Despite everyone's best intentions "stuff happens".  Whether it's braces or Invisalign or any other type of appliance things can get broken, displaced, or just plain lost.  We'll try to help guide you through your best options should things go awry during or even after your orthodontic treatment.  As always, if what you are experiencing is a medical emergency, please call 911 as soon as possible.  


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.


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.  


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.


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