Supplies to have available…Discomfort It is normal for a patient to have discomfort for a day or two after braces are placed or adjusted. Reassure the patient that the discomfort is both normal and temporary. Encourage soft foods. If the patient’s parent/guardian has given written permission to the school, dispense an over-the-counter pain reliever (such as ibuprophen or acetaminophen) in the appropriate dose for the patient’s weight. Ties/Wire Ligatures Come Off Tiny rubber bands, known as ties, hold the wire to the bracket. If a tie should come off, you may be able to put it back in place using sterile tweezers. If a fine wire ligature is being used to hold the wire in place and it begins to unravel, simply remove it with sterile tweezers. If the wire ligature is sticking out into the lip, but is not loose, it may be bent back down with a Q-tip or pencil eraser to eliminate the irritation. Irritation of Lips or Cheeks Sometimes braces can be irritating to the mouth, especially after they have been placed and the patient is not used to them yet. A small amount of dental wax makes an excellent buffer between the bracket 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. Let the patient know that if the wax is accidentally ingested, the wax is harmless and it will not be a problem. If a sore has developed in the patient’s mouth, relief may be achieved by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the ulcerated surface using a cotton swab. Instruct the patient to reapply as needed. It is also recommended that the patient rinse frequently with warm salt water. Protruding Wire Use a Q-tip or pencil eraser to push the wire so that it is flat against the tooth. In a situation where the wire is extremely bothersome and the patient will not be able to see the orthodontist anytime soon, you may, as a last resort, clip the wire. Reduce the possibility of the patient swallowing the clipped piece of wire by using folded tissue or gauze around the area. Use sharp nail clippers and clip off the protruding wire as close to the bracket as possible. Place wax over the area if needed. Loose bracket (brace) If the bracket is not causing discomfort, leave it attached to the wire. If the patient is uncomfortable, remove the tie holding the bracket to the wire using a toothpick or sterile tweezers. Then lift the wire up and allow the bracket to slide out. Place the bracket in an envelope and send home with the patient to bring to his/her next orthodontic appointment. Advise the patient to have his/her parent call the orthodontist and schedule an appointment for repairs. Loose band (metal ring around the back molars) If the band comes completely out, please place it in an envelope and send home with the patient to bring to his/her next orthodontic appointment. If the band is loose, have the patient chew on the opposite side. This situation requires immediate attention from the patient’s orthodontist. Have the patient tell his/her parent call the orthodontist office to schedule an appointment.
These are a few examples of minor orthodontic emergencies. Any other situations, such as broken Herbst (lower jaw advancing appliance) or loose expander, needs to be referred to the orthodontist office immediately.