Orthodontic Emergencies

Serving Olympia, WA, Tumwater, Lacey, and South Puget Sound

If you are experiencing an orthodontic emergency, please see the information below for some helpful advice or call us with any questions you may have.

Handling Orthodontic Emergencies

Emergency Treatments

The following orthodontic emergencies and their treatments are listed in the order of severity. Its likely that you or a parent may be able to manage many of these yourself. However, more complex cases may require a call or visit to our office. Please don’t hesitate to contact us with any questions or concerns.

Food Caught Between Teeth

This is not an emergency but can be uncomfortable or embarrassing. It is easily fixed with a piece of dental floss. We recommend tying a small knot in the middle of the floss to help remove the food. An interproximal brush or a simple toothpick can also be used to dislodge food caught between teeth and braces.

Ligatures Come Off

Tiny rubber bands or small, fine wires, known as ligatures, hold the braces wire to the bracket. 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-tip or pencil eraser to eliminate the irritation.

Of course, when one ligature pops off or breaks, others may follow. Be sure to examine all ligatures. Missing or broken ligatures require contacting our office to determine the next steps.

If a rubber or wire ligature is lost, please notify our office so that we can advise you regarding an appointment.

Discomfort

Some discomfort is normal for a few days after braces or retainers are adjusted. This can make normal activities like eating uncomfortable. This mild discomfort is normal and temporary. We encourage soft foods and that you limit activities that may make the discomfort worse. We also encourage rinsing with warm saltwater. If discomfort persists, please feel free to reach out to us with your concerns.

Mouth Sores

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. Prompt 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.

Irritation of Lips or Cheeks

Sometimes new braces can be irritating to the mouth, especially when you’re eating. A small amount of non-medicinal relief wax makes an excellent buffer between metal 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. This wax is harmless, so there’s no concern if it is accidentally swallowed. Reapply the wax as needed.

Protruding Wire

Occasionally, the end of a wire will work itself out of place and may irritate your mouth. Use a Q-tip 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 relief wax. (See Irritation of Lips or Cheeks above for instructions on applying relief wax.) Please let our office know about this problem.

In a situation where the wire is extremely bothersome, and you are not able to see us soon, you may, as a last resort, clip the wire. Reduce the possibility of 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.

Loose Brackets, Wires or Bands

If the braces have come loose in any way, the parent/guardian needs to be notified, and they should call the orthodontist to determine appropriate next steps. 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 patient has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play. We 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 parent/guardian, and recommend that they immediately notify 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.

Piece of Appliance is Swallowed

This is rare, but when it does happen, it can be fairly alarming. First, it’s best to remain calm. If there is excessive coughing or difficulty breathing, the piece could have been aspirated. You should call 911 immediately.

If you are able to see the piece, you may carefully attempt to remove it. But do not make an attempt if you could cause harm. If appropriate under the circumstances, examine the braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above.

Andrew J. Kapust, DDS, PS

Orthodontics & Pediatric Dentistry