First Aid and Emergencies

In orthodontics, a true emergency is a rarity. More often, minor problems that might involve some discomfort can be easily addressed by the patient at home. A loose bracket or band, while important, can be fixed at the next regular office visit. In other cases, such as a loose appliance, scheduling an appointment as soon as possible may be recommended. Of course, there are situations that require immediate action.

The following information will help you determine what course of action is best if you experience a problem. Emergency appointments will be scheduled between 10:00 a.m. and 2:00 p.m.

True Emergencies

Tooth Knocked Out (Avulsion)

If a tooth has been knocked out, do not clean off the tooth.
Call Dr. Fulton's office or your dentist's office immediately to inform them about what has happened.
When you pick up the tooth, hold the enamel end of the tooth, not the pointed end (root).
Do not rinse the tooth in water or scrub the root. However, you may remove large debris. If possible, put the tooth back in its socket and hold it in place with gauze or washcloth. If you can't replace the tooth in its socket, put the tooth in a cup of milk or saline solution, or put it between your cheek and gum. Do not put the tooth in plain water.
Apply an ice pack to the soft tissue area where the tooth belongs to reduce swelling.
Do not let the tooth dry out. A tooth can often be saved if cared for properly and re-implanted within an hour.

Broken Tooth (Tooth Fracture)

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

Orthodontic Appliance Is Stuck in Airway or Swallowed

Someone trying to assist should encourage the patient to remain calm. If the patient is coughing excessively or having difficulty breathing, the appliance could have been aspirated (drawn into the airway or lung). Call 911 (or the appropriate emergency number for your area) 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.
If there is no coughing or difficulty in breathing, and you suspect the piece has been swallowed, call Dr. Fulton’s office for advice and instructions. This is rarely a true emergency. The appliance will simply pass through the digestive system.

Lip Is Caught on a Brace

Apply ice to the affected area until you have the opportunity to been seen.
Call Dr. Fulton’s office or your dentist’s office immediately.

Can't Open Mouth

Problems with the lower jaw joint or swelling around the soft tissues in the mouth can make it difficult to open the mouth.
Call your dentist and also inform Dr. Fulton’s office of your symptoms.

Problems That Require a Prompt Response

Ligature: The archwire is held to each bracket with a ligature, which can be either a tiny elastic or a twisted wire.
Archwire: The archwire is tied to all of the brackets and creates force to move teeth into proper alignment.
Brackets: Brackets are connected to the bands, or directly bonded on the teeth, and hold the archwire in place.  
Metal Band: The band is the cemented ring of metal which wraps around the tooth.  
Hooks

Loose Custom Soldered Appliance

Examples of custom soldered appliances are: an E-arch; palatal expander, RPE, PRA, space maintainer, lingual space maintainer, Nance and Herbst. Some of these appliances may need to be re-cemented earlier than your next appointment. A loose palate relieving appliance, PRA and RPE should be treated as soon as possible. Please call to ask us about it.

Lost Retainer or Biteplate

You should replace these as soon as possible. Call for an appointment to replace these because retainers are very important for maintaining results. Teeth can shift quickly.

Non-emergency Problems

Bracket Knocked Off

Brackets are the parts of braces attached to teeth with a special adhesive. Usually they are positioned in the center of each tooth and are linked to other brackets by a wire. If a bracket is off center and moves along the wire, the adhesive has probably failed. Call Dr. Fulton’s office and she and her team will determine the best course of action.

If the loose bracket has rotated on the wire and is sticking out, try to turn it back into its normal position and call Dr. Fulton’s office to schedule an appointment to have it reattached. You may wish to put orthodontic wax around the area to minimize the movement of the loose brace.

If the patient is experiencing discomfort, call Dr. Fulton’s office to inform us about the situation. If the patient is not in pain, this is not a true emergency. Please call our office at your earliest convenience to schedule an appointment to reattach the bracket to the tooth.

Remember, brackets can become loose as a result of chewing on hard, sticky or chewy foods or other objects, as well as from physical contact, such as during a sport. Be sure to wear a protective mouth guard while playing sports!

Archwire is Poking

If the end of an orthodontic archwire is poking in the back of the mouth, try to put wax over the area to protect the cheek. Call Dr. Fulton to schedule an appointment to have the wire end clipped. Be sure to inform us if the patient is uncomfortable.

If the poking wire is creating extreme discomfort and the patient will not be able to receive help from our practice immediately, as a last resort, the wire may be clipped with an instrument such as fingernail clippers. Be sure to use soap and water and alcohol to disinfect the clippers first.

Reduce the possibility of swallowing the snipped piece of wire by using folded tissue or gauze around the area to catch the piece when it is clipped. Use a pair of sharp clippers or wire cutters to snip off the protruding wire. Orthodontic wax may still be necessary to provide comfort to the irritated area.

Ligature Wire is Poking Lip or Cheek

Use a Q-tip, the back of a spoon or a 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 orthodontic wax. (See "Irritation of Cheeks or Lips" below for instructions on applying orthodontic wax.) Make Dr. Fulton’s office aware of the problem.

Loose Brackets, Wires or Bands

If braces have come loose in any way, call our office as soon as possible to determine appropriate next steps. We will need to schedule an appropriate amount of time at your next appointment for the added procedure. Save any pieces of the braces that break off and bring them to the repair appointment.

Irritation of Lips or Cheeks

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. Simply pinch off a small piece of wax 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 that is causing irritation. If possible, dry off the area first so that the wax will stick better. Orthodontic wax can help the patient eat more comfortably. Orthodontic wax is harmless if swallowed.

Mouth Sores

People who get 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.

Discomfort

Discomfort is normal for three to five days after braces or retainers are adjusted and can make eating uncomfortable. The patient should stick to eating soft foods. Rinsing the mouth with warm salt water can help. Over-the-counter pain relievers, such as acetaminophen and ibuprofen, may be effective in reducing or relieving discomfort.

Lost Ligature (Rubber or Wire)

Tiny rubber bands known as elastic ligatures are often used to secure the archwire to the bracket or brace. If an elastic ligature is lost, contact Dr. Fulton’s office and we’ll advise you about whether you should come in for an appointment. The same holds true for wire ligatures.

Food Caught Between Teeth

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 to dislodge food caught between teeth and braces.