Braces: First aid for the most common mishaps

Orthodontic treatment relies on various medical devices and techniques that gradually restore the alignment of the teeth and give the individual the beautiful, healthy smile they desire. However, sometimes accidents happen.

From a protruding wire to loose brackets, the unexpected issues that can arise are many and varied. Dr. Katerina Douma-Michelaki, DDS, PhD, specialist in Orthodontics for Children & Adults, explains what can happen and how it should be handled.

* Discomfort from braces. With modern technologies, the discomfort that may have existed in the past has been replaced by a mild discomfort that usually appears 4-6 hours after placement or adjustment and can last up to 1-2 days afterwards. It can be managed with simple pain relievers, if necessary.

* Food trapping between teeth. This can be particularly annoying but fortunately is easily corrected with an interdental brush, dental floss, or special dental toothpicks. Sometimes food can also be removed by brushing your teeth.

* Detachment of attachments. Attachments are small elastic rings (or thin wires) that hold the special orthodontic wire in place on the bracket (the bracket is the metal formation that attaches to the tooth). If an elastic attachment comes off, you can push it back into place with a sterilized tweezer. If it sticks out toward your lips but isn’t loose, you can push it into position with the tip of a cotton swab. If the attachment breaks, remove it with tweezers. And if the elastic or wire attachment is lost, notify the orthodontist who will advise when to visit them. However, remember that if one attachment breaks or comes off, others may follow, so they all need to be checked. Also, do not forget to inform the orthodontist so they can tell you when to visit them.

* Irritation to the lips and cheeks. Sometimes, when the braces are first placed, they can cause irritation in the oral cavity. This is more likely to happen during eating. To avoid irritation, the orthodontist will provide you with special wax that you can apply over the bracket causing the irritation. The wax is harmless, and there’s no problem if you swallow it. The wax is a temporary solution, as soon after, the soft tissues of the mouth (lips, cheeks) “harden” locally and become resistant to irritation from the braces.

* Mouth sores. Some patients are prone to developing sores (ulcers) on the soft tissues of the oral cavity (lips, cheeks, tongue). The sores may be due to factors such as aphthous ulcers or herpes infections. Local irritation from the braces can trigger the development of such ulcers or worsen them. Other factors that may play a role include stress, heredity, etc. It’s important to note that braces do not cause aphthous ulcers. Aphthous ulcers are an autoimmune disease. If you develop one or more sores in your mouth, you may need local application of cleaning, healing, and quick-relief preparations. Notify your orthodontist to suggest a suitable remedy and advise you on further steps.

* Protruding wire. Sometimes, the end of a wire may protrude and irritate the patient’s mouth. You can push it toward the teeth with a sterilized tweezer. If you cannot push it into a position where it no longer bothers you, cover it with some special wax and notify the orthodontist. If the wire is causing you a lot of discomfort and you cannot visit the orthodontist immediately, the last resort is to cut it with a sterilized cutter. However, before cutting it, wrap some gauze around it to prevent swallowing it.

* Loose brackets, wires, or rings. When braces loosen in any way, the orthodontist should be informed to determine what needs to be done (e.g., if the bracket is out of position, the bonding may have failed and needs correction).

The brackets, which are placed on the center of each tooth, can loosen or move, and the wires may bend if the patient bites down on hard food. The same can happen during play or sports.

Hard foods that orthodontic patients should avoid include, among others, whole hard nuts (walnuts, almonds, peanuts, etc.), whole hard fruits and vegetables (e.g., apples, pears, carrots), corn on the cob, hard pretzels, crusty bread, and hard pizza dough, ribs, hard rolls and cookies, and generally anything that requires biting down hard to break a piece off.

If the loose bracket has rotated on the wire and is protruding, the patient can temporarily correct it by using sterilized tweezers to move it along the wire until it is between two teeth. Once it reaches that point, rotate it until it is in the correct position, then slide it back to the center of the tooth. However, it needs to be checked and addressed by the orthodontist immediately afterwards.

* Swallowing a part of the appliance. This happens very rarely but for obvious reasons causes maximum concern for patients.

If the patient is symptom-free, the piece may have been passed into the stomach, where it will be expelled from the body. However, if after swallowing, the patient coughs excessively or has difficulty breathing, the piece may have entered the respiratory system.

If you think this has happened to you, urgently call your orthodontist and emergency services. In the meantime, if the swallowed piece is visible, try to remove it from your throat using tweezers (provided you do not injure the throat tissues).

If possible, check all your braces to make sure no other part is loose, ready to come off, so you can be aware of it.

In any case, if swallowing occurs, immediate notification to the orthodontist is required.