Be Ready For Anything

You probably won’t experience a true orthodontic emergency because they’re rare, but let’s face it, stuff happens.

If you find something is not quite right with your orthodontic appliance try to make yourself or your child as comfortable as possible and let us know via phone-call/text/email.

We’ll make every attempt to talk you through your scenario or adjust your appliance as soon as reasonably possible.

Here to Help

The following orthodontic emergencies and their treatments are listed in the order from least severe to most severe.

Only the most severe emergencies require immediate attention by Dr. Nordberg.

Braces Answers

With braces any number of things can happen that may constitute different types of emergencies. The most common thing to occur is that an individual bracket gets knocked off or comes loose. This typically happens when certain types of foods are consumed carelessly or are not prepared in an adequate manner. For this reason we generally have Food Recommendations for Braces and we advise our patients to stick to this model of dietary restriction. Hard foods can knock brackets off teeth or even dislodge bands (rings) that are glued around teeth.

Occasionally, orthodontic tooth movement itself will guide a tooth into close proximity to another tooth’s bracket and this undesired obstruction can cause the bracket in question to get knocked off as the other tooth hits against it. Regardless of the cause, please keep track of any loose brackets or bands and make sure to bring them with you if they get separated from the wire or the other braces themselves.

We will clean off the old “glue” as well as the old bracket and glue it back on for you. If a patient is extremely careless with their orthodontic appliances over numerous occasions, our office reserves the right to charge for additional lost or missing brackets or excessive emergency appointments.

“Pokey wires” are common in certain scenarios. Usually, “pokey-wires” involve space-closure and the excess wire length that used to connect teeth with spaces between them is no longer needed (because the teeth have moved closer to one another) and that excess wire now extends out the back of the very back bracket. This extra wire may irritate the cheeks.

If the patient happens to be in the initial stages of orthodontic treatment where the wires used are very soft and gentle and the patient or parent feel brave enough, these soft wires can often be cut with a fingernail clipper. If a patient or parent does not feel comfortable clipping the wire with a fingernail clipper, a soft piece of “comfort wax can act as a good buffer until the wire can be clipped at the office. Make sure to dry the wire or bracket in question as this aids the wax in adhering to that surface.

Lesser emergencies may involve the hook that rubber bands are attached to becoming dislodged or a bracket’s “gate” coming open. While not true emergencies in the traditional sense of the word, they may contribute to a slightly longer treatment duration and thus all parties will benefit from fixing this scenario as soon as reasonably possible. Please let us know as soon as you become aware of lost, misconfigured, or missing appliance components and we will attempt to address the scenario as soon as reasonably possible.

Occasionally, elastics alone aren’t enough to correct a front-to-back bite discrepancy and “springs” are employed. This springs can very rarely become displaced or separated into two individual pieces and may need to be reinserted or replaced with a slightly larger size. You can try to replace the parts yourself or simply let the various pieces “dangle” until the office can replace or reinsert the pieces.

Aligner Answers

With clear aligners, very few “true” emergencies occur. Occasionally the hook used to wear elastics may become dislodged or a “bump” will get knocked off. These scenarios may extend the total treatment time that a patient experiences but should not cause any real discomfort.

The bumps are particularly important to replace as they allow us to tackle more difficult tooth movement scenarios that are usually only handled with braces. Failure to replace the “bumps” within a timely period may contribute to the need for an additional round of aligners. Please alert the office to this scenario and we will try to replace those components as soon as possible.

Rarely, aligners will be used in conjunction with TADs and those TADs can become loose. The best way to deal with this is to prevent the scenario in the first place with excellent oral hygiene that will not allow periodontal inflammation to contribute to TAD-loosening.

If a TAD comes loose, please alert the office and we will make arrangements to either remove the TAD completely (if it has served its purpose) or replace it in a slightly different position.

Food Caught Between Your Teeth

This isn’t an emergency, but it can be uncomfortable or embarrassing. It’s 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 your teeth and your braces.

Ligatures Coming Off

Tiny rubber bands or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber ligature comes off, you may be able to put it back in place using sterile tweezers. If a wire ligature comes loose, remove it with sterile tweezers.

If your wire ligature is sticking out into the lip but is not loose, you can bend it back down with a Q-tip or pencil eraser so it doesn’t irritate your lip. Of course, when one ligature pops off or breaks, others may follow.

Be sure to examine all your ligatures. Missing or broken ligatures should be brought to the attention of Dr. Nordberg. If a rubber or wire ligature is lost, tell Dr. Nordberg so he can advise whether you should be seen.

Discomfort

It’s normal for you to have discomfort for a day or two after braces or retainers are adjusted, but it can make eating uncomfortable.

This discomfort is very normal and only for a short time.

Try eating soft foods and rinse the mouth with warm saltwater.

Mouth Sores

You may be susceptible to mouth sores. While your braces don’t cause them, they may be made worse by irritation from braces.

One or several patches of sores may appear on the cheeks, lips or tongue. This is not an emergency, but it may be very uncomfortable for you.

Get quick relief by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the area with sores using a cotton swab.

You can reapply as needed.

Irritated Lips or Cheeks

Sometimes new braces can irritate your mouth, especially when you’re eating. A small amount of non-medicinal relief wax makes an excellent buffer between the metal and your 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.

Then, you can eat more comfortably. If you accidentally swallow the wax, it’s not a problem. The wax is harmless.

Protruding Wire

Pokey wires” are common in certain scenarios. Usually, “pokey-wires” happen when spaces close, and the excess wire length that used to connect teeth with spaces between them is no longer needed (because the teeth have moved closer to one another), and that excess wire now extends out the back of the very back bracket.

This extra wire may irritate the cheeks. If the patient happens to be in the initial stages of orthodontic treatment where the wires used are very soft and gentle, and the patient or parent feel brave enough, these soft wires can often be cut with a fingernail clipper.

If a patient or parent does not feel comfortable clipping the wire with a fingernail clipper, a soft piece of “comfort wax can act as a good buffer until the wire can be clipped at the office.

Make sure to dry the wire or bracket in question to help the wax stay in place.

Loose Brackets, Wires, or Bands

The most common thing to occur is that an individual bracket gets knocked off or comes loose. This typically happens when certain types of foods are consumed carelessly or are not prepared correctly.

That’s why we generally have food recommendations for braces patients. Hard foods can knock brackets off teeth or even dislodge bands (rings) glued around your teeth.

Occasionally, orthodontic tooth movement itself will guide a tooth into close proximity to another tooth’s bracket, and this undesired obstruction can cause the bracket in question to get knocked off as the other tooth hits against it.

Regardless of the cause, please keep track of any loose brackets or bands and make sure to bring them with you if they get separated from the wire or the other braces themselves.

We will clean off the old “glue” as well as the old bracket and glue it back on for you.

You Swallow a Piece of Your Appliance

This is rare, but when it does happen, it can be alarming. It’s important to stay calm.

If you’re coughing excessively or having difficulty breathing, you may have inhaled the piece into your airways or lungs.

If you can see the piece, you may carefully attempt to remove it.

DO NOT try if you could cause harm.

If appropriate under the circumstances, examine your braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above.

If you can’t see the piece and believe you may have inhaled it, call Dr. Nordberg immediately.

Retainer Answers (Spring Retainers, Fixed Retainers, etc.)

Retainers are very rarely used to accomplish small and predictable tooth movements. If the retainer becomes deformed, broken, or lost it may not be successful in accomplishing these desired movements. Please let us know so that we may address the situation as soon as reasonably possible.

Fixed retainers can occasionally become dislodged from their “resting place” (get knocked away from the teeth they happen to be glued to). If this happens to you, please let us know if the entire retainer has become dislodged or just a part of the retainer and we will plan our treatment accordingly. If the retainer becomes dislodged soon after treatment has completed the teeth may not be stable enough to maintain their new position.

Please try to wear your additional clear overlay retainer during this time period to limit the potential for “relapse”. If the fixed retainer becomes dislodged years after treatment has been completed the additional stability gained may mean that the teeth in question may take months to relapse or they may never move back.

In other scenarios years after treatment has completed, teeth may move relatively quickly if the final resting position is not perfectly stable. Your individual scenario may be unique so please let us know if you sense that teeth are moving away from their stable resting place.

Retainers during growth and observation periods are very beneficial and common. For patients who have started an “early treatment” phase these are used to maintain the initial results and/or influence the remaining growth present. Removable retainers lost in the ocean or dropped to the bottom of the lake must be replaced. “Glued-in” retainers should be replaced quickly as these can hold space for erupting adult teeth.