How to handle an orthodontic emergency?

Luckily in orthodontics there are not many true emergencies. Common problems are minor issues such as loose wire and brackets. The best thing to avoid any orthodontic emergency is prevention. Diet and food selection can the keys for patients wearing braces. While in orthodontic treatment, patients in braces should avoid hard and sticky foods, and should cut food up into small pieces, and take small bites. These daily habits will prevent loose brackets and broken wires. Patients in Invisalign treatment may have a few composite attachments and occasionally experience them coming off. Attachments can be replaced at the following visit.

There are 2 types of orthodontic emergencies. They are categorized as major and minor emergencies. 

Major orthodontic emergencies:

Major emergencies are any direct injuries to the face, mouth, jaw or teeth. Patients with these problems should be seen by a medical professional such as physician or dentist right away. You may need x-rays or advanced imaging to determine the extent of your injury. If the injury affects the orthodontic appliances, the appliances may need to be removed, replaced or adjusted right away.

Samples of major emergencies:

• Lacerated lips and oral tissues due to contact sports - go to an emergency room for evaluation and treatment.
• Fractures of teeth and jaw due to facial injury - go to an emergency room for further imaging and treatment.
• Infected teeth that cause bleeding, swelling or pain associated with the mouth - call your dentist for further diagnoses and treatment.

Minor emergencies:

While these are not true emergencies, they require some home care remedies and the problem can be fixed at the next office visit or subsequent visits.

Samples of minor emergencies:

• Loose wire - if it is not pokey, leave it alone and wait until the next orthodontic visit. If it is pokey, then cut the pokey end with a clean nail clipper or bend the pokey end until comfortable using the eraser end of a pencil or a cotton swab.
• Loose brackets, loose bands, lose elastic band - chew food on the opposite side and wait until the next orthodontic visit.
• Loose appliances - if the entire appliance is loose, remove it and bring it to the next orthodontic visit for re-insertion. If only one side is loose, then call for an early appointment for removal and re-insertion.
• General soreness or canker sore - place wax on brackets that face the canker sore, stay away from foods that are too spicy or salty, and chew food on the opposite site until canker sores disappear. Canker sores usually heal and disappear within 5-7 days.
• Headgear or facemask that does not fit - stop wearing the appliance temporary and bring the appliance to the next orthodontic visit for re-fitting.
• Broke your retainer or lost your retainer - call our office to order a new one.

Any of those above issues can happen due to normal shifting while wearing your braces. Eating hard or sticky food can exacerbate the problems. Vigorous brushing can also contribute. Wide yawning or sharp opening of mouth while wearing rubber bands can cause brackets to come loose. Chewing gums or chewing on pens or pencils can cause appliances or brackets to loosen. These problems do not require immediate fixing; however, they will need repairs at subsequent office visits.

The on-the-spot remedy for those loose brackets or wires is wax to alleviate discomfort. Pokey wires can be moved with a cotton swab or clipped off with a clean nail clipper. Soreness and small abrasions in the mouth are normal due to new adjustments to orthodontic appliances. Rinse your mouth with salt water solution comprised of a cup of 8oz warm water and one teaspoon of salt, 3 times daily, for 2-3 days until better.

We have a lot of instructions on our website at www.CareOrthodontics.com to help you handle minor issues. We have instructions for emergency care under ‘Braces San Jose' > 'Emergency care’ tab. We have videos on how to handle common issues under ‘Orthodontic videos' > 'Instructions videos’ tab.

Whenever in doubt, be sure to contact our office to schedule an appointment with Dr. Phan at Care Orthodontics. We are always available for instructions, care and comfort. Our mission is to help you achieve the most beautiful smile with personal attention and care!