Orthodontic emergencies

• If a tooth has been knocked out, do not clean off the tooth.
• Call your family dentist and our office immediately to inform them of what has happened.
• Upon locating the tooth, hold the enamel end of the tooth, not the pointed end/root.
• Do not rinse the tooth in water. Do not scrub the root. You may remove large debris. If possible, put the tooth back in the socket where the tooth was and hold it in place with gauze or a washcloth. If it is not possible to replace the tooth in its socket, put the tooth into a cup of milk or saline solution, or put the tooth between the cheek and gum. Do not put the tooth in plain water.
• Apply an ice pack to the affected soft tissue area to reduce swelling
• Do not let the tooth dry out. A tooth can often be saved if cared for properly and reimplanted within an hour.

• Clean the injured area and apply an ice pack to the affected soft tissue area to reduce swelling.
• Save the tip of the tooth (for possible reattachment) and call your dentist right away.

• If you can see the piece, you may carefully attempt to remove it. But do not attempt if you would cause the patient harm.
• Encourage the patient to remain calm. If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated (drawn into the lung).
• If there is no coughing or difficulty in breathing, and you suspect the piece has been swallowed, call our office for advice and instructions.
• If you are unable to see the piece and believe it may have been aspirated, call 911 and the orthodontist immediately. The patient should be taken to an urgent care facility for an X-ray to determine the location of the piece. A physician will have to determine the best way to remove it.

Brackets (see diagram) are the parts of braces attached to teeth with a special adhesive. If the bracket is off-center and moves along the wire, the adhesive has likely failed. Usually, this can be left in place until seen in our office.

If the loose bracket has rotated on the wire and is sticking out, attempt to turn it back into its normal position. You may wish to put orthodontic wax around the area to minimize the movement of the loose brace (learn how to deal with a broken bracket or broken back bracket in these linked videos).

Note: Save any pieces of your braces that break off and bring them with you to your repair appointment.

If the end of an archwire is poking in the back of the mouth, attempt to put wax over the area to protect the cheek. If the wire is extremely bothersome and the patient cannot come in soon, the wire may be clipped with an instrument such as fingernail clippers. Reduce the possibility of swallowing the snipped piece of wire by using folded tissue or gauze around the area to catch the piece you will remove. 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.

Watch a video on how to fix a poking wire.

• Take a small piece of wax and roll it into a ball.
• DRY the wire or the bracket very well. If the area is wet, the wax will keep falling off.
• Gently press the wax on the wire or bracket.
• If you have run out of wax, you can pick some up from our office or at the nearest pharmacy. If the wax is accidentally swallowed it’s not a problem; it is harmless.

Picture showing the end of the archwire too long that may poke the cheek.

Picture showing rolling a small piece of wax into a ball.

Picture showing wax placed on the end of the archwire.

Picture showing clipping the end of the archwire with nail clippers (place gauze at the end of the wire to catch the piece that is cut off)

Gently grab the wire with a pair of tweezers and try to straighten it out. If the wire has come out of the last bracket and is not poking the gums or the cheek, simply let it be. If it is poking the gums, gently grab it with a pair of tweezers and move it above or below the bracket to get it away from the gums. You may need to apply some wax on it to provide comfort. Watch a video on fixing a bent or misplaced bracket.

Picture showing archwire coming out of the bracket.

Picture showing the use of tweezers to replace archwire into the brackets.

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. Make the orthodontist aware of the problem. Watch a video on fixing a poking wire or tie.

Picture showing archwire coming out of the bracket.

Picture showing the use of tweezers to replace archwire into the brackets.

This is not an emergency. Sometimes new braces can be irritating to the mouth. A small amount of orthodontic wax makes an excellent buffer between the braces and lips, cheek or tongue.

This is not an emergency. People who have mouth sores during orthodontic treatment may gain relief by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the sore area using a cotton swab. Reapply as needed.

This is not an emergency. It’s normal to have discomfort for three to five days after braces or retainers are adjusted. Although temporary, it can make eating uncomfortable. Eat soft foods and rinse the mouth with warm salt water. Over-the-counter pain relievers, acetaminophen or ibuprofen, are effective.

Tiny rubber rings known as alastic or “o” ligatures, are often used to hold the archwire into the bracket or brace. If a ligature is lost, this can usually wait till the next appointment. The same holds true for wire ligatures. Watch a video on lost ligatures.

If the space is lost, try to replace it with floss. If it is lost the day before the appointment, do not worry about it.

Watch a video on how it is done.

Watch a video on how to turn your upper expander.

Call the office immediately. Apply ice to the affected area until you have the opportunity to be seen by our office team or your family dentist.

This is not an emergency. However, we want to prevent your teeth from shifting so call us the next business day to schedule a professional repair. Bring all pieces of the broken retainer to the appointment. Please note that the patient must come to the appointment along with the broken retainer.

This is not an emergency. It can be resolved 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 (Proxabrush) to dislodge food caught between teeth and braces.

This is not an emergency. This is usually caused by improper brushing and flossing. Brush after every meal, using minimal toothpaste and floss once a day. Use warm salt water rinses to decrease the inflammation. Disclosing tablets are helpful to show where plaque remains after brushing. If there is associated pain, please call the office.