brush
- Non-prescription pain reliever
(acetaminophen or ibuprofen or any
over-the-counter medication typically used for a
headache)
- Oral topical anesthetic (such as Orabase or
Ora-Gel)
