Advice for Orthodontic Emergencies during Covid 19

Posted on 26/03/20

Orthodontic emergencies occur occasionally and, although they may be a little upsetting for the patient and parents, they are usually fairly simple to resolve by the patient or parents. But for some emergencies, patients may need to contact their orthodontist for advice.

Emergency Treatments
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 will require immediate attention by the emergency dentists/orthodontist. The majority of these can be easily dealt with by yourself at home or wait to see your orthodontist at the next visit.

1.Food Caught Between Teeth
This can be a little uncomfortable or embarrassing for the patient. It is easily fixed with a piece of dental floss or use an interproximal brush or toothpick to dislodge food caught between teeth and braces.

2. Lost Wire or Elastics (Rubber ) 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 or totally disengaged, notify your orthodontist before your next appointment with your Orthodontist. It is not an emergency and your Orthodontist will put a new one next time you are seen.


3. Ligatures Come Off
If a rubber ligature should come off partially, you or your guardian may be able to put it back in place using clean tweezers. If a wire ligature comes loose, simply remove it with clean tweezers. If the wire ligature is sticking out into the lip but is not loose, it may be bent back down with a cotton bud or pencil eraser to eliminate the irritation.
Of course, when one ligature pops off or breaks, others may follow. Missing or broken ligatures should be brought to the attention of your orthodontist next time you are seen. This is not an emergency.

4. Discomfort
It is 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. Stick to soft foods. Rinse the mouth out with warm salt water or antiseptic mouthwash. If you have no contraindication for over-the-counter pain relief, these may be effective as long as you adhere to the manufacturer instructions. This is not an emergency.

5. Irritation of Lips or Cheeks
Sometimes new braces can be irritating to the mouth, especially when you are eating. A small amount of non-medicinal relief wax (Orthodontic Relief Wax) makes an excellent buffer between the brackets 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. You may then function more comfortably. If the wax is accidentally ingested it is not a problem. The wax is harmless. The red wax coating on ‘Babybel’ cheese works well in this situation. This is not an emergency.

6. Loose Brackets, Wires or Bands
If the braces have come loose in any way, you can simply remove the ligature with a tweezer and bracket should slip out. If the bracket is not bothering you, let it just stay on the wire. You may need some wax to make it comfortable if it is twisting on the wire. This is not an emergency and you can wait till you are seen by your orthodontist.

7. Protruding Wire
Occasionally the end of a wire may work itself out of place and irritate your mouth. You or your guardian may be able to put it back in place using clean tweezers.
When the teeth are straight or when there is a gap from tooth that was removed there is more chance of the wire coming out of place. Wire can also come out from the last bracket on one side and it can become longer on the other side as the wire swings to one side as teeth become straighter. Use a tweezer and pull the end of the wire that has come out of the bracket. Once it is longer than enough to thread through the bracket slowly thread it into the last bracket.
In the second instance if you couldn’t do the first option then, try to use a suitable instrument like a cotton bud 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 Orthodontic Relief Wax.
In a situation where the wire is extremely bothersome (if this has made an ulcer) and it is not relievable with the above measures, telephone our practice phone number where you will be given further instructions what to do. Bear in mind that any components dismantled by the emergency on-duty dentist can be and will be replaced by your orthodontist at a later date. Orthodontic Relief Wax may still be necessary to provide further comfort to the irritated area. Inform, your orthodontist when you come for your next appointment.
If you are unable to see a dentist/orthodontist then you can take the ligatures out with a clean pin making sure not catching the lip’s one by one and pull the wire out. This should only be done if nothing above helps.

8. A Bracket is knocked off at the back and wire is digging into the cheek. Brackets are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the centre of each tooth. The bracket can be knocked off if you have eaten one of those hard or crunchy foods you are instructed to avoid, or if the mouth is struck while at play. (A protective mouth guard should be worn while playing sports). If the loose bracket has rotated on the wire and is sticking out, use Orthodontic Relief Wax to cover the offending component.
In a situation where the wire is extremely bothersome (if this has made an ulcer) and it is not relievable with the above measures, telephone our practice phone number where you will be given further instructions what to do. Bear in mind that any components dismantled by the emergency on-duty dentist can be and will be replaced by your orthodontist at a later date. Orthodontic Relief Wax or Gishy Goo orthodontic brace relief (white silicone this can be ordered online) may still be necessary to provide further comfort to the irritated area. Inform, your orthodontist when you come for your next appointment. Your orthodontist should be notified if the end of the wire is digging in and caused an ulcer.

9. Other broken metal components (Transpalatal Arch or a quad helix).
These fixed components tend to be fixed onto multiple back teeth through metal bands. These bands are normally stuck in place with a dental cement. If the whole component has detached from patient’s teeth, please leave it off and keep the component safe and present it to the orthodontist at the next appointment.
If part of the component has become loose but stayed in place, contact your orthodontist before your next appointment. This is not an emergency. If part of the component has become loose and dislodged, causing trauma to cheek/palate/tongue; or it is stopping you from biting your teeth together, you may need to be seen by the on-duty dentist to remove the whole component safely. Please telephone our practice phone number where you will be given further instructions what to do.

10. Piece of the appliance is swallowed or aspirated.
If a piece of the appliance is swallowed, there should be no coughing or difficulty in breathing. Usually the conservative approach is taken, and the piece is allowed to pass naturally. Your orthodontist should be notified as soon as practically possible.Very rarely, a piece of the appliance can be aspirated (caught in the airway). If you are coughing excessively or having difficulty breathing, the piece could have been aspirated. When this happens, you must remain calm. 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 harm.
If you are unable to see the piece and believe it may have been aspirated, you should attend an A&E Department for an x-ray to determine the location of the piece. A medical doctor will have to determine the best way to remove it if inhaled.

11. Trapped soft tissue onto fixed appliance following trauma.
Occasionally after falls and being ‘hit in the face’, the lip or cheek may become embedded onto the fixed appliance; with patient complaining ‘lip/cheek got stuck on the brace’. You need to be seen by the on-duty dentist to safely disengage the soft tissue from the brace. This could be done by administering appropriate Local Anaesthesia in order to disengage the soft tissue without discomfort. Stitches may be necessary under certain circumstances. Please telephone our practice phone number where you will be given further instructions what to do.

12. Broken Twin block brace
If you are able to wear the brace despite any of the clasps that has fractured, please continue wearing them. If the brace has come loose and it is falling out when you are asleep, please stop wearing them until you see your Orthodontist to tighten it. Again, in the current circumstance this is not considered an emergency. If any of the wire has broken off, but the brace fits and sits well in the mouth then please continue wearing them. This can sometimes happen with wear and tear of the metal parts of the brace as they are removed and put in mouth frequently.

13. Aligners
If any of the attachments have come loose, please don’t worry. Wear your aligners as advised by your Orthodontist until you are seen again. Due to the current situation you may be advised to wear your aligners for 2 weeks each instead of the one-week protocol. This is may be needed if you require slenderising or interproximal reduction of your teeth before you can move to the next aligner or you cannot get to us to have the next sets of aligners. Please wear the last aligner just at night as a retainer till we can see you again after they have been worn for two weeks fulltime.

14. Lost retainers or broken bonded retainers
We may not be able to make you a new retainer as most labs are closed and the rest may close in a week or two. Please make sure you keep hold of your current retainers and not lose them. If your bonded or fixed retainers has come off or broken on one tooth, try and wear your removable retainer every night for 12 hrs until you are seen by the Orthodontist when the practice reopens for routine care. If the part of your bonded retainer has snapped and is dangling then you can wear the removable retainer full time except eating, drinking and brushing your teeth. If retainer is lost - the patient could get a self-moulding gum shield from the chemist to wear at night in meantime.