The following is intended to provide general information regarding some of the more common orthodontic emergencies. Seek follow-up care with an orthodontist, dentist, or physician for more specific instructions.
Emergencies for patients in braces tend to be relatively infrequent and fortunately are not usually severely debilitating. Nevertheless, the discomfort from a problem with the braces can be upsetting. Listed below are some of the more common problems and some possible solutions to deal with the situation on a temporary basis until seen by an orthodontist.
Broken or loose braces are generally not considered an urgent problem in most cases. There are times when a loose brace may cause some problems, however, so it is best to call the orthodontic office when the problem occurs and ask for their recommendation. When a bracket comes off of a tooth, it is still normally attached to the wire with an elastics tie. This will prevent the bracket from being swallowed, but it may move or spin around on the wire. If this is a problem for the patient, a little wax pressed against the bracket will keep it from moving around.
When a band (ring around the back teeth) comes loose, the patient is in no immediate harm. However, the band is normally cemented on the tooth with an adhesive that seals the inner portion of the band from saliva and plaque. If the band is left loose for a period of time (3-4 weeks), saliva and bacteria may enter into the crevice between the tooth and the band. The bacteria produce an acidic byproduct, which then eats away at the enamel (demineralization). The result is decalcification (white spot) or a cavity on the tooth surface. It can form rather quickly, causing damage to the enamel, so a phone call to the orthodontist is recommended.
Many times as the teeth move in the early phase of treatment, the wire used to straighten the teeth has no place to go except out the back of the molar band area. Also, if spaces are being closed or if the bite is being corrected, the wire will begin to get longer at the back of the braces. Fortunately, most times this can be handled at home very simply with some orthodontic wax. It is important to try and dry the area first (with a paper towel), then roll up a piece of wax into a ball. Place the ball of wax into the area of the poking wire. The wax will smooth the area and keep the tissue from getting caught on the end. If wax does not resolve the pain, the orthodontist should be called so that the wire can be clipped.
Orthodontic pain and discomfort
As was previously discussed, pain and discomfort is a normal part of orthodontic treatment. Some patients will be surprised by this fact, even though they have been warned of the possibility. The pain tends to occur about 4-6 hours after the braces are placed or after an adjustment appointment. Over the next day or two, the pain will progressively become worse. Then, after days 3-5, the pain will begin to subside. Most orthodontists recommend over the counter pain medication just prior to and after the adjustment appointments. This allows the medication to already be in the system before the pain begins, improving the effectiveness.
Significant dental injuries while in braces can be traumatic to the patient. Immediate care should be sought from a physician and dentist in those cases. In some cases, the braces have been known to actually prevent loss of teeth, since the braces and wires had provided stability. Home care is generally not recommended in these cases.
Loose Expander appliance
A rapid maxillary expander (see page 32) is an appliance used in some patients to help widen the upper jaw and teeth. If the appliance becomes loose, it may be more urgent to see the orthodontist, since the appliance may become quite uncomfortable for the patient. Also, if the appliance is not in its proper position, or if it falls out completely, the correction that has already been achieved may be lost. It would be best to call the orthodontist and follow their recommendations.
There are a number of variables that determine whether this is an urgent situation or not. For example, if the braces had recently been removed, there is a greater chance that the teeth will shift and move if a retainer is not replaced relatively quickly. However, every patient may differ with the potential amount of relapse. Also, certain types of tooth movements may have a greater tendency for relapse than others. For example, a space between the upper front teeth may have a greater tendency to reopen in some patients, so it may be important to replace the retainer. If a patient has been out of braces for a long period of time, and the teeth are in a relatively stable position, the chance of significant shifting may be low.
Swallowing Braces and Appliances
Swallowing braces or other appliances used during orthodontic treatment tends to occur relatively infrequently. This is because the braces and bands are normally still attached to the wire if they become loosened from a tooth. However, if it does occur, it is best to seek advice from the orthodontist and physician right away. Fortunately, the braces and rubber bands used for orthodontic treatment are quite small, and the patient will usually pass them without difficulty.
The braces have a tendency to feel rough against the cheeks, lips, and tongue, especially soon after the braces are placed. This will sometimes lead to soreness and cause discomfort. The tissues will develop a callous over time, so this becomes less of a problem while treatment progresses. In the initial stages of treatment, wax can be used in areas that are particularly painful. However, limiting the use of wax will help the patient build up the callous tissues. Temporary pain relief can also be obtained with topical anesthetics (i.e. Orabase®).