Tools & Supplies
With these tools and supplies on hand (most of which you already have), you will be prepared to handle the most common orthodontic emergencies.
•Small, sharp clipper
•Topical Anesthetic (such as Orabase or Ora-
This is not an emergency, but can be a little uncomfortable or embarrassing for the patient. It is easily fixed 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 or toothpick to dislodge food caught between teeth and braces.
Lost Wire or 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, notify the orthodontist so he may advise whether the patient should be seen.
Ligatures Come Off
If a rubber ligature should come off, you may be able to put it back in place using sterile tweezers. If a wire ligature comes loose, 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-
Of course, when one ligature pops off or breaks, others may follow. Be sure to examine all ligatures. Missing or broken ligatures should be brought to the attention of the orthodontist.
It’s normal for a patient to have discomfort for a day or two after braces or retainers are adjusted. But it can make eating uncomfortable. Reassure the patient that the discomfort is both normal and temporary. Encourage soft foods. Have the patient rinse the mouth with warm salt water. If the patient is allowed to have over-
Some patients are susceptible to episodes of mouth sores. While braces do not cause them, they may be precipitated or exacerbated by an irritation from braces. One or several areas of ulceration of the cheeks, lips or tongue may appear. This is not an emergency, but may be very uncomfortable for the patient. Prompt relief may be achieved by applying a small amount of topical anesthetic (such as Orabase or Ora-
Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of non-
Occasionally the end of a wire will work itself out of place and irritate the patient’s mouth. Use a Q-
In a situation where the wire is extremely bothersome and the patient will not be able to see the orthodontist anytime soon, as a last resort, you may clip the wire.
Reduce the possibility of the patient swallowing the snipped piece of wire by using folded tissue or gauze around the area. 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.
If the braces have come loose in any way, the parents need to be notified, and they should call the orthodontist to determine the appropriate next steps.
A Bracket is Knocked Off
Brackets are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the center of each tooth. The bracket can be knocked off if the student has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play. (Encourage all patients, especially those with braces, to wear a protective mouth guard while playing sports.
If the bracket is off center, the adhesive may have failed. Call the orthodontist, who will determine the course of action.
If the loose bracket has rotated on the wire and is sticking out, and the patient cannot immediately be taken to the orthodontist, you can do a temporary fix to alleviate discomfort and prevent further damage. But take care to prevent swallowing or other injury.
To put the bracket back in place, use sterile tweezers to slide the bracket along the wire until it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the center of the tooth.